| Background and Purpose:Peritoneal dialysis is one of the effective alternative therapies for end-stage renal disease.However,peritoneal tissues of patients receiving peritoneal dialysis treatment are exposed to peritoneal dialysis solution with poor biocompatibility for a long time(16-24 hours/day)and a large dose(8-10L/day),and the dialysis solution is heated.Glucose metabolites and glycosylated metabolites can be produced in the process,and the dialysate is high in sugar,high in permeability and low in PH value,and uremic toxins and other factors affect the peritoneal membrane of dialysis patients,which is in a micro-inflammatory state for a long time and a series of complications occur in peritoneal tissue.Miscellaneous changes:the microvilli of peritoneal mesothelial cells disappear,swell and deform,fall off,phenotype transformation,etc.At the same time,macrophages are activated.Both peritoneal mesothelial cells and macrophages secrete various cytokines and inflammatory mediators cooperatively.They interact with each other.Eventually HPMCs is lost,subcutaneous connective tissue hyperplasia,peritoneal neovascularization and vascular hyaloid change lead to increased peritoneal permeability and solute transport.With the extension of dialysis time,clearance of small molecular toxins increases in the initial stage.With the decrease of fluid ultrafiltration,peritoneal fibrosis and peritoneal function gradually decrease.Removal of small molecular toxins is also obstructed.Peritoneum cannot remove excessive fluid in the body,which eventually led to ultrafiltration failure,peritoneal dialysis technology failure,and patients withdrew from peritoneal dialysis.At present,the standard peritoneal equilibrium test(PET)proposed by Twardowski is widely used in clinic to evaluate the peritoneal transport characteristics of peritoneal dialysis patients.However,the peritoneal equilibrium test is invasive,requiring blood samples to be taken at the same time when 2.5%glucose peritoneal dialysis solution is retained in the abdominal cavity for 2 hours to measure creatinine and glucose concentration in serum.At present,studies have shown that IL-6?TGF-?1 and MMP2 in peritoneal dialysis effluent may be related to the peritoneal transport function of patients.Relevant biomarkers in clinical practice is easy to measure in peritoneal effluent and could represent the rate of transfer of solute,Through reading the literature,various studies found that OPN can be secreted under the stimulation of pro-inflammatory and pro-fibrotic factors which may also evolved the process of peritoneal membrane fibrosis and the secretion of OPN in effluents may be regulated by interleukin-33.Therefore,in our study,The expression levels of osteopontin(OPN)and interleukin 33(IL-33)in effluents were analyzed in combination with peritoneal balance test to analyze their relationship with peritoneal transport function.To explore whether OPN in effluents can be a new biomarker for evaluating peritoneal transport function.Methods:A cross-sectional observation study was conducted on the patients who received maintenance abdominal palpation dialysis in the Center for Abdominal Dialysis of Department of Nephrology,First Affiliated Hospital of Suzhou University from April 2018 to December 2018.A total of 47 patients who met the criteria were selected according to the selection and exclusion criteria of the study plan.At the same time,16 patients with dialysis-related peritonitis admitted to the Center were collected during the corresponding period of time,and relevant clinical data of all patients were collected.Including gender,age,primary disease,dialysis age,24-hour urine volume,medication and other general data,dialysis dosage,abdominal retention time,dialysate glucose concentration,ultrafiltration volume and other dialysis data;Fasting blood calcium,blood phosphorus,blood uric acid,blood creatinine,blood albumin,hemoglobin,parathyroid hormone,cholesterol,triglyceride and other blood examination results;CAPD group underwent standard peritoneal dialysis balance test and calculated the results of 4hD/PCr and D/DO),record the ultrafiltration volume for 4 hours;At the same time calculate the urea removal index(kt/v);Peritoneal dialysis effluent from CAPD group patients who were left abdominal for 8-12 hours at night were collected,and OPN and IL-33 in the samples were detected by ELISA method.Peritonitis patients collected peritoneal dialysis effluents before intraperitoneal administration.The levels of OPN and IL-33 in samples were detected by ELISA and analyzed statistically by SPSS software.Results:The OPN level of peritoneal dialysis effluent from 47 CAPD patients was 2.7597±2.1321,and pearson correlation test was used.Correlation analysis between OPN and PET test results showed that OPN was significantly positively correlated with D/PCr(r=0.4265,P=0.0043);Negative correlation with D/DO(r=-0.3540,p=0.0146);According to the characteristics of peritoneal transport function,patients were divided into High transport and high average transport(H/A,D/PCr>0.65)group,low transport and low average transport(L/A,D/PCr<0.65)group,It was found that OPN level of effluent in H/A group was higher than that in L/A group(P<0.05).Correlation Analysis of OPN and Clinical Indexes of Dialysis Patients,It is suggested that OPN is negatively correlated with triglyceride(r=-0.2978,P=0.0421)and uric acid(r=-0.0318,P=0.0294).It is negatively correlated with blood phosphorus(r=-0.2919,p=0.0465),blood albumin(r=-0.3002,p=0.0404),and hemoglobin(r=-0.3468,p=0.0169);After multiple regression analysis,no index was found to be an independent influencing factor for the increase of OPN level,At the same time,the IL-33 level in peritoneal dialysis effluent of 47 CAPD patients was measured to be 7.411±2.942.Correlation analysis between IL-33 and OPN showed that IL-33 was positively correlated with OPN(R=0.4553,P=0.0013);The level of OPN and IL-33 in dialysis effluent of peritonitis patients was significantly higher than that of 47 CAPD patients without peritonitis.The levels of osteopontin(OPN),interleukin-33(IL-33)in serum of peritonitis patients and 47 CAPD patients were detected.Statistical analysis showed that there was no significant difference in serum OPN and IL-33 levels between patients with peritonitis and patients without peritonitis.The levels of OPN and IL-33 in peritoneal dialysis effluent of patients were significantly different:The OPN level in peritoneal dialysis effluent between peritonitis group and non-peritonitis group is different(18.64±3.261versus2.409 soil 0.295;p<0.001);The IL-33 level in peritoneal dialysis effluent between peritonitis group and non-peritonitis group is different(29.1±8.573versus7.411±0.4291;P<0.0001)?Conclusion:1.Osteopontin level in dialysis effluent of peritoneal dialysis patients is correlated with peritoneal transport function(D/PCr,D/DO);The OPN level in the high and high average transport groups is higher than that in the low average transport group.2.OPN level in peritoneal dialysis effluent is correlated with nutritional status of dialysis patients.3.Expression and release of OPN in peritoneal dialysis effluent may be regulated by L33.4.The levels of OPN and IL-33 were significantly increased in dialysis effluent of peritoneal dialysis-related peritonitis patients. |
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