丙酮酸盐腹膜透析液对酸碱平衡、电解质代谢、腹腔巨噬细胞功能及腹膜间皮的影响

Effects of pyruvate buffered peritoneal dialysis solution on peritoneal macrophages function, electrolytes metabolism, acid-base balance and peritoneal mesothelium in uremic rats

目的 观察丙酮酸盐腹膜透析液对尿毒症大鼠代谢性酸中毒、电解质代谢、腹膜巨噬细胞功能及腹膜间皮的影响，并与乳酸盐腹膜透析液比较 方法 分两期对大鼠行 ５／６肾切除，３个月后分别用丙酮酸盐腹膜透析液（ＰＢＰＤＦ）。乳酸盐腹膜透析液（ＬＢＰＤＦ）及含相同葡萄糖浓度的平衡盐水（ＧＮＳ）进行腹腔内注射，４ｈ后引流、分离透出液中的巨噬细胞进行孵育，测定用 ＬＰＳ刺激后细胞超氧阴离子及肿瘤坏死因子。（ＴＮＦ－α）的产量。首次透前及透析５周后做动脉血气分析及血清生化检查，并在光镜及电镜下观察腹膜间支形态。结果 透析５周后ＰＢＰＤＦ组大鼠动脉血ｐＨ、ＨＣＯ３浓度、腹膜巨噬细胞超氧阴离子及ＴＮＦ－α的产量均高于ＬＢＰＤＦ组，并且腹膜间皮损伤也较轻、而两组血清Ｋ－、Ｎａ＋、Ｃｌ－水平差异无显著性意义。结论 丙酮酸盐腹膜透析液较乳酸盐腹膜透析液能更有效地纠正尿毒症大鼠的代谢性酸中毒，时腹膜巨噬细胞的抑制作用较轻，也能更好地维持腹膜间皮的完整性。

Objective To observe the effects of peritoneal dialysate containing pyruvate on peritoneal macrophages functions, electrolytes, metabolic acidosis and peritoneal mesothelium in uremic rats and compare with conventional lactate based solution. Methods The rats with stable chronic uremia were induced by two stages of 5/6 nephrectomy. After three months, all the animals received intraperitoneal injection of dialysis solution (25 ml/d) . After five weeks, the blood-gas analysis of artery was performed. The macrophages were separated from the peritoneal effluent for a dwell time of four hours. O2 the secretion of tumor necrosis factor-α (TNF-α) from the cells stimulated by LPS were investigated. Results The macrophages in the supernatant of pyruvate peritoneal effluent generated greater levels of 0: than that of lactate peritoneal effluent. The TNF-α secretion of macrophages from pyruvate peritoneal effluent increased significantly than that from lactate peritoneal effluent. Arterial plasma bicarbonate levels and pH of the rats received pyruvate dialysate were higher than those received lactate peritoneal solution. Light microscopy showed extensive mesothelial cell denudation, the surface was covered in some places with a thin layer of fibrin in rats received lactate peritoneal dialysate. Transmission electron microscopy revealed mesothelial cells microvilli missing. The rats received pyruvate peritoneal dialysate showed in part denudation of mesothelium. Transmission electron microscopy revealed the cells microvilli were sparse. Conclusions The peritonea] dialysate with pyruvate is more effective in correcting metabolic acidosis and preserving the peritoneal mesothelium. The cytotoxicity effect on macrophages can be lessened by using pyruvate anions.