| Objective: Prior to the peritoneal dialysis catheter, by detecting the expression ofperitoneal Vascular endothelial growth factor(VEGF),Endothelial nitric oxide synthase（eNOS）and miscrovessel density in uremia patient’s peritoneum，to explore therelationship between Peritoneal microvascular endothelial function and baselineperitoneal transport characteristics.Method:1. Criteria of inclusion and exclusion:30uremia patients who aregoing to take peritoneal dialysis catheter operation and with no history of peritonealcavity surgery and infection were selected from Dalian Central Hospital, among them,patients whose protopathy is lupus nephritis, nephritis of Schonlein-Henoch purpura andprimary small vessel vasculitis are excluded.2. Specimen collection and testingmethods:1) Clinical parameter: Take records for patients’ gender, age and protopathyand make evaluation for their residual renal function, hemoglobin, blood uremicnitrogen, blood creatinine, uric acid, serum albumin, total protein, total cholesterol,trilaurate glycerin, parathyroid hormone, calcium and phosphorus etc.2) Peritonealspecimen: Take about1cm2of parietal peritoneal tissue from the position where ispurse-string sutured during implanting peritoneal dialytic catheters, and note some ofthe tissue with CD34so as to make immunohistochemical staining, then note down thedensity of peritoneal microvascular under a microscope, namely, pre-dialysis peritonealMVD value,in the meantime, put the rest of peritoneal tissue in a refrigerator insidewhich the temperature shall be bellow-80℃and make quantitative analysis forperitoneal tissue VEGF and eNOS through the method of RT-PCR (reversetranscriptase-polymerase chain reaction).3. Test Grouping: Take continuousambulatory peritoneal dialysis CAPD treatment for1month, and then make peritoneal equilibration test and take record for the ratio of peritoneal dialysis creatinine and bloodcreatinine (D/P) every4hours. Take D/P=0.65as a dividing value, group of which D/P＞0.6is high-speed group and group (Group H) of which D/P≤0.65is low-speed group(Group L).Results: There are30patients in total, among them,16patients belong to GroupHand14patients belong to Group L. No acute peritonitis attack was found during thestudy period.1. Analysis of clinical parameters differences between two groups: theanalysis of clinical parameter comparison between Group H and Group L is nostatistically significance for P>0.05.2. Analysis of microvessel density differencesbetween groups: MVD value of Group H is substantially higher than the GroupL(t=2.116,P=0.044).3. Differences of eNOS and VEGF between two groups: VEGFvalue of Group H is substantially higher than Group L (t=4.362, P=0.000), and eNOSvalue of Group H is also higher than Group L (t=4.614, P=0.000).4.Correlation analysisbetween peritoneal VEGF, eNOS and MVD value:There is positive correlation betweenperitoneal VEGF and MVD value (r=0.448, P=0.013). There is significantly positivecorrelation between peritoneal eNOS and MVD value (r=0.639, P=0.000).5. Correlationanalysis between baseline D/P and MVD, peritoneal VEGF, eNOS: There issignificantly positive correlation between baseline D/P and peritoneal MVD(r=0.506,P=0.004).There is significantly positive correlation between baseline D/P and peritonealVEGF(r=0.646, P=0.000).There is significantly positive correlation between baselineD/P and peritoneal eNOS (r=0.638, P=0.000).Conclusion:1. After the peritoneal dialysis, the patient presents different baselineperitoneal transport characteristics; however, there is no statistics difference as perclinical index obtained before dialysis.2. There is a significant difference in microvessel density in uremic petientsbefore dialysis,high transport group is significantly higher than that of low transportgroup.3. There is a significant difference in the expression levels of VEGF and eNOS inperitoneal local in uremic patients before dialysis,which is the pathological basis ofdifferences in baseline peritoneal transport characteristics.4. There is significantly positive correlation between the expression levels of theperitoneal local VEGF and eNOS and baseline peritoneal transport characteristics inuremic patients before dialysis,indicates that the degree of peritoneal microvascular cell dysfunction may be one of an important factor in determining baseline peritonealtransport characteristics.5. There is positive correlation between peritoneal microvessel density andbaseline peritoneal transport characteristics,and microvessel density also correlates withthe expression levels of the peritoneal local VEGF and eNOS,indicates that peritonealmicrovascular cell dysfunction may effect the baseline peritoneal transportcharacteristics by regulating the number of peritoneal microvascular. |
