Ryckelynck Jean-Philippe, Béchade Clémence, Bouvier Nicolas, Ficheux Maxence, Hurault de Ligny Bruno, Lobbedez Thierry
Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, 14033 Caen cedex, France.
Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, 14033 Caen cedex, France.
Nephrol Ther. 2017 Jun;13(4):211-219. doi: 10.1016/j.nephro.2017.01.020. Epub 2017 May 30.
Encapsulating peritoneal sclerosis is a rare but devastating complication of long-term peritoneal dialysis with a high mortality rate. The incidence is between 0.5 and 2.5%, decreasing with time. PSE is defined as a clinical syndrome with signs of gastrointestinal obstruction, inflammation parameters, radiological and macroscopic changes. The duration of treatment and the cessation of peritoneal dialysis are the main risks. About 75% occured in patients on hemodialysis or after kidney transplantation. Morphological alterations are disappearance of mesothelial layer, submesothelial fibrosis, interstitial sclerosis and vasculopathy. Ultrafiltration failure, fast transport status of the peritoneal membrane and loss of sodium sieving, the most powerful predictor, are the functional abnormalities. Biomarkers in peritoneal effluent include cancer antigen 125, interleukin-6. The pathophysiology is probably a consequence of a multiple-hit process in which expression of growth factors and cytokines play a central role. Medical strategies (corticosteroids, tamoxifen) in association with parenteral nutrition and/or surgery (enterolysis) are discussed. Prevention is the use of physiological peritoneal dialysis solutions, icodextrine instead of high glucose concentration solutions and peritoneal lavage after peritoneal dialysis stopping.
包裹性腹膜硬化是长期腹膜透析罕见但极具破坏性的并发症，死亡率很高。发病率在0.5%至2.5%之间，并随时间下降。包裹性腹膜硬化被定义为一种具有胃肠道梗阻体征、炎症参数、放射学和宏观变化的临床综合征。治疗持续时间和腹膜透析停止是主要风险。约75%发生在血液透析患者或肾移植后。形态学改变包括间皮细胞层消失、间皮下纤维化、间质硬化和血管病变。超滤失败、腹膜快速转运状态以及钠筛的丧失（最有力的预测指标）是功能异常。腹膜透析液中的生物标志物包括癌抗原125、白细胞介素-6。病理生理学可能是一个多因素作用过程的结果，其中生长因子和细胞因子的表达起核心作用。讨论了与肠外营养和/或手术（肠粘连松解术）联合使用的医学策略（皮质类固醇、他莫昔芬）。预防措施包括使用生理性腹膜透析液、使用艾考糊精而非高糖浓度溶液以及在停止腹膜透析后进行腹膜灌洗。
