Ho-dac-Pannekeet M M, Hiralall J K, Struijk D G, Krediet R T
Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.
Kidney Int. 1997 Mar;51(3):888-93. doi: 10.1038/ki.1997.125.
Mesothelial changes occur during peritoneal dialysis. CA125 provides a way to study the mesothelial cells in the in vivo situation. In the present study longitudinal changes of CA125 were analyzed. In addition, the appearance of CA125 in peritoneal effluent and day-to-day variability were studied. CA125 was measured in the effluent of five stable CAPD patients during four hour dwells with 1.36% glucose, with 3.86% glucose and with 7.5% icodextrin. In addition, CA125 was determined on six consecutive days in four hour effluents of three patients and appearance rates (AR) were calculated. Longitudinal follow-up was performed in 31 patients in whom three to seven yearly observations had been made. Linear appearance of CA125 was present in all dwells. No difference was found between the appearance rates of CA125 with 3.86% glucose, compared to either 1.36% glucose or icodextrin. Mean day-to-day coefficient of variation was 6.4% for CA125 AR, but a wide variation existed in stable CA125 values among patients (mean 22.1, range 2 to 48 U/ml). A negative trend with duration of CAPD was present in the longitudinal study. A mean decrease of 2.2% per year could be calculated, but substantial interindividual differences existed. Sudden decreases of CA125 AR were found in five patients. Possible causes were found in all of them and included a severe or recurrent peritonitis, and temporary cessation of peritoneal dialysis. In one patient a sudden decrease preceded the manifestation of peritoneal sclerosis. It can be concluded that CA125 can be used for the in vivo follow-up of the mesothelium in peritoneal dialysis patients. The appearance of CA125 in effluent is linear in time and not influenced by the initial lysis of mesothelial cells. A gradual loss of mesothelial cells is likely to occur, although interindividual variability is substantial. An acceleration of the process may be caused by severe peritonitis and perhaps by temporary cessation of peritoneal dialysis. A sudden decrease in CA125 may be an alarming sign for the development or manifestation of peritoneal sclerosis.
间皮变化发生在腹膜透析过程中。CA125为体内研究间皮细胞提供了一种方法。在本研究中，分析了CA125的纵向变化。此外，还研究了CA125在腹膜透析液中的出现情况以及每日变化情况。对5例稳定的持续性非卧床腹膜透析（CAPD）患者在使用1.36%葡萄糖、3.86%葡萄糖和7.5%艾考糊精进行4小时留腹期间的透析液进行CA125检测。此外，对3例患者连续6天的4小时透析液进行CA125检测并计算出现率（AR）。对31例患者进行了纵向随访，这些患者每年进行3至7次观察。所有留腹期间CA125均呈线性出现。与1.36%葡萄糖或艾考糊精相比，3.86%葡萄糖时CA125的出现率无差异。CA125 AR的每日平均变异系数为6.4%，但患者间稳定的CA125值存在很大差异（平均22.1，范围2至48 U/ml）。纵向研究中发现CAPD持续时间与CA125呈负相关趋势。每年平均下降2.2%，但个体间差异很大。5例患者出现CA125 AR突然下降。所有患者均发现了可能的原因，包括严重或复发性腹膜炎以及暂时停止腹膜透析。1例患者在腹膜硬化表现出现之前CA125突然下降。可以得出结论，CA125可用于腹膜透析患者间皮的体内随访。CA125在透析液中的出现随时间呈线性，不受间皮细胞初始溶解的影响。尽管个体间差异很大，但间皮细胞可能会逐渐丢失。严重腹膜炎以及可能暂时停止腹膜透析可能会导致该过程加速。CA125突然下降可能是腹膜硬化发生或表现的警示信号。
