肾素-血管紧张素系统抑制剂对CAPD患者VEGF水平的影响

摘要

Objective This study discusses the effects of rennin-angiotensin system inhibitor (RASI) on vascular endothelial growth factor (VEGF) levels in serum and dialysis fluid in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods A total of 34 patients received CAPD and in stable conditions were enrolled in this study.Twenty cases were treated with RASI (treatment group),and 14 cases did not use any ACEI/ARB (control group).They were observed for 6 months.Estimation of peritoneal function,such as Kt/V and cCr of the peritoneum and protein in dialysis fluid,was performed.Serum and dialysate were collected for the assay of VEGF.Results ①There were no significant differences in basal data between treatment group and control group.②There were no differences in clinical indicators including 4h D/P Cr,Kt/V,MTAC Cr,etc,between the two groups at the beginning and after the treatment for 6 months.③There were no significant differences in serum and dialysate VEGF at the beginning between the two groups (P＞0.05).After 6 months of the treatment,however,serum VEGF was significantly lower in treatment group than in control group (171.515±84.831 vs.276.598± 129.866pg/ml,t=-2.859,P=0.007),but dialysate VEGF had no difference between the two groups (46.017± 19.104 vs.54.673± 19.691 pg/ml,t=-1.284,P=0.208).④There was no significant difference in protein loss from dialysate at the beginning between the two groups.After 6 months of the treatment,however,protein loss from dialysate was significantly lower in treatment group than in control group (3.379±2.329 vs.6.397±3.049g/day,Z=-2.800,P=0.005).Conclusion RASI can reduce and stabilize VEGF expression level on peritoneum and thus protect peritoneal function in CAPD patients.%目的 本文通过研究肾素血管紧张素抑制剂(rennin angiotensin system inhibitors,RASI)对持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者血管内皮生长因子(vascular endothelial growth factor,VEGF)水平的影响,探讨RASI对腹膜功能的相关保护作用. 方法 选取在福州总医院规律随访的CAPD患者(n=34),根据是否应用RASI分成治疗组(n=20),对照组(n=14)观察时间为6个月,对患者的一般资料、血液、尿液、腹膜透析液的生化指标进行检测和记录,并行腹膜平衡实验等进行腹膜转运功能及透析充分性评估,并收集血清及腹膜透析液,分别进行VEGF浓度测定,进行统计分析. 结果 ①纳入研究前2组患者一般资料间的差异无统计学意义.②在0个月和6个月时2组的各项临床指标无显著差异.③在0个月时治疗组与对照组的血清及腹膜透析液的VEGF水平无差异;6个月后治疗组血清VEGF水平较对照组显著降低[(171.515±84.831) pg/ml比(276.598±129.866) pg/ml,t=-2.859,P=0.007],而腹透液VEGF水平较对照组不显著降低[(46.017±19.104) pg/ml比(54.673±19.691) pg/ml,t=-1.284,P=0.208].④在0个月2组间的腹透蛋白丢失量无差异;6个月后,治疗组的腹透蛋白丢失量较对照组显著下降[(3.379±2.329) g/24h比(6.397±3.049),Z=-2.800,P=0.005]. 结论 RASI可以减轻或使CAPD患者腹膜VEGF的表达处于稳定状态,减轻腹膜血管新生及渗透性,减少腹透蛋白丢失,从而起到保护腹膜的作用.