文章来自福岛医科大学肾脏内科Hiroyuki Terawaki（Dialysis center1Fukushima Medical，University, Fukushima, Japan，Department of Internal Medicine2Kashima Hospital, Iwaki, Japan Department of Nephrology3Fukushima Medical Hospital, Fukushima, Japan）

email: terawaki@fmu.ac.jp

文章发表在《腹膜透析国际》杂志上。

Successful Treatment of Encapsulating Peritoneal Sclerosis by Hemodialysist.pdf

           文章作者之一Nakayama M中山昌明教授，目前在福島県立医科大学腎臓高血圧糖尿病内分泌代謝内科学。

包裹性腹膜硬化症的发生率和病死率较高，因病情严重程度不同，死亡率从14-84%不等。包裹性腹膜硬化症或硬化性腹膜炎是长期腹膜透析最严重的并发症之一。与单纯性腹膜硬化不同的是，包裹性腹膜硬化症除腹膜硬化外还伴有肠粘连及急性不完全性或间隙性肠梗阻，甚至完全性肠梗阻；组织学上主要表现为腹膜增厚，间质区域增宽并异常致密，光镜下可见大量单核细胞和多形核白细胞浸润。腹腔灌洗引流术又称治疗性持续性腹腔灌洗引流术，不是一项新的治疗方法，近年来重新得到重视，并逐渐加以改进。腹腔灌洗也能引起包裹性腹膜硬化症。

氢气作为一种选择性抗氧化物质，对多种炎症和氧化损伤相关疾病中具有理想的治疗效果，日本近年利用氢气透析液预防透析引起的各种副作用，已经初步取得了效果，但关于氢气对抗长期腹膜透析引起的包裹性腹膜硬化症过去没有报道，最近日本一课题组报道了个案，提示氢对这种疾病具有治疗作用，这给长期腹膜透析患者提供了一种可能的救命策略。

病例一、63岁日本男性患者，6年持续腹膜透析，因为连续7天便秘和恶心急症住院。该患者在40岁时候被诊断为糖尿病，57岁患帕金森病。经检查腹腔通透性比较好，实行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）。无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.入院时血压155/80 mmHg，脉搏70次/分，体温37.8°C。腹肌软，甘油灌肠未能引起大便。怀疑为包裹性腹膜硬化症。

经过血液和腹腔组织病理学诊断为包裹性腹膜硬化症。入院31天后使用高浓度氢饱和透析，血液炎症指标CRP下降和恶心症状好转，连续77天后患者出院。2月后病理诊断发现组织学恢复良好，出院后随访18月未再出现异常。

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)

参考文献

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