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氫氣對長期腹膜透析引起的包裹性腹膜硬化癥

發布時間:2017-06-17 瀏覽次數:次 字號:  【關閉】
文章來自福島醫科大學腎臟內科Hiroyuki Terawaki(Dialysis center1Fukushima Medical,University, Fukushima, Japan,Department of Internal Medicine2Kashima Hospital, Iwaki, Japan Department of Nephrology3Fukushima Medical Hospital, Fukushima, Japan)
  
  email: [email protected]
  
  文章發表在《腹膜透析國際》雜志上。文章作者之一Nakayama M中山昌明教授,目前在福島県立醫科大學腎臓高血圧糖尿病內分泌代謝內科學。
  
  包裹性腹膜硬化癥的發生率和病死率較高,因病情嚴重程度不同,死亡率從14-84%不等。包裹性腹膜硬化癥或硬化性腹膜炎是長期腹膜透析最嚴重的并發癥之一。與單純性腹膜硬化不同的是,包裹性腹膜硬化癥除腹膜硬化外還伴有腸粘連及急性不完全性或間隙性腸梗阻,甚至完全性腸梗阻;組織學上主要表現為腹膜增厚,間質區域增寬并異常致密,光鏡下可見大量單核細胞和多形核白細胞浸潤。腹腔灌洗引流術又稱治療性持續性腹腔灌洗引流術,不是一項新的治療方法,近年來重新得到重視,并逐漸加以改進。腹腔灌洗也能引起包裹性腹膜硬化癥。
  
  氫氣作為一種選擇性抗氧化物質,對多種炎癥和氧化損傷相關疾病中具有理想的治療效果,日本近年利用氫氣透析液預防透析引起的各種副作用,已經初步取得了效果,但關于氫氣對抗長期腹膜透析引起的包裹性腹膜硬化癥過去沒有報道,最近日本一課題組報道了個案,提示氫對這種疾病具有治療作用,這給長期腹膜透析患者提供了一種可能的救命策略。
  
  病例一、63歲日本男性患者,6年持續腹膜透析,因為連續7天便秘和惡心急癥住院。該患者在40歲時候被診斷為糖尿病,57歲患帕金森病。經檢查腹腔通透性比較好,實行2.27%葡萄糖透析(每袋2L,每天2袋)和7.5%艾考糊精腹膜透析液(每袋2L,每天1袋)。無腹腔感染和腹腔出血史。Defecation ability ceased 7 days before presenting at our emergency room with constipation and nausea.入院時血壓155/80 mmHg,脈搏70次/分,體溫37.8°C。腹肌軟,甘油灌腸未能引起大便。懷疑為包裹性腹膜硬化癥。
  
  經過血液和腹腔組織病理學診斷為包裹性腹膜硬化癥。入院31天后使用高濃度氫飽和透析,血液炎癥指標CRP下降和惡心癥狀好轉,連續77天后患者出院。2月后病理診斷發現組織學恢復良好,出院后隨訪18月未再出現異常。



  Histological findings of parietal peritoneum before (A, B) and after (C, D) treatment with hydrogen-enriched dialysate. (A) Thin membrane covering peritoneum consists mainly of homogeneous or lamellar fibrinous material containing fibroblasts stained with hematoxylin and eosin (HE). Mononuclear cell infiltration is visible in some areas (arrowheads). (B) Fibrinous materials (red or blue with Masson trichrome stain) suggest fibrin or organized fibrin components. (C) Sub-mesothelial connective tissue (compact zone) has become obviously thinner after treatment with H2 (mean: 190 μm; HE stain). (D) Surface is covered by mesothelial monolayer and fibrinous materials are absent (Masson trichrome stain). 254×366mm (72 × 72 DPI)
參考文獻
Terawaki H, Nakano H, Zhu WJ, Nakayama M. Successful Treatment of Encapsulating Peritoneal Sclerosis by Hemodialysis and Peritoneal Lavage Using Dialysate Containing Dissolved Hydrogen. Perit Dial Int. 2015 1-2;35(1):107-112.
Terawaki H, Zhu WJ, Matsuyama Y, Terada T, Takahashi Y, Sakurai K, Kabayama S, Miyazaki M, Itami N, Nakazawa R, Ito S, Era S, Nakayama M. Effect of a hydrogen (H2)-enriched solution on the albumin redox of hemodialysis patients. Hemodial Int. 2014 Apr;18(2):459-66.
Terawaki H, Hayashi Y, Zhu WJ, Matsuyama Y, Terada T, Kabayama S, Watanabe T, Era S, Sato B, Nakayama M. Transperitoneal administration of dissolved hydrogen for peritoneal dialysis patients: a novel approach to suppress oxidative stress in the peritoneal cavity. Med Gas Res. 2013 Jul 1;3(1):14
Nakayama M, Kabayama S, Nakano H, Zhu WJ, Terawaki H, Nakayama K, Katoh K, Satoh T, Ito S. Biological effects of electrolyzed water in hemodialysis. Nephron Clin Pract. 2009;112(1):c9-15
Nakayama M, Kabayama S, Terawaki H, Nakayama K, Kato K, Sato T, Ito S. Less-oxidative hemodialysis solution rendered by cathode-side application of electrolyzed water. Hemodial Int. 2007 Jul;11(3):322-7.
Zhu WJ, Nakayama M, Mori T, Nakayama K, Katoh J, Murata Y, Sato T, Kabayama S, Ito S. Intake of water with high levels of dissolved hydrogen (H2) suppresses ischemia-induced cardio-renal injury in Dahl salt-sensitive rats. Nephrol Dial Transplant. 2011 Jul;26(7):2112-8
Nakayama M, Nakano H, Hamada H, Itami N, Nakazawa R, Ito S. A novel bioactive haemodialysis system using dissolved dihydrogen (H2) produced by water electrolysis: a clinical trial. Nephrol Dial Transplant. 2010 Sep;25(9):3026-33
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