腹膜透析患者透出液糖类抗原125浓度变化的观察

Changes in dialysate CA125 and its significance in peritoneal dialysis patients

目的分析腹膜透析透出液糖类抗原125（carbohydrate antigen125，CA125）浓度在长期腹膜透析过程中的变化，探讨CA125在腹膜透析中的临床意义。方法以2013年1月至2014年12月在陕西省人民医院腹膜透析中心随访的终末期肾脏疾病患者32例为研究对象，其中男15例，女17例；年龄29~64岁，平均年龄为（50．1±16．4）岁。随访期内有7例患者发生过1次腹膜透析相关性腹膜炎。观察持续不卧床腹膜透析患者2年中透出液CA125浓度及腹膜功能的变化；观察仅发生1次腹膜透析相关性腹膜炎患者（7例）透出液中CA125在腹膜炎前、腹膜炎时、腹膜炎治愈后（1个月）的浓度变化；采用微量酶免疫法测定CA125浓度，行腹膜平衡试验评估腹膜转运功能。结果腹膜透析透出液中CA125的浓度呈逐渐递减趋势：0个月时为（17．1±3．1）U／m1，6个月时为（18．4±3．5）U／ml，12个月时为（16．5±2．4）U／ml，18个月时为（15．6±1．9）U／ml，24个月时为（10．3±2．9）U／ml；而代表腹膜功能的平衡试验中4h腹透液与血清肌酐的比值（4-hour dialysate-to-plasma creatinine，4h D／Per）呈逐渐升高趋势：0个月时为0．57±0．02，6个月时为0．60±0．15，12个月时为0．61±0．16，18个月时为0．62±0．13，24个月时为0．65±0．11。在随访过程中，共发生腹膜炎7例；腹膜炎时CA125浓度明显升高[（34．9±5．8）U／ml]，与腹膜炎前CA125浓度[（16．5±2．7）U／ml]及腹膜炎治愈后CA125浓度[（17．4±2．1）U／ml]相比，差异均有统计学意义（P均〈0．05）。结论随着腹膜透析时间的延长，透出液CA125的浓度有所减少，腹膜转运功能逐渐增加；腹膜炎时，透出液CA125呈短期骤升表现，CA125浓度变化与腹膜炎有相关性。

Objective To investigate the changes in dialysate CA125 during long-term perito- neal dialysis, and the clinical significance of CA125 in peritoneal dialysis. Methods We observed the changes of CA125 concentration and peritoneal function in patients with continuous ambulatory perito- neal dialysis （32 cases, 15 males and 17 females with the age ranging from 29 to 64 years） during 2 years. The changes of dialysate CA125 concentration in patients with peritoneal dialysis-related perito- nitis （7 cases） were recorded. The dialysate CA125 concentration was ＇determined by micro enzyme immunoassay. Peritoneal transport function was assessed with the peritoneal equilibrium test. Results The concentration of CA125 in the dialysate was gradually decreased [0 month： （17. 1 ± 3.1） U/ mL; 6 month： （18. 4 ± 3. 5） U/mL; 12 month： （16. 5 ± 2. 4） U/mL; 18 month： （15. 6 ± 1.9） U/ mL; 24 month; （10. 3 ± 2. 9） U/mL]. 4h D/Pcr showed a gradual increasing trend （0 month： 0. 57 ± 0. 02; 6 month： 0. 60 ± 0. 15; 12 month： 0. 61 ± 0. 16; 18 month： 0. 62 ± 0. 13; 24 month. 0. 65 ± 0. 11）. CA125 concentration was significantly increased in peritonitis. During the follow-up period, there were 7 cases of peritonitis, and CA125 concentration was significantly increased [（34. 9 ± 5.8）U/mL] as compared with that pre-peritonitis [（16. 5 ± 2. 7） U/roLl and after healing of peritonitis [（17. 4±2. 1） U/mL] （P〈0. 05 for both）. Conclusions With the extension of peritoneal dialysis time, The concentration of dialysate CA125 was decreased, and peritoneal transport function was gradually increased. In peritonitis, dialysate CA125 showed a short-term increase. The change of CA125 concentration was correlated with peritonitis.