【摘要】目的探讨持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)患者水通道蛋白1(aquaporin 1，AQP1)、转化生长因子-β1(transforming growth factor-β1，TGF-β1)、血管内皮生长因子(vascular endothelial growth factor，VEGF)与腹膜转运功能的关系。方法选取新乡医学院第一附属医院CAPD 患者40 例。收集空腹血及留腹4h 的腹膜透析液(peritoneal dialysis effluent, PDE)，检测AQP1、TGF-β1、VEGF，根据腹膜转运特性、透析龄及超滤量分组，分析AQP1、TGF-β1、VEGF 及生化指标与腹膜转运功能的关系。结果①高-高平均转运组(high-high-average transporters，H-HA)每日超滤量及血清尿素氮水平均低于低-低平均转运组(low-low-average transporters，L-LA)(t=2.420,P=0.020；t=2.478,P=0.018)。②H-HA 组血清及PDE 中TGF-β1 水平明显高于L-LA
组(t=-2.719, P=0.010；t=- 3.407, P=0.002)，VEGF 水平高于L- LA 组(t=- 2.977, P=0.005；t=- 2.553, P=0.015)；PDE中AQP1水平低于L-LA组(t=2.391, P=0.022)。③长期透析龄组血清中TGF-β1、VEGF均高于短期透析龄组(F=4.025, P=0.026；F=4.197, P= 0.023)，血清中AQP1 水平中期和长期透析龄组均低于短期透析龄组(H=9.504,P=0.009)；PDE 中VEGF 长期透析龄组高于短期透析龄组(F=4.547,P=0.017)。④相关性分析：超滤量与PDE 中AQP-1 呈正相关(r=0.776,P＜0.001)，与PDE 中TGF-β1、VEGF 呈负相
关(r=-0.825,P＜0.001；r=-0.385,P=0.014)。⑤Logistic 回归提示PDE 中AQP1 水平越高发生超滤衰竭的风险越低(OR=0.514，95% CI：0.280～0.946，P=0.033)。结论透析龄越长，血清及PDE 中TGF-β1、VEGF 水平越高，腹膜转运水平越高，超滤量越少，提示腹膜纤维化及新生血管可增加腹膜溶质转运，降低超滤量；相比TGF-β1、VEGF，PDE中AQP1水平是CAPD患者发生超滤失败的重要相关因素。
【Abstract】Objective To investigate the relationship between the molecules of aquaporin 1 (AQP1), transforming growth factor- β1 (TGF-β1) and vascular endothelial growth factor (VEGF) and the peritoneal transport function in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A total of 40 CAPD patients treated in the First Affiliated Hospital of Xinxiang Medical University were enrolled in this study. The levels of AQP1, TGF-β1 and VEGF in serum and 4-hour peritoneal dialysis effluent (PDE) were measured. The CAPD patients were divided into groups according to the characteristics of peritoneal transport function, dialysis duration and ultrafiltration volume. The relationship between peritoneal transport function and the levels of AQP1, TGF-β1, VEGF and biochemical markers were analyzed. Result ①Daily ultrafiltration volume and serum urea nitrogen were significantly lower in the high-high-average peritoneal transporter (H-HA) group than in the low-low-average peritoneal transporter (L-LA) group (t=2.420, P=0.020; t=2.478, P=0.018). ②In H-HA group, TGF-β1 in serum and PDE were higher than those in L-LA group
(t=- 2.719, P=0.010; t=- 3.407, P=0.002), VEGF in serum and PDE were higher than those in L-LA group (t=- 2.977, P=0.005; t=- 2.553, P=0.015), but AQP1 in PDE was lower than that in L-LA group (t=2.391,P=0.022). ③In long-term dialysis group, TGF-β1 and VEGF in serum were higher than those in short-term dialysis group (F=4.025, P=0.026; F=4.197, P=0.023); VEGF in PDE was higher than that in short-term dialysis group (F=4.547, P=0.017). AQP1 in serum was lower in mid-term and long-term dialysis group than in short-term dialysis group (H=9.504, P=0.009). ④Correlation analyses showed that ultrafiltration volume was
positively correlated with AQP1 in PDE (r=0.776, P＜0.001), and was negatively correlated with TGF-β1 and VEGF in PDE (r= -0.825, P＜0.001; r=-0.385, P=0.014). ⑤Logistic regression analyses found that AQP1 in PDE was a protective factor for ultrafiltration (OR=0.514, 95% CI 0.280～0.946, P=0.033). Conclusion Higher TGF-β1 and VEGF in serum and PDE were present in long-term dialysis patients, and lower ultrafiltration volume was present in high-high-average peritoneal transporter (H-HA) patients, suggesting that peritoneal fibrosis and vessel proliferation may result in the increase of solute transportation and the decrease of ultrafiltration volume. AQP1 in PDE was a protective factor for ultrafiltration in CAPD patients.
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