中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (10): 739-743.doi: 10.3969/j.issn.1671-4091.2023.10.005

• 临床研究 • 上一篇    下一篇

腹膜透析滤出液中游离mtDNA与腹膜透析患者腹腔微炎症的相关性分析

邱杰山    暨利军    王燕翔    王丹萍    陈静静    方燊燊   

  1. 317300 仙居，1仙居县人民医院(浙江省人民医院浙东南院区)肾脏内科
  • 收稿日期:2023-06-15 修回日期:2023-07-27 出版日期:2023-10-12 发布日期:2023-09-28
  • 通讯作者: 邱杰山 E-mail:qiujieshanww@126.com
  • 基金资助:
    浙江省中医药科技计划项目;仙居县人民医院青年创新人才支持计划

The correlation between free mtDNA in outflow dialysate and peritoneal micro-inflammation in patients undergoing peritoneal dialysis

QIU Jie-shan, JI Li-jun, WANG Yan-xiang, WANG Dan-ping, CHEN Jing-jing, FANG Shen-shen   

  1. Department of Nephrology, Xianju People’s Hospital (Southeast District of Zhejiang Provincial People's Hospital), Xianju 317300, China
  • Received:2023-06-15 Revised:2023-07-27 Online:2023-10-12 Published:2023-09-28
  • Contact: 317300 仙居，1仙居县人民医院(浙江省人民医院浙东南院区)肾脏内科 E-mail:qiujieshanww@126.com

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摘要： 目的  探讨腹膜透析滤出液中游离线粒体DNA(mitochondrial DNA，mtDNA)与腹膜透析(peritoneal dialysis，PD)患者腹膜及腹腔微炎症的相关性。 方法  收集行PD治疗的患者85例，分为A组(1.5%葡萄糖腹膜透析液治疗组)和B组[高浓度(2袋以上2.5%或4.25%)葡萄糖腹膜透析液治疗组]。检测血生化指标，腹膜透析滤出液中白细胞介素6(interleukin 6，IL-6)、肿瘤坏死因子α(tumor necrosis factor-α，TNF-α)、白细胞介素1β(interleukin 1β，IL-1β)及白细胞介素(interleukin 18，IL-18)及mtDNA。比较2组患者上述指标的差异；将mtDNA分别与临床参数做相关性分析；通过多元回归分析明确影响腹膜透析滤出液中mtDNA浓度的危险因素。 结果 B组患者透析龄长于A组(t =-2.206,P=0.030)，血白蛋白(Alb)低于A组(t =2.635,P=0.010)，腹膜透析滤出液中IL-6(t =      -4.835,P＜0.001)、TNF-α(t =-6.557,P＜0.001)、IL-1β(t =-2.395,P =0.019)、IL-18(t =-2.318,  P=0.023)及游离mtDNA(t =-3.920,P＜0.001)均高于A组。腹膜透析滤出液中mtDNA与IL-6(r =0.721,P＜0.001)、TNF-α(r =0.418,P＜0.001)、IL-1β(r =0.771,P＜0.001)、IL-18(r =0.634,P＜0.001)及透析龄(r =0.240,P=0.030)均呈正相关,与Alb呈负相关(r =-0.319,P=0.003)。多元回归分析显示腹膜透析液中葡萄糖浓度升高(β=0.358,P=0.005)、长透析龄(β=0.292,P＜0.001)及Alb降低(β=-0.272, P=0.027)是腹膜透析滤出液中mtDNA水平升高的危险因素。 结论  腹膜透析滤出液中mtDNA与PD患者腹膜及腹腔慢性微炎症状态相关。高浓度葡萄糖腹膜透析液、长透析龄及低蛋白血症是导致其水平升高的危险因素。

关键词: 腹膜透析, 腹膜透析滤出液, 线粒体DNA, 微炎症

Abstract: Objective  To investigate the relationship between free mitochondrial DNA (mtDNA) level in outflow dialysate and chronic peritoneum inflammation in patients undergoing peritoneal dialysis (PD).  Methods  A total of 85 patients with PD for more than 6 months were enrolled and divided into group A (using dialysate with 1.5% glucose) and group B (using dialysate with 2.5% or 4.25% glucose more than twice a day). Blood samples were collected and serum biochemical parameters were tested. The outflow dialysate was collected to measure interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-18 (IL-18) and free mtDNA in the fluid. The differences of these parameters were compared between the two groups. The correlation between mtDNA in outflow dialysate and clinical parameters was analyzed. Multivariate regression was used to define the risk factors for mtDNA in dialysate.  Results  PD duration was longer (t=-2.206, P=0.030) and serum albumin was lower (t=2.635, P=0.010) in group B than in group A. IL-6, TNF-α, IL-1β, IL-18 and free mtDNA in the dialysate were significantly higher in group B than in group A           (t=-4.835, -6.557, -2.395, -2.318 and -3.920 respectively; P<0.001, <0.001, =0.019, =0.023 and <0.001 respectively). Free mtDNA level in the dialysate was positively correlated with the levels of IL-6, TNF-α, IL-1β and IL-18 in dialysate and PD duration (r=0.721, 0.418, 0.771, 0.634 and 0.240 respectively; P＜0.001, <0.001,    <0.001 and =0.03 respectively), and was negatively correlated with serum Alb (r=-0.319, P＜0.01). Multivariate linear regression showed that higher glucose concentration in dialysate (β=0.358, P=0.005), longer PD duration (β=0.292, P=0.000) and lower serum Alb concentration (β=-0.272, P=0.027) were the risk factors for higher free mtDNA in outflow dialysate.  Conclusion  Elevated mtDNA in outflow dialysate is associated with chronic micro-inflammatory status of the peritoneum in PD patients. Higher glucose concentration in dialysate, longer PD duration and lower serum Alb concentration are the risk factors for higher free mtDNA in outflow dialysate.

Key words: Peritoneal dialysis, Outflow dialysate, Mitochondrial DNA, Micro-inflammation

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