Tawada Mitsuhiro, Ito Yasuhiko, Banshodani Masataka, Yamashita Masahiro, Shintaku Sadanori, Sun Ting, Suzuki Yasuhiro, Kinashi Hiroshi, Kubo Yoko, Ando Masahiko, Yamaguchi Makoto, Katsuno Takayuki, Mizuno Masashi, Kawanishi Hideki
Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan.
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nephrol Dial Transplant. 2021 Jul 23;36(8):1519-1526. doi: 10.1093/ndt/gfaa073.
Encapsulating peritoneal sclerosis (EPS) is an uncommon but life-threatening complication of peritoneal dialysis (PD) therapy. The causative factors of EPS remain unclear. Pathological studies of the peritoneum affected by EPS and relationships with clinical factors including PD solutions remain lacking. The objective of this study was to examine peritoneal samples from EPS patients and to identify the associations of peritoneal pathology with different clinical factors.
Peritoneal specimens were obtained at the time of surgical enterolysis in Tsuchiya General Hospital from 1993 to 2016. A total of 223 PD patients were enrolled and analyzed. Tissues were fixed with formalin and processed with hematoxylin and eosin and Masson's trichrome staining, as well as immunohistochemical staining for CD31 and CD68.
Evaluations could be made in 174 patients who received surgical enterolysis. Conventional or pH-neutral low-glucose degradation product PD solutions were utilized during PD treatment. The conventional PD solution group showed less angiogenesis (P = 0.013) but more severe vasculopathy, in the form of a lower ratio of luminal diameter to vessel diameter (L/V ratio) (P < 0.001) in association with longer PD treatment. Multivariate Cox proportional hazard models revealed that L/V ratio (per 0.1 increase, hazard ratio = 0.88, 95% confidence interval 0.77-0.99, P = 0.047) was significantly associated with a lower incidence of EPS relapse. In contrast, most of the cases in the pH-neutral solution group showed milder vasculopathy.
The pathology of EPS differed between conventional and pH-neutral solution groups. Vasculopathy was related to the development and relapse of EPS in the conventional solution group.
包裹性腹膜硬化（EPS）是腹膜透析（PD）治疗中一种罕见但危及生命的并发症。EPS的致病因素尚不清楚。目前仍缺乏对受EPS影响的腹膜进行病理研究以及其与包括PD溶液在内的临床因素之间的关系。本研究的目的是检查EPS患者的腹膜样本，并确定腹膜病理与不同临床因素之间的关联。
1993年至2016年期间，在土屋综合医院进行手术肠粘连松解时获取腹膜标本。共纳入223例PD患者并进行分析。组织用福尔马林固定，进行苏木精-伊红染色、Masson三色染色以及CD31和CD68免疫组化染色。
对174例接受手术肠粘连松解的患者进行了评估。PD治疗期间使用了传统或pH中性低葡萄糖降解产物的PD溶液。传统PD溶液组显示血管生成较少（P = 0.013），但血管病变更严重，表现为管腔直径与血管直径之比（L/V比）较低（P < 0.001），且与较长的PD治疗时间相关。多变量Cox比例风险模型显示，L/V比（每增加0.1，风险比 = 0.88，95%置信区间0.77 - 0.99，P = 0.047）与EPS复发率较低显著相关。相比之下，pH中性溶液组的大多数病例显示血管病变较轻。
传统溶液组和pH中性溶液组的EPS病理不同。在传统溶液组中，血管病变与EPS的发生和复发有关。
