The Impact Of Serum And Peritoneal IL-6on Baseline Peritoneal Transport Function In Predialysis Uremic Patients

objective: Through the detection of serum and peritoneal tissue IL-6and peritonealmicrovascular density of the predialysis uremic patients，to study the influence of thesystem and peritoneal inflammation on baseline peritoneal transport function and thepossible mechanism.Methods:1, The inclusion and exclusion criteria included: Selected Dalian CentralHospital30cases of uremic patients undergoing peritoneal dialysis catheter. no previoushistory of abdominal operation and infection history; the incidence of patients withlupus nephritis, Henoch-Schonlein purpura nephritis and primary small vessel vasculitiswere excluded.2, Specimen collection and detection methods:1) Recorded clinicalparameters of patients: gender, age, primary disease, residual renal function,hemoglobin (Hemoglobin, Hb), blood urea nitrogen (Blood uremic nitrogen, BUN),serum creatinine (Blood creatinine, Scr), uric acid (Uric, acid, UA), albumin (Serumalbumin, Alb), total protein (Total, protein, TP), total cholesterol (Total, cholesterol, TC),triglyceride (trilaurate glycerin, TG), parathyroid hormone (Parathyroid, hormone, PTH),calcium (Calcium, Ca), phosphorus (Phosphorus, P) and other indicators. Serumsamples of2): Before inserting peritoneal dialysis catheter,drawing blood samples ofpatients in10ml and centrifuged extract serum in-80℃refrigerator, using ELISA(enzyme-linked immunosorbent assay) method for detection of serum IL-6(interleukin-6).3) Peritoneal tissue samples were obtained at the time of PD catheterinsertion,the purse-string suture site of about1cm2, with CD34as the endothelialmarker for immunohistochemical staining, microscopy counting peritonealmicrovascular density, i.e. pre-dialysis peritoneal MVD value. At the same time,keepinganother part of the peritoneum at-80℃refrigerator, by RT-PCR (reverse transcriptionpolymerase chain reaction) analysis of expression of peritoneal tissue IL-6semi quantitative.3, Experimental groups: continuous ambulatory peritoneal dialysis(Continuous ambulatory peritoneal dialysisCAPD)1months after,taking peritonealequilibrium test (Peritoneal equilibration test, PET),recording4hours of dialysatecreatinine and serum creatinine ratio (D/P), with D/P=0.65for the sector, D/P>0.65isdivided into high transport group (H group), D/P≤0.65for low transport group (Lgroup).Results: A total of30patients, including16cases of H group,14cases in group L, noacute peritonitis during the study period.1) Analysis of differences in clinicalparameters between the groups: the clinical parameters of H group and L group had nosignificant difference (P>0.05). According to the primary disease patients were dividedinto diabetic group and non-diabetic group, compared two groups of baseline D/P, nostatistical difference system inflammation index and peritoneal inflammatory index.2)Analysis of differences in system inflammation between the groups: there was nosignificant difference of serum IL-6, albumin difference between H group and L group(P>0.05).3) Analysis of microvessel density differences between groups: H group,MVD value is higher than the L group (t=2.116, P=0.044);4) Analysis of peritonealtissue IL-6between groups: peritoneal tissue IL-6expression level of H group wassignificantly higher than that of L group (t=2.916, P=0.012).5) The correlation analysisbetween IL-6and MVD: MVD of peritoneum and peritoneal tissue IL-6expressionpositive correlation (r=0.368, P=0.045).6), The correlation analysis betweeninflammatory marker of system、peritoneal tissue IL-6、MVD and D/P: baseline D/Phad no correlation with systemic inflammatory markers; baseline D/P and peritonealMVD value had a significant positive correlation(r=0.476, P=0.008); baseline D/P andperitoneal tissue IL-6expression (r=0.640, p=0.000). Multiple linear regressionanalysis showed that baseline D/P and expression of peritoneal tissue IL-6(P=0.004) had a significant positive correlation.Conclusion:1.Athough the performance of baseline peritoneal transport characteristicsis different in peritoneal dialysis patients, but before dialysis relevant clinical indexeswere not statistically significant. No difference is found in baseline transport functionbetween diabetes group and non diabetes group.2.Systemic inflammation is no statistical difference. In high transportgroup and low transport group before peritoneal dialysis.3. Peritoneal microvessel count in uremiac patients before dialysis has significant difference, high transport group was significantly higher than that of lowtransport group.4. There was a significant difference in IL-6expression level inperitoneum,which is the physiological and pathological basis of differences in baselineperitoneal transport characteristics.5. The baseline peritoneal transport characteristics has positive correlationwith the expression of IL-6in pretoneum, microvessel count also was positivecorrelative with peritoneal local IL-6expression levels, suggesting peritonealinflammation may indirectly affect baseline transport by regulating the peritonealmicrovessels,increasing the peritoneal surface area.No correlation between systemicinflammation and baseline peritoneal transport function was found.