كليدواژه :
دياليز صفاقي مزمن , بيوماركر , تست تعادل صفاق , CA125
چكيده فارسي :
دياليز صفاقي روشي از درمان جايگزيني كليوي در بيماران مبتلا به نارسايي مزمن كليه مرحله انتهايي است. به مرور زمان در طول دياليز صفاقي غشاي صفاقي دچار آسيب شده كه اين مساله مي‌تواند بر روي عملكرد صفاق تاثير منفي گذارد كه منجر به توقف دياليز صفاقي و شروع همودياليز و حتي سوتغذيه و مرگ بيمار گردد. با توجه به ماهيت تهاجمي بيوپسي صفاقي براي بررسي آسيب و فيبروز صفاق، بررسي ساختار غشاي صفاقي بر اساس بيوماركرهايي انجام مي‌گردد كه توسط غشاي صفاقي ترشح مي شوند و در پساب دياليز صفاقي مورد سنجش قرار مي گيرند. بيوماركرهاي متعددي براي اين منظور مورد بررسي قرار گرفتند از جمله اينترلوكين 6، هيالورونان ، فاكتور رشد اندوتليال عروقي و... . يكي از اين نشانگرها، آنتي ژن CA125 است كه به عنوان مقياسي از سلامت و توده سلول هاي مزوتليال پوشاننده صفاق قلمداد مي شود كه برخلاف ساير بيوماركرها از سلول ديگري بجز سلول‌هاي مزوتليال ترشح نمي‌شود. CA125 گليكوپروتييني است كه توسط سلول هاي سرطاني تخمدان توليد شده و به همين منظور امروزه به طور گسترده اي براي غربالگري سرطان تخمدان استفاده مي گردد. همچنين اين آنتي ژن توسط سلول‌هاي مزوتليال پوشاننده غشاي صفاقي ترشح شده و در پساب دياليز صفاقي قابل اندازه گيري مي‌باشد. ميزان آن تحت تاثير نوع محلول دياليز نمي‌باشد. سطح دياليزي CA125 دامنه توزيع وسيعي داشته و در بازه بين U/ml 65-0/5 و مقادير CA125-AR U/min/1.73m2 471-3/6 متغير مي‌باشد. با توجه به اين كه سطوح دياليزي CA125 در بيماران به طور قابل توجهي متفاوت است اندازه گيري سريال آن در هر فرد ممكن است يك نشانگر با ارزش تر در پيگيري بيماران خاص باشد به طوري كه انحراف از روند كاهش زماني آن مي تواند يك علامت نگران كننده باشد. با وجود گذشت بيش از 30 سال از تحقيقات اوليه‌اي كه CA125 را به عنوان يك بيوماركر از توده مزوتليال غشاي صفاقي معرفي كرد، اما هنوز بسياري از نتايج متناقض بوده و درك كاملي از اهميت بيولوژيكي اين بيوماركر بدست نيامده است و به نظر مي‌رسد بررسي تغييرات سطح آن در هر فرد منحصرا و در بازه زماني ارزشمند بوده و مطالعات بيشتر از اين نظر مورد نياز است.
چكيده لاتين :
Peritoneal dialysis is a method of renal replacement therapy in patients with end-stage chronic renal failure. Over time, peritoneal dialysis damages the peritoneal membrane, which can adversely affect peritoneal function, leading to cessation of peritoneal dialysis and the onset of hemodialysis, and even malnutrition and death. Due to the invasive nature of peritoneal biopsy to evaluate peritoneal injury and fibrosis, the structure of the peritoneal membrane is evaluated based on biomarkers that are secreted by the peritoneal membrane and measured in the peritoneal dialysis effluent. Several biomarkers were studied for this purpose, including interleukin-6, hyaluronan, vascular endothelial growth factor and etc. One of these markers is CA125 antigen, which is considered as a measure of the health and mass of mesothelial cells lining the peritoneum, which, unlike other biomarkers named above, is not secreted by any cell other than mesothelial cells. CA125 is a glycoprotein produced by ovarian cancer cells and is widely used for ovarian cancer screening today. This antigen is also secreted by mesothelial cells lining the peritoneal membrane and can be measured in peritoneal dialysis effluent. Its amount is not affected by the type of dialysis solution. Visser et al. (1995) first proposed the theory of measuring CA125 levels of dialysis fluid at the end of a four-hour peritoneal equilibration test (PET) as a diagnostic biomarker for mesothelial cell function in patients undergoing peritoneal dialysis. Therefore, finding a suitable diagnostic biomarker for rapid detection and identification of peritoneal membrane damage as well as peritoneal function at a lower cost is very valuable and will be of great help in patient management. In this review article, 25 studies with a total of 623 patients over 18 years old and 73 patients under 18 years old undergoing peritoneal dialysis were reviewed and summarized. These 25 studies included clinical trials, descriptive studies, and prospective studies to evaluate the relationship between CA125 dialysis effluent and peritoneal function and to evaluate the value of using this biomarker in evaluating mesothelial cell health and dialysis quality and its relationship with peritonitis and demographic characteristics. Patients were evaluated and summarized. Normal baseline values for CA125 dialysis concentration have not yet been determined. To date, numerous studies have been performed on peritoneal dialysis patients in both age groups of children and adults to determine the concentration of CA125 in dialysis effluent. In these studies, the level of CA125 dialysis had a wide distribution range between 0.5-65 U / ml and values CA125-AR U / min / 1.73m2 was variable 3.471-6. Due to the fact that CA125 dialysis levels in patients are significantly different, its serial measurement in each individual may be a more valuable indicator in the follow-up of specific patients, so that deviation from the process of time reduction can be a worrying sign. Significant difference between CA125 and CA125-AR peripheral concentrations (CA-125 Apearrance rate) with patientschr('39') demographic information including age, sex, BMI (Body mas index), primary biopsy results and cause of chronic renal failure leading to dialysis Not seen in various studies. Degradation of the mesothelium over time due to contact with high concentrations of peritoneal dialysis solution, toxicity of glucose metabolites, and the occurrence of peritonitis may explain the decrease in CA125 dialysis concentration. Peritoneal biopsy data show loss of mesothelial layer integrity after 5 years in patients undergoing peritoneal dialysis. It is a gradual process, so its changes over time can be an indication of mesothelial cell mass. This can be used in the longitudinal follow-up of rolling patients. Information on the relationship between CA125 concentration and peritoneal transport is somewhat inconsistent. Only in three papers a positive correlation between CA125 dialysis level and peritoneal transport parameters was reported (11,14,15) and no similar correlation was seen in other studies. Dialysis levels of CA125 are temporarily increased during peritonitis and return to the level of patients without peritonitis after recovery. Due to the fact that the increase in CA125 concentration in the acute peritonitis episode occurs due to both reversible damage to mesothelial cells and cell death, it can not have a prognostic effect in patients with acute peritonitis. Despite more than 30 years of initial research introducing CA125 as a biomarker of the mesothelial mass of the peritoneal membrane, many of the results are still contradictory and a full understanding of the biological significance of this biomarker has not yet been established. Changes in its level in each person are unique and valuable over time, and further studies are needed in this regard..
