腹腔巨噬细胞产生一氧化氮对腹膜透析失超滤的作用

Effect of Macrophage Nitric Oxide on the Ultrafiltration Failure of Long-term Peritoneal Dialysis

目的 研究腹腔巨噬细胞产生的一氧化氮 (NO)对腹膜淋巴孔的作用 ,探讨腹膜淋巴孔的淋巴重吸收对长期腹膜透析失超滤的影响。方法 应用腹透液建立腹膜透析小鼠模型 ;用全自动酶标仪动态测定 NO量 ;用扫描电镜观察不同时间点腹膜间皮超微病理变化 ;使用计算机与扫描电镜联机的图象处理系统 ,测定不同腹膜透析时间点腹膜淋巴孔的变化。结果 随腹膜透析时程延长 ,透析组有大量巨噬细胞从腹膜淋巴孔游出 ,在腹膜表面形成许多乳斑。巨噬细胞产生高浓度的 NO,使间皮细胞损伤 ,腹膜淋巴孔开放数量增多 ,分布密度增高。至腹膜透析40 d,Bieffe组腹膜淋巴孔显著增大 (P<0 .0 5 )。停止腹膜透析 ,由巨噬细胞形成乳斑的数量减少 ,NO量逐渐降低 ,间皮细胞修复 ,腹膜淋巴孔恢复正常。结论 长期腹膜透析 ,巨噬细胞产生大量 NO,损伤间皮细胞 ,舒张腹膜淋巴孔 ,使腹膜腔淋巴重吸收增加 ,引起腹膜透析失超滤。

The regulation of macrophage nitric oxide on peritoneal lymphatic stomata was studied for revealing the mechanism of ultrafiltration failure during long-term peritoneal dialysis. Methods (1) The model of peritoneal dialysis was created by using peritoneal dialysate; (2) Dynamic measurements of nitric oxide (NO) were made during peritoneal dialysis and its cessation; (3) The pathological change of the peritoneal mesothelium in different dialysis time was observed by scanning electron microscope (SEM); (4) Dynamic changes of the peritoneal lymphatic stomata were studied during this experiment by using a computer image processing system attached to SEM. Results Numerous macrophages went into the peritoneal cavity through the lymphatic stomata to form a lot of milky spots during peritoneal dialysis.A great quantity of NO produced by macrophages damaging mesothelial cells and increasing numbers and density of lymphatic stomata.After 40 days of peritoneal dialysis,the diameters of the lymphatic stomata were significantly increased in Bieffe group (P<0.05).During cessation of peritoneal dialysis, few macrophage milky spots were observed and NO quantity was gradually decreased.Then the mesothelium damage began to repair and the peritoneal lymphatic stomata tended to become normal. Conclusions Our data demonstrate that a great quantity of NO produced by macrophages would damage peritoneal mesothelium and relax lymphatic stomata which enhance lymphatic reabsorption from the pentoneal cavity so as to make ultrafiltration failure on long-term peritoneal dialysis.