Morphological changes in the peritoneal vasculature of patients on CAPD with ultrafiltration failure
Morphological changes in the peritoneal vasculature of patients on CAPD with ultrafiltration failure
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DOI：
10.1159/000188837
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发表时间：
1996-02-01
期刊：
影响因子：
2.5
通讯作者：
Nihei, H
中科院分区：
文献类型：
--
作者：
Honda, K;Nitta, K;Nihei, H
对持续性非卧床腹膜透析（CAPD）超滤失败患者的腹膜血管变化进行了组织化学评估。光镜下可见广泛的间质纤维化、间皮剥脱和血管改变。在不同水平观察血管的形态学变化。这些患者的血管系统的具体变化的特点是严重的纤维化和透明化的中膜静脉。免疫荧光显微镜显示广泛的沉积等细胞外基质IV型胶原和层粘连蛋白在血管壁。电子显微镜检查显示胶原纤维显著增加，中膜平滑肌细胞变性。然而，在受影响的血管水平的内皮细胞保存相对良好。超滤失败的CAPD患者血管系统的这些病理学改变表明某些毒性因素，如高渗透析液或低pH透析液，从外膜侧而不是内皮侧影响腹膜血管系统。腹膜中的这些血管变化被认为是不可逆的，与腹膜功能的恶化相关，并且在长期CAPD治疗的患者中引起超滤失败。
Vascular changes in the peritoneum were histochemically assessed in patients on continuous ambulatory peritoneal dialysis (CAPD) with ultrafiltration failure. Light microscopy showed extensive interstitial fibrosis, mesothelial denudation and vascular changes. Morphological changes in the vasculature were observed at different levels. The specific changes in the vasculature in these patients were characterized by severe fibrosis and hyalinization of the media of venules. Immunofluorescence microscopy revealed extensive deposition of such extracellular matrices as type IV collagen and laminin in the vascular wall. Electron microscopy revealed a significant increase in collagenous fibers and degeneration of smooth muscle cells in the media. However, the endothelial cells at the levels of vasculature affected were relatively well preserved. These pathological alterations in the vasculature in CAPD patients with ultrafiltration failure suggest that certain toxic factors, such as a high osmolar dialysate or low pH of dialysate, had affected the peritoneal vasculature from the adventitial side rather than the endothelial side. These vascular changes in the peritoneum are thought to be irreversible, associated with deterioration of peritoneal function, and to cause ultrafiltration failure in the patients on longterm CAPD therapy.