中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (02): 82-85.doi: 10.3969/j.issn.1671-4091.2016.02.006

• 临床研究 • 上一篇    下一篇

腹膜透析患者透出液Gremlin水平对腹膜功能改变的影响

马东红,刘云,吕玉敏,化秋菊,郭明好   

  1. 新乡医学院第一附属医院肾病科
  • 收稿日期:2015-10-15 修回日期:2015-12-14 出版日期:2016-02-12 发布日期:2016-02-19
  • 通讯作者: 马东红 dhmasxmu@163.com E-mail:dhmasxmu@163.com

The effect of gremlin content in peritoneal dialysate effluent on peritoneal function

  • Received:2015-10-15 Revised:2015-12-14 Online:2016-02-12 Published:2016-02-19

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摘要： 目的观察腹膜透析患者透出液Gremlin的水平变化，探讨其对腹膜功能改变的影响。方法收集2010 年1 月～2015 年1 月新乡医学院第一附属医院肾内科规律随访的持续不卧床腹膜透析(continous ambulatory peritoneal dialysis,CAPD)患者78 例，采用ELISA 方法检测不同时间点透出液中Gremlin 和TGF-β1的水平，同时定期评价腹膜转运功能，分析Gremlin 对腹膜功能改变的影响。结果①随着透析龄延长，腹膜平衡试验结果显示低转运及低平均转运比例逐渐减少，部分患者腹膜功能逐渐转化为高转运或高平均转运；和初始相比，腹膜平衡试验各比率在随访3 年、4 年、5 年时χ2值分别为12.219、9.154 和10.707，P 值分别为0.007、0.027 和0.013，均有明显统计学差异，说明腹膜溶质转运功能逐渐增强。②腹膜透析1 个月，透出液中Gremlin 和转化生长因子β1(transforming growth factor-β1, TGF-β1)水平均较低，分别为(3.54±2.51)pg/mL 和(4.04±2.58)pg/mL，随着透析龄的延长，二者水平均逐渐升高，5 年时可达到(232.71±55.01)pg/mL 和(367.25± 182.34) pg/mL，随访6 月、1 年、2 年、3年、4 年、5 年的数据分别和腹膜透析1个月比较，t值分别为-5.956，-11.303，-22.187，-21.502，-34.255，-38.759，P 值均为0.000，有明显统计学差异。③透出液中Gremlin 和TGF-β1水平与透析龄长短呈明显正相关，相关系数分别为0.744 和0.873,P 值分别为0.029 和0.017。结论Gremlin 可能参与了腹膜透析患者腹膜纤维化的发生，从而导致腹膜溶质转运功能发生改变。干预Gremlin 表达有望为抑制或逆转腹膜纤维化提供理论依据。

关键词: Gremlin, 腹膜纤维化, 腹膜透析, 腹膜功能

Abstract: Objective To investigate the gremlin level in peritoneal dialysate effluent and its influence on peritoneal function. Methods A total of 78 cases of continuous ambulatory peritoneal dialysis (CAPD) patients treated in the First Affiliated Hospital of Xinxiang Medical College from Jan. 2010 to Jan. 2015 were enrolled in this study. Gremlin and TGF-β1 in peritoneal dialysate effluent were measured by ELISA, and peritoneal function was assessed by peritoneal equilibrium test. The relationship between gremlin level and peritoneal function was then evaluated. Results ① With the extension of dialysis, peritoneal equilibrium test showed that the proportion of low transport and low average transport were gradually reduced, and some patients transformed into high transport or high average transport. Compared to the baselines, the χ2 values for the peritoneal equilibrium test ratios in the follow- up of 3 years, 4 years, 5 years were 12.219, 9.154 and
10.707, respectively, with the P values of 0.007, 0.027 and 0.013, respectively, indicating that peritoneal solute transport function gradually enhanced. ②In initial stage of peritoneal dialysis (CAPD for one month), gremlin and TGF-β1 in the peritoneal dialysate effluent were 3.54 ± 2.51pg/mL and 4.04 ± 2.58pg/mL, respectively. With the extension of dialysis, gremlin and TGF-β1 levels increased gradually and reached 232.71±55.01pg/mL and 367.25 ± 182.34pg/mL, respectively, in the follow- up of 5 years. The values at the follow- up period of 6 months, one year, 2 years, 3 years, 4 years and 5 years were statistically different from those at the baseline condition (P=0.000). ③Gremlin and TGF-β1 levels in peritoneal dialysate effluent were positively correlated with duration of dialysis, with the correlation coefficient of 0.744 and 0.873, respectively. Conclusions Gremlin may be involved in the pathogenesis of peritoneal fibrosis, resulting in the changes of peritoneal solute transport function. Intervention of gremlin expression may be useful for inhibiting or reversing peritoneal fibrosis.

Key words: Gremlin, peritoneal fibrosis, peritoneal dialysis, peritoneal function