论文部分内容阅读
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 compare the effects of peritoneal dialysis fluid (PD4) with 1.25mmol / L calcium concentration and peritoneal dialysis fluid (PD2) with 1.75mmol / L calcium concentration on the PD efflux carcinoembryonic antigen (PD) 125 in patients with maintenance peritoneal dialysis (PD) Antigen 125, CA125, VEGF, eNOS and IL-6 The effects of different concentrations of calcium dialysate on the peritoneal tissue injury and local micro-inflammatory state of abdominal cavity were evaluated. Methods The patients with persistent non-clinical non-patient with PD2≥2 months were selected in the peritoneal dialysis center of Dalian Central Hospital from June to August in 2013. The patients were divided into two groups: PD4 group and PD2 group were randomly assigned to meet the inclusion criteria: PD4 was discontinued using PD2 instead of PD4; PD2 patients continued to use PD2. Set into the group when 0 months, the end of the experimental observation for June. The corresponding clinical indexes of 0 and 6 months were recorded. The concentrations of CA125, VEGF, eNOS and IL-6 in PD effusion fluid were collected from the peritoneal dialysis fluid collected at 0 and 6 o’clock overnight. The results were finally included in 34 cases, 17 cases in each group. Baseline clinical data were matched in 2 groups. After 6 months of treatment, the concentration of CA125 in PD effusion of PD2 group was significantly decreased [(41.54 ± 12.27) U / ml vs (32.84 ± 9.10) U / ml, t = 2.760, P = 0.014], eNOS in PD4 group and PD2 group were significantly higher (32.25 ± 7.37 U / ml vs 46.85 ± 10.04 U / ml, t = -5.463, P <0.001; 29.83 ± 8.13 U / ml, ml in the PD4 group and PD2 group [(74.67 ± 22.67) ng / L vs (83.16 ± 23.08, respectively)] were significantly higher than those in the PD2 group (52.10 ± 9.49 U / ml, t = -9.918, L, t = 4.871, P <0.001; (70.98 ± 21.59) ng / L ratio (80.05 ± 20.82) ng / L, t = 6.804, P <0.001]. The level of CA125 in PD4 group showed a decreasing trend, and the VEGF in PD4 group and PD2 group showed an increasing trend, but there was no statistical significance (P> 0.05). The comparison between groups showed that the reduction of CA125 in PD effusion of PD4 group was significantly lower than that in PD2 group after 6 months [-0.05 (-1.15,1.30) U / ml vs 2.50 (0.03,4.85) U / ml, Z = -2.242, P = 0.045]. The magnitude of eNOS increase was also significantly lower than that in PD2 group [-13.68 (-19.02, -5.95) U / ml vs -22.37 (-27.76, -15.77) U / ml, Z = 2.197 , P = 0.040]. There was no significant difference in the increase of VEGF and IL-6. Conclusion The maintenance of PD in patients with short-term use of 1.25mmol / L calcium dialysate (PD4) has a protective effect of peritoneal mesothelial cells and microvascular endothelial cells, but peritoneal neovascularization and peritoneal local inflammation little effect.