血管内皮生长因子（VEGF）对腹膜透析患者腹膜功能影响的临床相关性研究

发布时间：2018-06-12 21:16

本文选题：腹膜透析 + 血管内皮生长因子　；参考：《福建中医药大学》2017年硕士论文

【摘要】：研究背景:腹膜透析是终末期肾脏病的替代治疗方法之一,近年来腹膜透析相关并发症也越来越受到重视。腹膜转运特性是评估腹膜透析效能的指标,影响着PD治疗的质量及预后。腹膜血管新生是影响腹膜转运功能的机制之一,可引起腹膜纤维化、腹膜透析超滤衰竭。而血管内皮生长因子是血管新生的关键因子,肾素-血管紧张素-醛固酮系统可通过影响VEGF在血管新生的调节中起着重要的作用。目的:1、探讨影响尿毒症腹膜透析患者血清VEGF、腹膜透出液VEGF水平的相关因素,及VEGF介导的血管新生对腹膜转运功能的影响;2、研究肾素-血管紧张素抑制剂对CAPD患者VEGF水平及腹透蛋白丢失的影响。方法及结果:一、血管内皮生长因子与腹膜转运功能相关性的横断面研究:以2016年01月到2017年01月在福州总医院规律随访的122例CAPD患者为研究对象,分别以腹膜平衡实验(PET)实验结果及透析龄进行分组,以同期因大量腹水的肾病综合征患者(10例)作为对照组,测定各组患者血清VEGF(sVEGF)、腹膜透出液VEGF(pVEGF)水平及相关生化检查结果,用SPSS软件进行统计分析。结果:1、根据转运系数(D/P Cr)分组比较结果:(1)不同腹膜转运水平的各组CAPD患者sVEGF均较对照组明显增高;(2)高转运组的sVEGF显著高于高平均组、低平均组及低转运组;(3)对于pVEGF,高转运组水平明显高于高平均转运组、低平均转运组、低转运组、对照组,其它3组较对照组的差异不明显。2、根据透析龄分组比较结果:以1、2年为标准分为长、短期透析组,两组间的sVEGF、pVEGF水平差异无统计学意义;以3年为分界标准,长期透析组患者的sVEGF明显高于短期透析组,pVEGF组间差异不明显。3、CAPD患者中sVEGF与pVEGF水平呈正相关;多因素回归分析提示sVEGF水平、空腹血糖、高胆固醇血症是对pVEGF水平有影响,其中sVEGF水平的影响作用最大。另外,腹透液葡萄糖浓度是影响CAPD患者sVEGF、pVEGF水平的危险因素,而ACEI/ARB类药物的应用则是保护性因素。4、肌酐的腹膜溶质转运系数(MTACCr)与sVEGF水平呈正相关,与pVEGF水平无相关性;多因素回归分析提示sVEGF水平是影响MTAC Cr的危险因素。5、腹透蛋白丢失量与sVEGF、MTAC Cr呈正相关,多因素回归分析提示腹膜转运水平是腹透蛋白丢失的危险因素,ACEI/ARB类药物是保护性因素。二、肾素-血管紧张素系统抑制剂对CAPD患者VEGF水平的影响:收集2016年01月至2017年01月于我院规律随访的CAPD患者34例,根据是否应用ACEI/ARB类药物分成治疗组(n=20),对照组(n=14),观察时间为6个月,收集患者的一般资料、相关生化指标,分别在进入治疗前及治疗6个月后进行临床评估,评估内容包括D/P Cr、KT/V、CCr、24h腹透蛋白丢失量等,并分别收集当时的血清及腹透液标本,检测sVEGF及pVEGF浓度,进行统计分析。结果:1、纳入研究前治疗组和对照组在一般资料之间的差异不具有统计学意义。2、在治疗前后2组患者在pVEGF及各项临床指标之间的差异无统计学意义。3、在基线水平治疗组与对照组的sVEGF水平、腹透蛋白丢失量差异不具有统计学意义;6个月后治疗组的sVEGF水平、腹透蛋白丢失量较对照组显著降低。结论:1、腹膜透析液的葡萄糖浓度是影响sVEGF、pVEGF水平的危险性因素,ACEI/ARB类药物对减少sVEGF、pVEGF有保护作用。sVEGF、血糖、高胆固醇血症是引起pVEGF水平升高的危险性因素,其中sVEGF水平对pVEGF的影响最大,推测pVEGE水平受循环系统及腹腔环境局部影响。2、VEGF水平越高,腹膜转运水平越高,两者具有显著的相关性,提示VEGF可促进腹膜血管新生及增加腹膜血管的通透性,进而增加腹膜溶质转运水平。3、CAPD患者的血清白蛋白水平与sVEGF、pVEGF负相关;腹膜转运水平及sVEGF与腹透蛋白丢失量正相关,提示VEGF可能通过影响腹膜转运功能,介导腹透蛋白流失,引起低蛋白血症。4、ACEI/ARB类药物可以抑制CAPD患者VEGF产生,减轻腹膜血管新生及渗透性,减轻CAPD患者腹透蛋白丢失量,从而起到保护腹膜的作用。
[Abstract]:Background: peritoneal dialysis is one of the alternative therapies for end-stage renal disease. In recent years, peritoneal dialysis related complications are becoming more and more important. Peritoneum transport characteristics are the indicators to evaluate the effectiveness of peritoneal dialysis, affecting the quality and prognosis of PD treatment. Peritoneal angiogenesis is one of the mechanisms affecting the peritoneal transport function, which can cause the abdomen. Membrane fibrosis and peritoneal dialysis ultrafiltration failure. Vascular endothelial growth factor (VEGF) is a key factor in angiogenesis. The renin angiotensin aldosterone system can play an important role in the regulation of VEGF in angiogenesis. Objective: 1, to explore the correlation of serum VEGF, VEGF level of peritoneal dialysis fluid in patients with uremia peritoneal dialysis. The effects of VEGF and VEGF mediated angiogenesis on the peritoneal transport function; 2. Study the effect of renin angiotensin inhibitor on VEGF and peritoneal dialysis in CAPD patients. Methods and results: first, a cross-sectional study of the correlation between vascular endothelial growth factor and peritoneal transport function: from 01 months to 01 months of 2017 2016 in Fuzhou General Hospital 122 CAPD patients were followed up. The results of peritoneal balance test (PET) and the age of dialysis were divided into groups. The patients with nephrotic syndrome (10 cases) with massive ascites were used as the control group. The serum VEGF (sVEGF), the VEGF (pVEGF) level of peritoneum and the results of biochemical examination were measured, and the SPSS software was used. Statistical analysis. Results: 1, according to the results of the transfer coefficient (D/P Cr) group comparison: (1) the sVEGF of all CAPD patients with different peritoneal transport levels was significantly higher than that of the control group; (2) the sVEGF of the high transport group was significantly higher than the high mean group, the low mean group and the low transport group; (3) the level of the high transport group was significantly higher than the high average transport group, and the low mean level was lower than the high mean transport group. The difference of the transport group, the low transport group, the control group and the other 3 