摘要
目的通过检测腹膜透析（简称腹透）流出液血管内皮生长因子（VEGF）和临床超滤量和溶质清除对比，观察艾考糊精腹透液对维持性腹透患者腹腔新生血管化的影响。方法选择2006年1至12月在我院肾内科透析的54例持续非卧床腹透（CAPD）患者行随机双盲前瞻性研究。入选的CAPD患者根据夜间使用的腹透液被随机分为7．5％艾考糊精腹透液组（ICO组，27例）和2．5％葡萄糖腹透液组（GLU组，27例）。为期4周。基线期测定4h腹透液和血液中肌酐的比值（D／PCr）反映腹膜功能。基线和4周时分别检测夜间腹透流出液超滤量、肌酐清除率（CCr）、VEGF和IL石水平。为消除超滤和留腹时间可能造成的误差，用腹透流出液VEGF呈现率反映腹腔中新生血管化情况。结果54例患者入选研究。基线期各组之间差异均无统计学意义。随访2和4周后ICO组超滤量和腹膜CCr均明显高于GLU组。夜间腹透流出液VEGF水平与留腹4h的D／PCr呈正相关（r=0．68，P〈0．01），与留腹4h的超滤量呈负相关（r=-0．51，P〈0．01）。2组患者基线期VEGF呈现率差异无统计学意义，随访4周后，VEGF呈现率在GLU组有上升趋势，在ICO组有下降趋势，但差异均无统计学意义，而AVEGF呈现率（4周VEGF呈现率-基线期VEGF呈现率）在2组之间差异有统计学意义（9．5±20．2vs-13．4±26．1，P〈0．01）。血IL-6和腹透流出液IL石水平以及腹透流出液细胞数在2组之间差异无统计学意义。结论与2．5％葡萄糖腹透液相比，艾考糊精腹透液能显著降低腹透流出液中的VEGF水平从而对改善腹腔局部的新生血管化具有益作用。
Objective To observe the effect of icodextrin on peritoneal membrane angiogenesis in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods This was a randomized double-blind perspective study of CAPD patients at our center between January 2006 to December 2006. The patients were randomized to receive either 7.5% icodextrin （ICO, n =27） or glucose （GLU, n =27） solution at night for 4 weeks. Peritoneal membrane function was defined as dialysate dwell for 4 hours to plasma ratio of creatinine （4 h D/Pcr） at baseline. Ultrafiltration volume, creatinine clearance （Ccr）, VEGF and IL-6 in peritoneal effluent during the long night dwell （UF） dialysate were measured at baseline and after 4 weeks. The VEGF appearance was used to adjust the influences of dwell time and ultrafiltration volume. Results A total of 54 patients were enrolled. The baseline conditions showed no difference between the groups. After 2 and 4 weeks of therapy, both net UF and peritoneal creatinine clearance of long dwell were significantly higher in the ICO group than the GLU group. VEGF in night dwell PD solution was positively correlated with D/PCr（r = 0. 68, P 〈 0.01 ） and negatively correlated to 4 hour ultrafiltration volume （ r = - 0. 51, P 〈 0.01 ）. The VEGF appearance was comparable between two groups at baseline. After a follow-up of 4 weeks, the VEGF appearance had an increasing tendency in the GLU group and a decreasing tendency in the ICO group but there was no significant difference. The △VEGF appearance （VEGF appearance in 4 week- VEGF appearance at baseline） was different between the GLU and ICO groups （9.5 ±20. 2 vs - 13.4 ±26. 1,P 〈0. 01 ）. IL-6 in night dwell dialysate had no difference between two groups. Conclusion As compared with glucose-based solution, 7. 5% icodextrin significantly decreases the local VEGF level in dialysate.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第40期2843-2847,共5页
National Medical Journal of China
基金
上海市科学技术委员会科研计划（08DZ1900500）
上海市教育委员会科研创新项目（09YZ83）
关键词
超滤
血管内皮生长因子类
新生血管化
病理性
Uhrafihration
Vascular endothelial growth factors
Neovascularization, pathologic
