Lin C Y, Chen W P, Yang L Y, Chen A, Huang T P
Department of Pediatrics, Veterans General Hospital, Taipei, Taiwan,
Am J Nephrol. 1998;18(6):513-9. doi: 10.1159/000013397.
The efficiency of continuous ambulatory peritoneal dialysis depends on the permeability of the peritoneal membrane. Peritoneal fibrosis (PF) causes loss of the dialytic function. Several studies have indicated that PF is closely related to the proliferation of peritoneal fibroblasts and the deposition of extracellular matrix. Transforming growth factor-beta 1 (TGF-beta1) plays a major role in stimulating extracellular matrix deposition. Frequent peritonitis occurrence may cause persistent TGF-beta1 mRNA expression. In an attempt to search for a factor related to PF, we designed a longitudinal study to measure TGF-beta1 levels in dialysate and TGF-beta1 mRNA expression in peritoneal mononuclear cells from peritoneal dialysate before onset, once a week during peritonitis, and after peritonitis in high and low peritonitis occurrence (HPO and LPO) patients. Fifteen patients with a LPO rate and 5 patients with a HPO rate were followed up longitudinally. Meanwhile, TGF-beta1 levels and TGF-beta1 mRNA expression were augmented in peritoneal dialysate effluents before, during, and after the episodes of peritonitis. The peritoneal permeability was evaluated by the peritoneal equilibration test. The results revealed that in the LPO group, TGF-beta1 and TGF-beta1 mRNA were detectable at early stages of peritonitis, but the levels decreased rapidly and were undetectable 2 weeks after peritonitis. On the other hand, in the HPO group, TGF-beta1 and TGF-beta1 mRNA persisted for a long time. We could detect TGF-beta1 and TGF-beta1 mRNA in dialysate effluents and peritoneal mononuclear cells even 2, 3, and 4 weeks after episodes of peritonitis. When compared with that of first or second episode of peritonitis, the peritoneal function evaluated with the peritoneal equilibration test was found to obviously deteriorate during the third episode of peritonitis. These findings were confirmed by an in situ hybridization technique to evaluate the relationship between TGF-beta1 mRNA expression and PF from biopsied peritoneal specimens. These findings suggest that the high TGF-beta1 levels in the dialysate are related to an increased expression of TGF-beta1 in the peritoneum. Thus, the persistent TGF-beta1 expression in the peritoneum may serve as a useful parameter in predicting PF in continuous ambulatory peritoneal dialysis patients with frequent peritonitis occurrence.
持续性非卧床腹膜透析的效率取决于腹膜的通透性。腹膜纤维化（PF）会导致透析功能丧失。多项研究表明，PF与腹膜成纤维细胞的增殖及细胞外基质的沉积密切相关。转化生长因子-β1（TGF-β1）在刺激细胞外基质沉积方面起主要作用。频繁发生腹膜炎可能导致TGF-β1 mRNA持续表达。为了寻找与PF相关的因素，我们设计了一项纵向研究，以测量高腹膜炎发生率（HPO）和低腹膜炎发生率（LPO）患者在腹膜炎发作前、腹膜炎发作期间每周一次以及腹膜炎发作后腹透液中TGF-β1水平和腹膜单核细胞中TGF-β1 mRNA的表达。对15例LPO率患者和5例HPO率患者进行了纵向随访。同时，在腹膜炎发作前、发作期间和发作后，腹透液流出物中的TGF-β1水平和TGF-β1 mRNA表达均升高。通过腹膜平衡试验评估腹膜通透性。结果显示，在LPO组中，腹膜炎早期可检测到TGF-β1和TGF-β1 mRNA，但水平迅速下降，腹膜炎发作2周后无法检测到。另一方面，在HPO组中，TGF-β1和TGF-β1 mRNA持续存在很长时间。即使在腹膜炎发作后2、3和4周，我们仍能在腹透液流出物和腹膜单核细胞中检测到TGF-β1和TGF-β1 mRNA。与腹膜炎第一次或第二次发作时相比，在腹膜炎第三次发作期间，通过腹膜平衡试验评估的腹膜功能明显恶化。这些发现通过原位杂交技术得到证实，该技术用于评估活检腹膜标本中TGF-β1 mRNA表达与PF之间的关系。这些发现表明，腹透液中高TGF-β1水平与腹膜中TGF-β1表达增加有关。因此，腹膜中TGF-β1的持续表达可能是预测频繁发生腹膜炎的持续性非卧床腹膜透析患者PF的一个有用参数。
