Krediet R T, Struijk D G, Boeschoten E W, Koomen G C, Stouthard J M, Hoek F J, Arisz L
Department of Internal Medicine, University of Amsterdam, The Netherlands.
Am J Kidney Dis. 1989 Apr;13(4):299-307. doi: 10.1016/s0272-6386(89)80036-8.
The time course of measurements of peritoneal solute transport in four continuous ambulatory peritoneal dialysis (CAPD) patients who developed sclerosing peritonitis is described. Loss of fluid removal capacity was found in all of them. In three, this loss was associated with an increase in peritoneal absorption of glucose from the dialysate and an increase in the transperitoneal transport rates of low-molecular-weight solutes and proteins. In the other patient a decrease in all these parameters was found. This seems to imply that the effective peritoneal surface area was increased in three patients and decreased in one. Peritoneal permeability to macromolecules remained unchanged as judged by the ratio between the clearance of IgG and albumin. Among the possible factors that contribute to the development of sclerosing peritonitis, some are likely to lead to a larger effective peritoneal surface area, like prostacyclin and the formation of new capillaries in poorly vascularized parts of the peritoneum. Others, such as extensive formation of collagen, could lead to a smaller effective surface area. Individual differences in susceptibility to these factors may lead to an increase or decrease in peritoneal solute transport rates. Follow-up measurements of peritoneal solute kinetics are necessary to identify those patients who are at risk.
本文描述了4例发生硬化性腹膜炎的持续性非卧床腹膜透析（CAPD）患者腹膜溶质转运的测量时间过程。发现所有患者均出现超滤能力丧失。其中3例患者超滤能力丧失与透析液中葡萄糖的腹膜吸收增加、低分子量溶质和蛋白质的跨腹膜转运速率增加有关。另一例患者则出现所有这些参数的下降。这似乎意味着3例患者的有效腹膜表面积增加，1例患者的有效腹膜表面积减少。根据IgG和白蛋白清除率之比判断，腹膜对大分子的通透性保持不变。在导致硬化性腹膜炎发生的可能因素中，一些因素可能会导致有效腹膜表面积增大，如前列环素以及腹膜血管化不良部位新毛细血管的形成。其他因素，如广泛的胶原形成，则可能导致有效表面积减小。个体对这些因素易感性的差异可能导致腹膜溶质转运速率增加或降低。对腹膜溶质动力学进行随访测量对于识别有风险的患者很有必要。
