肝素对腹膜透析大鼠腹膜电荷屏障及蛋白质丢失的影响

Role of heprin on the variation of peritoneal charge barrier and peritoneal albumin loss in rats with peritoneal dialysis

目的:观察尿毒症及腹膜透析(PD)两种状态对对大鼠腹膜电荷屏障的影响,研究电荷屏障与PD液白蛋白丢失的相关性,探讨肝素对PD大鼠腹膜电荷屏障与PD液白蛋白丢失的作用。方法:选取SD大鼠40只,随机分为对照组(假手术组,n=10)、尿毒症组(5/6肾切除,n=10)、PD组(n=10)和肝素组(n=10);所有大鼠PD 4周后收集血清及PD液,采用清除法测定胰淀粉酶清除率(Cpam)及唾液淀粉酶的清除率(Csam)的比值(Cpam/Csam)用以评价腹膜电荷屏障,同时测定PD液白蛋白的丢失量。结果:(1)对照组、尿毒症组、PD组及肝素组的腹膜Cpam/Csam结果分别为1.91±0.89,2.32±0.74、3.11±0.76和2.24±0.59。尿毒症组、PD组与对照组比较均有显著差异(P均<0.01),但尿毒症组和PD组间无显著差异;肝素组与PD组比较也有显著差异(P=0.008)。(2)尿毒症组、PD组及肝素组PD液白蛋白量显著高于对照组(41.3±8.34 mg,49.2±3.61 mg、39.9±3.73 mg vs 27.1±5.66 mg,P均<0.01);同时,PD组还显著高于尿毒症组(P=0.04),肝素组与PD组相比,亦有显著差异(P=0.001)。(3)所有大鼠Cpam/Csam与PD液白蛋白丢失量显著相关(r=-0.469,P=0.002)。结论:尿毒症会损害腹膜的电荷特性,PD会进一步损害电荷屏障,增加PD液白蛋白的丢失。PD液中增加肝素可改善电荷屏障,减少白蛋白丢失。

Objective： To observe the influence of uremia, peritoneal dialysis on rat peritoneal charge barrier and the correlation between charge barrier and albumin loss from peritoneal dialysate, and to investigate the role of heparin on charge barrier and albumin loss. Methodology： Forty male SD rats were randomly divided into control group （sham operated group,n=10）,uremia group （5/6 nephrectomy,n=10） , uremia with PD group （n=10） and heparin with PD group （n=10） . Study was carried out 4 weeks and blood sample and peritoneal fluid were collected, and then peritoneal charge barrier was measured by differential clearance of isoamylase （Cpam/Csam）. Protein loss of peritoneal fluid was also determined. Result： （1）Cpam/Csam of control group, uremia group, PD group and heparin group were 1.91±0.89, 2.32±0.74 , 3.11±0.76 and 2.24±0.59 respectively. Figure of the three former were higher than control group significantly （P〈0.01 all） and there was also significantly difference between PD group and Heparin group, while no difference between uremia group and PD group. （2） Albumin loss of peritoneum in uremia group, PD group and Heparin group were significantly higher than that in control group （41.3±8.34 mg, 49.2±3.61 mg and 39.9±3.73 mg vs 27.1±5.66 mg, P〈0.01 all ）. At the same time, the figure in PD group was remarkably higher than that in uremia group, P〈0.05. On the contrary, the figure in heparin group was significantly lower than that in PD group. （3） Cpam/Csam was negative correlated with protein loss （r=-0.469, P〈0.01）. Conclusion： Charge barrier of peritoneum could be damaged at uremic state, and peritoneal dialysis may do harm to charge barrier further, however, heparin could improve charge barrier status and reduce the loss of albumin.