中国血液净化

›› 2010, Vol. 9 ›› Issue (3): 152-155.

• 临床研究 • 上一篇    下一篇

肾素血管紧张素系统抑制剂对长期腹膜透析患者腹膜纤维化和残余肾功能的作用

孙 晶 张 虹 于克洲 王 群 王 荣   

  1. 山东大学附属省立医院肾脏科
  • 收稿日期:2009-05-26 修回日期:1900-01-01 出版日期:2010-03-12 发布日期:2010-03-12

Effect of rennin-angiotensin system (RAS) inhibitors on peritoneal fibrosis and residual renal function in peritoneal dialysis patients

SUN Jing, ZHANG Hong, YU Ke-zhou, Wang Qun, WANG Rong   

  1. Department of Kidney, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
  • Received:2009-05-26 Revised:1900-01-01 Online:2010-03-12 Published:2010-03-12

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摘要：

【摘要】目的 探讨血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor，ACEI)和(或）血管紧张素受体拮抗剂(angiotensin receptor blocker，ARB)在长期腹膜透析患者中的作用。方法 选择山东大学附属省立医院腹膜透析中心68例新腹膜透析患者，分为两组：ACE/ARB组39例，对照组为未使用ACE/ARB药物，共29例。观察期12个月，观察开始和结束时均行腹膜平衡实验(peritoneal equilibration tests，PET)。酶联免疫法(ELISA)检测PET前过夜腹透液中的纤维粘连蛋白(fibronectin，FN)、转化生长因子(transforming growth factor 1，TGF-1)、血管内皮生长因子(vascular endothelial growth factor，VEGF)和水通道蛋白(aquaporin 1，AQP1)。结果 两组患者基础临床参数没有明显差别。整个研究过程中两组腹膜炎的发生率没有明显差别。ACE/ARB组和对照组的残余肾功能[(4.7±1.9)ml/min和(4.6±2.0)ml/min]在起始时没有明显差别，12个月后两组的残余肾功能分别降低为(3.17±1.35)ml/min和(2.78±1.41)ml/min, 差异有统计学意义(P=0.014)。两组的透析液葡萄糖浓度(4 h)比值(D4/D0)都表现为轻微的下降，但两组间差异无统计学意义(P＞0.05)。与ACE/ARB组比较，12个月后对照组的透析液/血清肌酐(4 h)比值(D/Pcr)升高的速度明显增加，?D/Pcr分别为(0.08±0.031)和(0.15±0.033)，超滤量也显著性降低，?超滤量分别为(-87.5±42.6)ml/4h和(-161.8±61.4)ml/4h，差异均有统计学意义(P＜0.05)。对照组过夜腹透液中除AQP1外，TGF-1,FN和VEGF表达明显增加(P＜0.05)，而ACE/ARB组没有显著性变化。结论 在长期腹膜透析患者中肾素血管紧张素系统抑制剂可降低超滤量和残余肾功能下降的速度，抑制腹膜纤维化的发生和发展，在抗腹膜生硬化和保护腹膜功能上起到了积极的作用。

关键词: 腹膜透析, 肾素血管紧张素系统, 腹膜纤维化

Abstract:

【Abstract】 Objective Long-term peritoneal dialysis (PD) may lead to peritoneal fibrosis and ultrafiltration failure. It has been demonstrated that the rennin-angiotensin system (RAS) plays a key role in the regulation of peritoneal function in rats on peritoneal dialysis. We investigated the effects of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) on long-term PD patients. Methods We analyzed data from 68 patients treated with PD in this hospital for at least 12 months, during which at least 2 peritoneal equilibration tests (PET) were performed. Thirty-nine patients were treated with ACEI or ARB (ACEI/ARB group); and 29 patients received none of the above drugs during the entire follow-up period (control group). The expression of fibronectin, transforming growth factor-β1 (TGF-β1), aquaporin-1 (AQP1) and vascular endothelial growth factor (VEGF) in the overnight effluent before PET were examined by enzyme-linked immunosorbent assay (ELISA). Results The demographic data showed no difference between the 2 groups, nor did the prevalence of peritonitis in the study period. At the beginning of study, no difference was found in residual renal function between ACEI/ARB group (4.7±1.9ml/min) and control group (4.6±2.0ml/min). After the treatment for 12 months, residual renal function decreased to 3.17±1.35mL/minute in ACEI/ARB group and to 2.78±1.41mL/minute in control group (P= 0.014), the glucose concentration ratio in dialysate at 0h and 4h (D4/D0) decreased slightly in both groups (P>0.05), the ratio of creatinine in dialysate and in plasma at 4h (D/Pcr) was higher in control group (0.15±0.03, P<0.05) than in ACEI/ARB group (0.08±0.0313), and ultrafiltration volume was lower in control group (-87.5±42.6ml/4h) than in ACEI/ARB group (-161.8±61.4ml/4h, P<0.05). Fibronectin, TGF-β1 and VEGF in overnight effluent increased in control group (P<0.05), but not in ACEI/ARB group (P>0.05). Conclusion ACEI and ARB appear to decelerate the deterioration of ultrafiltration efficiency and residual renal function, and to effectively protect against peritoneal fibrosis in long-term peritoneal dialysis.

Key words: Renin-angiotensin system, Peritoneal fibrosis