Barreto Deirisa Lopes, Sampimon Denise E, Struijk Dirk G, Krediet Raymond T
Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Dianet Foundation, Amsterdam-Utrecht, The Netherlands.
Perit Dial Int. 2019 Jan-Feb;39(1):83-89. doi: 10.3747/pdi.2017.00194. Epub 2018 Nov 25.
No diagnostic tool or methodology is currently available for early detection of imminent encapsulating peritoneal sclerosis (EPS). The objective of this study was to investigate the predictive value of free water transport (FWT) and construct a panel of peritoneal effluent proteins for EPS alone or in combination with FWT. These parameters could be incorporated in the follow-up of peritoneal dialysis (PD) patients.
A case-control study, nested in a longitudinal PD patient cohort, was conducted. Time-specific areas under the receiver operating characteristic (ROC) curve were calculated for FWT and effluent biomarkers at a lag time up to 3 years before EPS diagnosis. Free water transport was combined with appearance rates (AR) of biomarkers to assess their clinical validity.
Free water transport volume and AR of effluent biomarkers were investigated in 11 EPS patients and 34 long-term PD patients. Diagnostic performance was best for FWT (area under the curve [AUC] 0.94) followed by plasminogen activator inhibitor (PAI-1) AR. Throughout, diagnostic panels of FWT and AR of cancer antigen 125 (CA125), interleukin-6 (IL-6), or (PAI-1) yielded specificity estimates above 84%. The combination of FWT and PAI-1 AR identified the largest proportion of EPS patients at 1 year prior to diagnosis (sensitivity 100%, specificity 94%).
Measurement of FWT is simple and has the highest predictive value for imminent EPS. The addition of effluent biomarkers provides an all-round insight into the state of the peritoneum. Our data indicate that combining FWT with either PAI-1, CA125, or IL-6 has the highest specificity. This is required to avoid unnecessary discontinuation of PD treatment.
目前尚无用于早期检测即将发生的包裹性腹膜硬化（EPS）的诊断工具或方法。本研究的目的是探讨自由水转运（FWT）的预测价值，并构建一组单独或与FWT联合用于EPS的腹膜透析液蛋白指标。这些参数可纳入腹膜透析（PD）患者的随访中。
进行了一项嵌套于纵向PD患者队列中的病例对照研究。在EPS诊断前长达3年的滞后时间内，计算FWT和透析液生物标志物的时间特异性受试者操作特征（ROC）曲线下面积。将自由水转运与生物标志物的出现率（AR）相结合，以评估其临床有效性。
对11例EPS患者和34例长期PD患者的自由水转运量和透析液生物标志物的AR进行了研究。FWT的诊断性能最佳（曲线下面积[AUC]为0.94），其次是纤溶酶原激活物抑制剂（PAI-1）的AR。总体而言，FWT与癌抗原125（CA125）、白细胞介素-6（IL-6）或PAI-1的AR组成的诊断指标组特异性估计值高于84%。FWT与PAI-1的AR相结合，在诊断前1年识别出的EPS患者比例最高（敏感性100%，特异性94%）。
FWT的测量简单，对即将发生的EPS具有最高的预测价值。添加透析液生物标志物可全面了解腹膜状态。我们的数据表明，将FWT与PAI-1、CA125或IL-6相结合具有最高的特异性。这对于避免不必要地停止PD治疗是必要的。
