Nakamoto Hirotaka, Hamada Chieko, Shimaoka Tetsutaro, Sekiguchi Yoshimi, Io Hiroaki, Kaneko Kayo, Horikoshi Satoshi, Tomino Yasuhiko
Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
J Artif Organs. 2014 Mar;17(1):60-8. doi: 10.1007/s10047-013-0741-1. Epub 2013 Dec 14.
Characteristics of pathological alterations in long-term peritoneal dialysis (PD) are thickening of submesothelial compact (SMC) zone, small-vessel vasculopathy, and loss of mesothelial cells. Bioincompatible PD fluid plays crucial roles in peritoneal injury. Encapsulating peritoneal sclerosis (EPS), a rare and serious complication, occurred in patients on long-term PD or frequent peritonitis episodes, and ~50 % of EPS developed after PD cessation. We hypothesized that PD-related peritoneal injury factors induced by bioincompatible PD fluid accumulated in the peritoneum and might induce EPS. We therefore examined the accumulation of advanced glycation end products (AGE) and beta 2-microglobulin (β2M) in peritoneum and evaluated the relationship between their accumulation, clinical parameters, and outcome after PD cessation. Forty-five parietal peritoneal specimens were obtained from 28 PD patients, 14 uremic patients, and three patients with normal kidney function. The peritoneal equilibration test was used for peritoneal function. AGE- and β2M-expressing areas were found in vascular walls, perivascular areas, and the deep layer of the SMC in short-term PD patients and extended over the entire SMC in long-term patients. Peritonitis and prolonged PD treatment aggravated peritoneal thickening and the proportion of AGE-expressing areas. The proportion of β2M-expressing areas was increased in long-term PD patients. Thickening of the SMC and the proportions of AGE- and β2M-expressing areas were not related to ascites or EPS after PD withdrawal. It appears that the increased proportion of AGE and β2M deposition induced by long-term exposure of PD fluid may be a marker of peritoneal injury.
长期腹膜透析(PD)的病理改变特征包括间皮下致密(SMC)区增厚、小血管血管病变和间皮细胞丢失。生物不相容的腹膜透析液在腹膜损伤中起关键作用。包裹性腹膜硬化(EPS)是一种罕见且严重的并发症,发生于长期腹膜透析患者或频繁发生腹膜炎的患者,约50%的EPS在腹膜透析停止后出现。我们假设生物不相容的腹膜透析液诱导的与腹膜透析相关的腹膜损伤因子在腹膜中蓄积,可能诱发EPS。因此,我们检测了腹膜中晚期糖基化终末产物(AGE)和β2微球蛋白(β2M)的蓄积情况,并评估了它们的蓄积与临床参数以及腹膜透析停止后的预后之间的关系。从28例腹膜透析患者、14例尿毒症患者和3例肾功能正常的患者中获取了45份壁层腹膜标本。采用腹膜平衡试验评估腹膜功能。在短期腹膜透析患者的血管壁、血管周围区域和SMC深层发现了表达AGE和β2M的区域,而在长期患者中这些区域扩展至整个SMC。腹膜炎和长期腹膜透析治疗加重了腹膜增厚以及表达AGE区域的比例。长期腹膜透析患者中表达β2M区域的比例增加。SMC增厚以及表达AGE和β2M区域的比例与腹膜透析停止后的腹水或EPS无关。长期暴露于腹膜透析液诱导的AGE和β2M沉积比例增加似乎是腹膜损伤的一个标志物。