del Peso Gloria, Jiménez-Heffernan José Antonio, Selgas Rafael, Remón César, Ossorio Marta, Fernández-Perpén Antonio, Sánchez-Tomero José Antonio, Cirugeda Antonio, de Sousa Erika, Sandoval Pilar, Díaz Raquel, López-Cabrera Manuel, Bajo María Auxiliadora
Servicio de Nefrología, Instituto de Investigación (IdiPAZ), Hospital Universitario La Paz, Madrid, Spain
Servicio de Anatomía Patológica, Instituto de Investigación Sanitaria (IIS-IP), Hospital Universitario La Princesa, Madrid, Spain.
Perit Dial Int. 2016 Mar-Apr;36(2):129-34. doi: 10.3747/pdi.2014.00038. Epub 2015 Oct 16.
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Chronic exposure to conventional peritoneal dialysis (PD) solutions has been related to peritoneal function alterations in PD patients, and associated with mesothelial cell loss, submesothelial fibrosis, vasculopathy, and angiogenesis. In vitro and ex vivo analyses, as well as studies with animal models, have demonstrated that biocompatible PD solutions attenuate these morphological alterations. Our aim was to confirm the morphological benefits of biocompatible solutions in PD patients. ♦
We analyzed biopsies from 23 patients treated with biocompatible solutions (study group, SG), and compared them with a control group (n = 23) treated with conventional solutions (CG), matched for time on PD. ♦
A total of 56.5% of SG patients showed total or partial preservation of mesothelial cells monolayer, in contrast with 26.1% of patients in CG (p = 0.036). Peritoneal fibrosis was not significantly less frequent in SG patients (47.8% SG vs 69.6% CG; p = 0.13). In patients without previous peritonitis, a significantly lower prevalence of fibrosis was present in SG patients (41.7% SG vs 77.8% CG; p = 0.04). Hyalinizing vasculopathy (HV) was significantly lower in SG (4.3% SG vs 30.4% CG; p = 0.02). Cytokeratin-positive fibroblast-like cells were detected in 10 patients (22%), but the prevalence was not significantly lower in SG. In the univariate regression analysis, the use of biocompatible solutions was associated with mesothelial monolayer integrity (p = 0.04) and an absence of vasculopathy (p = 0.04). ♦
The present study demonstrates in vivo in human biopsies that biocompatible solutions are better tolerated by the peritoneum in the medium and long term than conventional solutions.
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长期接触传统腹膜透析（PD）液与PD患者的腹膜功能改变有关，并与间皮细胞丢失、皮下纤维化、血管病变和血管生成相关。体外和离体分析以及动物模型研究表明，生物相容性PD液可减轻这些形态学改变。我们的目的是证实生物相容性溶液对PD患者的形态学益处。♦
我们分析了23例接受生物相容性溶液治疗患者（研究组，SG）的活检样本，并将其与接受传统溶液治疗的对照组（n = 23，CG）进行比较，两组患者的PD治疗时间相匹配。♦
共有56.5%的SG组患者间皮细胞单层完全或部分保留，相比之下，CG组患者的这一比例为26.1%（p = 0.036）。SG组患者腹膜纤维化的发生率并没有显著降低（SG组为47.8%，CG组为69.6%；p = 0.13）。在既往无腹膜炎的患者中，SG组患者纤维化的发生率显著较低（SG组为41.7%，CG组为77.8%；p = 0.04）。SG组玻璃样变血管病（HV）的发生率显著较低（SG组为4.3%，CG组为30.4%；p = 0.02）。在10例患者（22%）中检测到细胞角蛋白阳性的成纤维细胞样细胞，但SG组的发生率并没有显著降低。在单因素回归分析中，使用生物相容性溶液与间皮单层完整性（p = 0.04）和无血管病变（p = 0.04）相关。♦
本研究在人体活检中证实，中长期来看，腹膜对生物相容性溶液的耐受性优于传统溶液。
