Impact of uremia, diabetes, and peritoneal dialysis itself on the pathogenesis of peritoneal sclerosis: A quantitative study of peritoneal membrane morphology
Impact of uremia, diabetes, and peritoneal dialysis itself on the pathogenesis of peritoneal sclerosis: A quantitative study of peritoneal membrane morphology
复制标题
DOI：
10.2215/cjn.03630807
复制
发表时间：
2008-05-01
影响因子：
9.8
通讯作者：
Hirano, Hiroshi
中科院分区：
文献类型：
--
作者：
Honda, Kazuho;Hamada, Chieko;Hirano, Hiroshi
背景和目标：腹膜透析和其他相关疾病（例如，尿毒症）。腹膜活检评估的定量方法需要调查可能的致病因素和腹膜透析相关腹膜改变的严重程度。设计、设置、参与者和测量：173例尿毒症患者的腹膜活检（腹膜透析前）对80例腹膜透析患者进行了超滤功能评价，并与正常对照组比较结果：尿毒症患者腹膜厚度随透析时间延长而增加，腹膜厚度随透析时间延长而进行性增厚。尿毒症患者的管腔/血管直径比低于正常人，并随着腹膜透析时间的延长而进行性降低。在腹膜透析前腹膜中，糖尿病患者的管腔/血管直径比与非糖尿病患者相比显著降低。超滤能力受损患者的平均腹膜厚度显著高于维持超滤能力的患者;然而，两组之间的毛细血管后微静脉厚度和管腔/血管直径比无显著差异。平均腹膜厚度和管腔/血管直径比是量化尿毒症和腹膜透析患者腹膜改变严重程度的有用形态学参数。尿毒症和糖尿病对腹膜透析前腹膜硬化的发病有影响。腹膜透析治疗本身对腹膜硬化症的进展有更大的影响。
Background and objectives: Peritoneal interstitial fibrosis and hyalinizing vasculopathy were induced by peritoneal dialysis and other associated conditions (e.g., uremia). A quantitative method for peritoneal biopsy evaluation is required to investigate possible causative factors and severity of the peritoneal dialysis-related peritoneal alterations.Design, setting, participants, & measurements: Peritoneal biopsy specimens from 173 uremic (before peritoneal dialysis) and 80 peritoneal dialysis patients with or without impaired ultrafiltration capacity were evaluated by average peritoneal thickness of submesothelial compact zone measured at five randomly selected points of peritoneum and by lumen/vessel diameter ratio at postcapillary venule.Results: The average peritoneal thickness was increased in uremic patients and progressively thickened as the duration of peritoneal dialysis prolonged. The lumen/vessel diameter ratio was lower in uremia than normal and progressively decreased as the duration of peritoneal dialysis prolonged. In pre-peritoneal dialysis peritoneum, patients with diabetes showed significant decrease in lumen/vessel diameter ratio compared with patients without diabetes. The average peritoneal thickness was significantly higher in patients with impaired ultrafiltration capacity than in patients with maintained ultrafiltration capacity; however, no significant difference was observed in the postcapillary venule thickness and lumen/vessel diameter ratio between the two groups.Conclusions: The average peritoneal thickness and lumen/vessel diameter ratio were useful morphologic parameters to quantify the severity of the peritoneal alterations in uremic and peritoneal dialysis patients. Uremia and diabetes had an impact on the pathogenesis of peritoneal sclerosis in pre-peritoneal dialysis peritoneum. Peritoneal dialysis treatment itself had a much stronger impact on the progression of peritoneal sclerosis.