groups was not obvious.2. According to the results of the dialysis age group, the difference between the two groups was long, the short-term dialysis group and the two groups were sVEGF, the difference of pVEGF level was not statistically significant; the sVEGF of the 3 years was significantly higher than the short-term dialysis group, and the pVEGF group was significantly higher than the short-term dialysis group. The difference was not obvious in.3, and there was a positive correlation between sVEGF and pVEGF levels in patients with CAPD. Multivariate regression analysis suggested that sVEGF level, fasting blood glucose and hypercholesterolemia had an influence on the level of pVEGF, and the effect of sVEGF level was the greatest. In addition, the concentration of glucose in peritoneal dialysis was a risk factor affecting the sVEGF, pVEGF level of CAPD patients and ACEI/ARB drugs. The application of the substance is the protective factor.4, the peritoneal solute transport coefficient (MTACCr) of creatinine is positively correlated with the level of sVEGF, and is not related to the level of pVEGF. The multifactor regression analysis suggests that the sVEGF level is the risk factor of MTAC Cr,.5, the loss of peritoneal dialysis is positively correlated with sVEGF, MTAC Cr, and the multifactor regression analysis suggests the level of peritoneal transport. A risk factor for loss of peritoneal dialysis (ACEI/ARB) is a protective factor. Two, the effect of renin angiotensin system inhibitor on the level of VEGF in patients with CAPD: 34 cases of CAPD patients who were followed up in our hospital from 01 months to 01 months of 2016, according to whether the use of ACEI/ARB drugs was divided into the treatment group (n=20), and the control group (n=14). The time was 6 months. The general data of the patients were collected and the related biochemical indexes were evaluated before and after 6 months of treatment. The evaluation contents included D/P Cr, KT/V, CCr, 24h peritoneal dialysis loss and so on. The serum and peritoneal fluid samples were collected and the concentrations of sVEGF and pVEGF were detected respectively. Results: 1. There was no statistically significant difference between the pre study treatment group and the control group in the general data. There was no statistically significant difference between the 2 groups of patients before and after the treatment in the 2 groups, and there was no significant difference between the pVEGF and the clinical indicators. The difference in the sVEGF level between the baseline and the control group was not statistically significant; the treatment group was 6 months later. The loss of sVEGF was significantly lower than that in the control group. Conclusion: 1, the glucose concentration in Liquor Dialysisintraperitoneus is a dangerous factor affecting the level of sVEGF and pVEGF. ACEI/ARB has a protective effect on the decrease of sVEGF, pVEGF,.SVEGF, blood glucose and hypercholesterolemia are the risk factors for the increase of pVEGF level, of which sVEGF level is to pV. The effect of EGF is the greatest. It is speculated that the level of pVEGE is partly influenced by the circulation system and the peritoneal environment, the higher the level of the VEGF, the higher the level of peritoneal transport, the higher the correlation between the two. It suggests that VEGF can promote the angiogenesis of peritoneum and increase the permeability of the peritoneal vessels, and then increase the level of.3 in the peritoneal solute transport and the serum albumin level of the CAPD patients. There is a negative correlation with sVEGF, pVEGF, the peritoneal transport level and sVEGF are positively related to the loss of peritoneal dialysis protein, suggesting that VEGF may mediate peritoneal transport function, mediate the loss of peritoneal dialysis, cause low proteinemia.4, and ACEI/ARB drugs can inhibit VEGF production in CAPD patients, reduce the angiogenesis and permeability of the abdominal membrane, and reduce the peritoneal dialysis in CAPD patients. Loss of quantity, which plays a role in protecting the peritoneum.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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