不同钙离子浓度透析液对腹膜组织损伤及腹腔炎症标志的影响

Effect of different calcium concentrations in dialysate on peritoneum injury and abdominal inflammation markers

目的通过比较1.25mmol/L钙浓度腹膜透析液（PD4）与1.75mmol/L钙浓度腹膜透析液（PD2）对维持性腹膜透析（peritoneal dialysis,PD）患者PD透出液中癌抗原125（carcinoembryonic antigen125,CA125）、血管内皮生长因子（vascular endothelial growth factor,VEGF）、内皮源性一氧化氮合酶（endothelial nitric oxide synthase,e NOS）、白介素-6（interleukin-6,IL-6）水平变化的影响,评估不同钙浓度透析液对腹膜组织损伤及腹腔局部微炎症状态的影响。方法选取2013年6～8月间于大连市中心医院腹膜透析中心持续使用PD2≥2月的持续性非卧床腹膜透析患者。符合入组条件的随机分配到PD4组和PD2组：PD4组患者停止使用PD2改用PD4;PD2组患者继续使用PD2。设入组时为0月,实验观察结束时为6月。记录0月、6月相应的临床指标,同时收集0月、6月过夜留腹腹膜透析液集中检测PD透出液中CA125、VEGF、e NOS、IL-6的水平。结果最终纳入34例,每组各17例。2组患者基线临床资料匹配。组内自身前后比较显示：经过6个月的治疗,PD2组PD透出液中CA125浓度明显下降[（41.54±12.27）U/ml比（32.84±9.10）U/ml,t=2.760,P=0.014],PD4组及PD2组e NOS明显升高[分别为（32.25±7.37）U/ml比（46.85±10.04）U/ml,t=-5.463,P〈0.001;（29.83±8.13）U/ml比（52.10±9.49）U/ml,t=-9.918,P〈0.001];PD4组及PD2组IL-6亦明显升高[分别为（74.67±22.67）ng/L比（83.16±23.08）ng/L,t=4.871,P〈0.001;（70.98±21.59）ng/L比（80.05±20.82）ng/L,t=6.804,P〈0.001]。PD4组CA125水平呈下降趋势,PD4组及PD2组VEGF呈升高趋势,但均无统计学意义（P〉0.05）。组间比较显示：6个月后PD4组PD透出液中CA125降低的幅度明显低于PD2组[-0.05（-1.15,1.30）U/ml比2.50（0.03,4.85）U/ml,Z=-2.242,P=0.045];e NOS升高的幅度亦明显低于PD2组[-13.68（-19.02,-5.95）U/ml比-22.37（-27.76,-15.77）U/ml,Z=2.197,P=0.040];而VEGF、IL-6升高的幅度无统计学差异。结论维持性PD患者短期内应用1.25mmol/L钙透析液（PD4）具有保护腹膜间皮细胞及微血管内皮细胞的作用,但对腹膜血管新生及腹腔局部微炎症的影响甚小。

Objective To evaluate the effects of calcium 1.25 mmol/L（PD4） and calcium 1.75 mmol/L（PD2） in dialysate on peritoneum injury and abdominal local microinflammatory state by comparing the changes of carcinoembryonic antigen 125（CA125）, vascular endothelial growth factor（VEGF）, endothelial nitric oxide synthase（e NOS）, and interleukin- 6（IL- 6） in the effluent from maintenance peritoneal dialysis（PD） patients. Method A total of 48 PD patients treated with PD2 for more than 2 months and followed-up regularly in Dalian Central Hospital from Jun. 2013 to Aug. 2013 were randomly divided into PD4 group and PD2 group. The PD4 group started to use PD4 instead of PD2, and the PD2 group maintained the PD2 dialy-sate. We defined the start time as 0 month and the end time as 6th month. We recorded the clinical indices and stored the effluent samples overnight to measure CA125, VEGF, e NOS and IL-6 by ELISA. Results Thirtyfour patients（n=17 in PD4 group; n=17 in PD2 group） finished the study course. The baseline clinical data were comparable between the two groups. After the treatment for 6 months, CA125 in the effluent decreased in PD2 group（41.54 ± 12.27 U/ml vs. 32.84 ± 9.10 U/ml, t=2.760, P=0.014）; e NOS increased in both groups（32.25±7.37 U/ml vs. 46.85±10.04 U/ml, t=-5.463, P〈0.001 for PD4 group; 29.83±8.13 U/ml vs. 52.10±9.49U/ml, t=-9.918, P〈0.001 for PD2 group）; IL-6 increased in both groups（74.67±22.67 ng/L vs. 83.16±23.08ng/L, t=4.871 P〈0.001 for PD4 group; 70.98±21.59 ng/L vs. 80.05±20.82 ng/L, t=6.804 P〈0.001 for PD2group）; CA125 declined in PD4 group and VEGF increased in both groups, but without statistical significance（P〈0.05）. The decrease range of CA125 was less in PD4 group than in PD2 group [-0.05（-1.15. 1.30） U/ml vs. 2.50（0.03, 4.85） U/ml, Z=- 2.242, P=0.045]. The increase range of e NOS was less in PD4 group than in PD2 group [- 13.68（- 19.02,- 5.95） U/ml vs.- 22.37（- 27.76,- 15.77） U/ml, Z=2.197, P=0.04]. There were no statistical differences in the increase rate of VEGF and IL-6 between the two groups（P〈0.05）. Conclusion For maintenance PD patients, using 1.25mmol/L calcium dialysate for a short time of period may protect peritoneal mesothelial cells and microvascular endothelial cells without significant influences on peritoneal angiogenesis and local abdominal microinflammation.