Vascular Endothelial Cell Injury Is an Important Factor in the Development of Encapsulating Peritoneal Sclerosis in Long-Term Peritoneal Dialysis Patients.
Vascular Endothelial Cell Injury Is an Important Factor in the Development of Encapsulating Peritoneal Sclerosis in Long-Term Peritoneal Dialysis Patients.
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DOI：
10.1371/journal.pone.0154644
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Takei Y
中科院分区：
文献类型：
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作者：
Tawada M;Ito Y;Hamada C;Honda K;Mizuno M;Suzuki Y;Sakata F;Terabayashi T;Matsukawa Y;Maruyama S;Imai E;Matsuo S;Takei Y
包裹性腹膜硬化症（EPS）是腹膜透析（PD）的一种罕见但严重且危及生命的并发症。然而，确切的发病机制仍不清楚，此外，预测和早期诊断生物标志物的EPS尚未建立。检查了在导管移除时采集的83份腹膜样本，以确定慢性腹膜恶化的病理学特征，慢性腹膜恶化促进了接受长期PD治疗且腹膜炎发生率较低的患者的EPS。对病理结果进行单因素Logistic回归分析，腹膜厚度（P = 0.045），新膜形成评分（P = 0.006），管腔直径与血管直径的比值（L/V比，P<0.001）、CD 31阴性血管的存在（P = 0.021）、纤维蛋白沉积（P<0.001）和胶原体积分数（P = 0.018）与EPS的发展相关。在PD治疗期、非糖尿病和PD溶液匹配的有和无EPS的样本分析中，单变量分析将L/V比（每增加0.1：比值比（OR）0.44，P = 0.003）和纤维蛋白沉积（OR 6.35，P = 0.027）确定为与EPS相关的因素。有纤维蛋白渗出的患者L/V比低于无纤维蛋白渗出的患者。这些结果表明，血管内皮细胞损伤（以低L/V比为代表）可能是EPS发生的预测结果，特别是在未受腹膜炎影响的长期PD患者中。
Encapsulating peritoneal sclerosis (EPS) is a rare but serious and life-threatening complication of peritoneal dialysis (PD). However, the precise pathogenesis remains unclear; in addition, predictors and early diagnostic biomarkers for EPS have not yet to be established. Eighty-three peritoneal membrane samples taken at catheter removal were examined to identify pathological characteristics of chronic peritoneal deterioration, which promotes EPS in patients undergoing long-term PD treatment with low occurrence of peritonitis. According to univariable logistic regression analysis of the pathological findings, thickness of the peritoneal membrane (P = 0.045), new membrane formation score (P = 0.006), ratio of luminal diameter to vessel diameter (L/V ratio, P<0.001), presence of CD31-negative vessels (P = 0.021), fibrin deposition (P<0.001), and collagen volume fraction (P = 0.018) were associated with EPS development. In analyses of samples with and without EPS matched for PD treatment period, non-diabetes, and PD solution, univariable analysis identified L/V ratio (per 0.1 increase: odds ratio (OR) 0.44, P = 0.003) and fibrin deposition (OR 6.35, P = 0.027) as the factors associated with EPS. L/V ratio was lower in patients with fibrin exudation than in patients without fibrin exudation. These findings suggest that damage to vascular endothelial cells, as represented by low L/V ratio, could be a predictive finding for the development of EPS, particularly in long-term PD patients unaffected by peritonitis.