Wu Chia-Lin, Wu Hung-Ming, Chiu Ping-Fang, Liou Hung-Hsiang, Chang Chirn-Bin, Tarng Der-Cherng, Chang Chia-Chu
Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Inflammation Research and Drug Development Center, Changhua Christian Hospital, Changhua, Taiwan.
PLoS One. 2014 Oct 6;9(10):e109558. doi: 10.1371/journal.pone.0109558. eCollection 2014.
Endotoxemia is exaggerated and contributes to systemic inflammation and atherosclerosis in patients requiring continuous ambulatory peritoneal dialysis (CAPD). The risk of mortality is substantially increased in patients requiring CAPD for >2 years. However, little is known about the effects of long-term CAPD on circulating endotoxin and cytokine levels. Therefore, the present study evaluated the associations between plasma endotoxin levels, cytokine levels, and clinical parameters with the effects of a short-dwell exchange on endotoxemia and cytokine levels in patients on long-term CAPD.
A total of 26 patients were enrolled and divided into two groups (short-term or long-term CAPD) according to the 2-year duration of CAPD. Plasma endotoxin and cytokine levels were measured before and after a short-dwell exchange (4-h dwell) during a peritoneal equilibration test (a standardized method to evaluate the solute transport function of peritoneal membrane). These data were analyzed to determine the relationship of circulating endotoxemia, cytokines and clinical characteristics between the two groups.
Plasma endotoxin and monocyte chemotactic protein-1 (MCP-1) levels were significantly elevated in the long-term group. PD duration was significantly correlated with plasma endotoxin (r = 0.479, P = 0.016) and MCP-1 (r = 0.486, P = 0.012). PD duration was also independently associated with plasma MCP-1 levels in multivariate regression. Plasma MCP-1 levels tended to decrease (13.3% reduction, P = 0.077) though endotoxin levels did not decrease in the long-term PD group after the 4-h short-dwell exchange.
Long-term PD may result in exaggerated endotoxemia and elevated plasma MCP-1 levels. The duration of PD was significantly correlated with circulating endotoxin and MCP-1 levels, and was an independent predictor of plasma MCP-1 levels. Short-dwell exchange seemed to have favorable effects on circulating MCP-1 levels in patients on long-term PD.
内毒素血症在持续非卧床腹膜透析（CAPD）患者中被夸大，并导致全身炎症和动脉粥样硬化。接受CAPD治疗超过2年的患者死亡风险显著增加。然而，关于长期CAPD对循环内毒素和细胞因子水平的影响知之甚少。因此，本研究评估了血浆内毒素水平、细胞因子水平和临床参数与短期留腹换液对长期CAPD患者内毒素血症和细胞因子水平影响之间的关联。
共纳入26例患者，根据CAPD治疗时长2年分为两组（短期或长期CAPD）。在腹膜平衡试验（一种评估腹膜溶质转运功能的标准化方法）期间进行4小时留腹换液前后，测量血浆内毒素和细胞因子水平。分析这些数据以确定两组之间循环内毒素血症、细胞因子与临床特征的关系。
长期组血浆内毒素和单核细胞趋化蛋白-1（MCP-1）水平显著升高。腹膜透析时长与血浆内毒素（r = 0.479，P = 0.016）和MCP-1（r = 0.486，P = 0.012）显著相关。在多变量回归中，腹膜透析时长也与血浆MCP-1水平独立相关。长期腹膜透析组在4小时短期留腹换液后，虽然内毒素水平未降低，但血浆MCP-1水平有下降趋势（降低13.3%，P = 0.077）。
长期腹膜透析可能导致内毒素血症加剧和血浆MCP-1水平升高。腹膜透析时长与循环内毒素和MCP-1水平显著相关，并且是血浆MCP-1水平的独立预测因素。短期留腹换液似乎对长期腹膜透析患者的循环MCP-1水平有有利影响。
