臨牀透析 Vol.20 No.11(5-1)


特集名 CAPD療法の新たな展開
題名 被嚢性腹膜硬化症 (EPS) の予防対策と治療 (1) 内科的予防対策および治療
発刊年月 2004年 10月
著者 丸山 之雄 東京慈恵会医科大学腎臓・高血圧内科
著者 中山 昌明 東京慈恵会医科大学腎臓・高血圧内科
【 要旨 】 被嚢性腹膜硬化症 (encapsulating peritoneal sclerosis;EPS) はもっとも重大な腹膜透析療法の合併症の一つであり,本邦での発症率は0.8-2.8%と報告されている.EPSの死亡率はきわめて高く,その予防対策と治療法の確立は急務である.従来の治療法は,腸管の安静やtotal parenteral nutrition (TPN) といった保存的治療が主体であるが,疾患活動性自体を制御する治療には及ばないのが現実であった.しかしながら最近では,副腎皮質ステロイド薬による治療が有効であり,そして慢性イレウス持続例に対しては積極的に手術療法が励行されている.また,peritoneal equilibrium test (PET) を用いた透析液/血清クレアチニン比 (D/P Cr) 測定や中皮細胞診はハイリスク患者の同定に利用されている.腹膜透析離脱後の腹腔洗浄がEPS発症を予防できるのかについての答えは明確ではない.
Theme New Development in CAPD Therapy
Title Prevention of and therapy for encapsulating peritoneal sclerosis (EPS)
Author Yukio Maruyama Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine
Author Masaaki Nakayama Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine
[ Summary ] Incidence of encapsulating peritoneal sclerosis (EPS), which is one of the most serious complications of peritoneal dialysis (PD), has been reported to be from 0.8% to 2.8% in Japan. Since mortality rates with EPS are extremely high, it is urgent to establish preventive measures and therapies for EPS. Although the therapeutic approaches for EPS are mainly composed of conventional therapies, such as peritoneal rest and total parenteral nutrition (TPN), these treatments can not suppress disease activity, per se. However, steroid administration has, recently, been recognized as an effective therapy. Furthermore, surgical therapy is strongly recommended for cases with persistent ileus. The dialysate to plasma creatinine ratio (D/P Cr), using a peritoneal equilibrium test (PET), as well as mesothelial cytology, has been widely adopted to evaluate patients at high risk for EPS. The clinical significance of peritoneal lavage after PD withdrawal warrants further study at present.
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