Zemel D, Betjes M G, Dinkla C, Struijk D G, Krediet R T
Department of Internal Medicine, Free University, Amsterdam, The Netherlands.
Perit Dial Int. 1995;15(2):134-41.
To investigate whether changes in peritoneal membrane characteristics and inflammatory mediators in dialysate precede the onset of overt infection during continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis.
CAPD patients with a high peritonitis incidence stored every night bag at 4 degrees C. Routinely, each bag was thrown away after two days. Only if patients developed peritonitis, all bags were delivered for study. Thus, two night bags immediately prior to the first peritonitis bag were available for analysis. A control study was done 14 days after recovery. Dialysate samples were measured for TNF alpha, IL-6, PGE2, 6-keto-PGF1 alpha, TxB2, and serum proteins. The clearance of beta 2-microglobulin was used as an indicator of the effective peritoneal surface area. The intrinsic peritoneal permeability was characterized by the restriction coefficient.
Eight episodes occurred in 5 patients. The night dwells available prior to the first peritonitis effluent were drained maximally nine dwells and minimally one dwell before the first peritonitis bag. Dialysate leukocyte counts exceeded 100 x 10(6)/L only on the day of manifest infection. However, bacterial cultures were already positive at least one day before overt infection in four episodes and in three of these cases two days before. No changes were observed prior to peritonitis for the clearance of beta 2-microglobulin or the restriction coefficient. In contrast to these permeability characteristics, the cytokines, TNF alpha and, though less significant, also IL-6, were increased in dialysate one day prior to overt infection, when compared to the values obtained at the control investigation. This was especially evident in effluents drained no longer than two dwells before the first peritonitis bag. Prostaglandin concentrations in dialysate were not different before the onset of manifest peritonitis from the values measured after recovery.
In this study, the increased effective peritoneal surface area and intrinsic peritoneal permeability during acute infection appeared to be preceded by elevations in the cytokines TNF alpha and, to a lesser extent, IL-6. These increments occurred only very shortly before the onset of clinical symptoms.
探讨在持续性非卧床腹膜透析（CAPD）相关性腹膜炎期间，腹膜特性和透析液中炎症介质的变化是否先于明显感染的发生。
腹膜炎发生率高的CAPD患者每晚将透析袋储存于4℃。通常，每个袋子两天后丢弃。仅当患者发生腹膜炎时，所有袋子才送检进行研究。因此，可获得首次腹膜炎透析袋之前的两个夜间透析袋用于分析。在恢复14天后进行对照研究。检测透析液样本中的肿瘤坏死因子α（TNFα）、白细胞介素-6（IL-6）、前列腺素E2（PGE2）、6-酮-前列腺素F1α（6-keto-PGF1α）、血栓素B2（TxB2）和血清蛋白。β2-微球蛋白的清除率用作有效腹膜表面积的指标。固有腹膜通透性以限制系数来表征。
5例患者发生了8次腹膜炎发作。首次腹膜炎流出液之前可获得的夜间留腹透析液，在首次腹膜炎透析袋之前最多留存了9次，最少留存了1次。仅在明显感染当天，透析液白细胞计数超过100×10⁶/L。然而，在4次发作中，细菌培养在明显感染前至少1天已呈阳性，其中3例在明显感染前两天已呈阳性。在腹膜炎发生前，β2-微球蛋白的清除率或限制系数未观察到变化。与这些通透性特征相反，与对照研究中获得的值相比，在明显感染前1天，透析液中的细胞因子TNFα以及虽不太显著但IL-6也升高。这在首次腹膜炎透析袋之前留存不超过2次的流出液中尤为明显。在明显腹膜炎发作前，透析液中前列腺素浓度与恢复后测得的值无差异。
在本研究中，急性感染期间有效腹膜表面积和固有腹膜通透性的增加似乎先于细胞因子TNFα以及程度较轻的IL-6的升高。这些升高仅在临床症状发作前很短时间出现。
