Zemel D, Koomen G C, Hart A A, ten Berge I J, Struijk D G, Krediet R T
Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands.
J Lab Clin Med. 1993 Dec;122(6):686-96.
Infectious reactions are known to comprise changes in vasopermeability and inflammatory mediators. We used peritonitis that complicated continuous ambulatory peritoneal dialysis (CAPD) as an in vivo inflammation model to study the time courses of peritoneal permeability characteristics and mediators in dialysate. Sixteen episodes of peritonitis were prospectively followed on eight consecutive days from the onset of the infection and once after recovery (control). Dialysate night dwells were examined for marker proteins of peritoneal permeability, cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6] and prostaglandins (PGE2, 6-keto-PGF1 alpha, and thromboxane B2 [TxB2]). The clearance of beta 2-microglobulin was used as indicator of the effective peritoneal surface area. The intrinsic permeability was characterized functionally by the peritoneal restriction coefficient. All protein clearances were increased during the acute phase of peritonitis and subsequently decreased to control. Likewise, the intrinsic peritoneal permeability was elevated, as demonstrated by a decrease of the peritoneal restriction coefficient. Peritoneal appearance rates of TNF-alpha, IL-6, and prostaglandins were also increased during the acute phase. Peak values were reached on day 1. The largest increase was observed for IL-6 (median 854-fold), followed by TNF-alpha (35-fold). The vasodilating PGE2 and 6-keto-PGF1 alpha were increased 12-fold and the vasoconstricting TxB2 was increased threefold. Evidence was obtained for local intraperitoneal synthesis of IL-6 and prostaglandins. TNF-alpha production appeared to be present only during the early acute inflammatory response. Analysis of variance for repeated measurements revealed that changes in the clearance of beta 2-microglobulin were related to those in IL-6 and marginally also to TNF-alpha in dialysate. Changes in the peritoneal restriction coefficient were also related to IL-6, but were more closely related to alterations in dialysate PGE2. These findings suggest that TNF-alpha, IL-6, and PGE2 are involved in the changes in permeability characteristics during CAPD-related peritonitis.
已知感染反应包括血管通透性和炎症介质的变化。我们将并发持续性非卧床腹膜透析（CAPD）的腹膜炎作为体内炎症模型，以研究腹膜通透性特征和透析液中介质的时间进程。从感染开始连续八天对16例腹膜炎发作进行前瞻性随访，并在恢复后进行一次检查（对照）。检查透析液夜间驻留液中的腹膜通透性标记蛋白、细胞因子（肿瘤坏死因子-α [TNF-α]、白细胞介素-6 [IL-6]）和前列腺素（PGE2、6-酮-PGF1α和血栓素B2 [TxB2]）。β2-微球蛋白的清除率用作有效腹膜表面积的指标。固有通透性通过腹膜限制系数进行功能表征。在腹膜炎急性期，所有蛋白质清除率均升高，随后降至对照水平。同样，腹膜固有通透性升高，表现为腹膜限制系数降低。TNF-α、IL-6和前列腺素的腹膜出现率在急性期也升高。在第1天达到峰值。观察到IL-6升高幅度最大（中位数854倍），其次是TNF-α（35倍）。血管舒张性PGE2和6-酮-PGF1α升高12倍，血管收缩性TxB2升高3倍。获得了IL-6和前列腺素在腹膜内局部合成的证据。TNF-α的产生似乎仅在早期急性炎症反应期间存在。重复测量的方差分析显示，β2-微球蛋白清除率的变化与IL-6的变化相关，并且在一定程度上也与透析液中的TNF-α相关。腹膜限制系数的变化也与IL-6相关，但与透析液中PGE2的变化关系更密切。这些发现表明，TNF-α、IL-6和PGE2参与了CAPD相关腹膜炎期间通透性特征的变化。
