腹膜透析為腎臟替代療法之一，和血液透析相比，其有一些獨特的優點。但是此種治療方式，其特色是患者腹腔內壓力會增加、且腹膜和腹腔內器官會長期直接或間接和非生理性傳統透析液(酸性、高乳酸值、高滲透壓、高濃度葡萄糖及過度醣化終產物等)接觸。而一些相關研究初步發現上述原因可能導致腹膜透析的患者在某些腹部疾病的發生率上會高於非透析患者及血液透析患者，但是至目前為止，此類相關的研究結果並無一致性。
所以在研究的第一部份，我們設計一回溯性世代研究，透過台灣健保資料庫來探討腹膜透析患者是否會因為上述原因，導致發生腹部疾病與腹部癌症的風險和血液透析患者及一般非尿毒症族群有所不同。研究結果顯示不論是腹膜透析或血液透析患者，其發生腸胃道疾患的風險都高於一般非尿毒症的族群。但是，腹膜透析和血液透析患者各自有其發生率較高的腸胃道疾患，其中胃食道逆流、腸阻塞、腸沾黏、和腹部疝氣在腹膜透析患者較常發生；消化性潰瘍、下腸胃道憩室、下腸胃道出血在血液透析患者較常發生；腸系膜缺血、肝硬化、和急性胰臟炎的風險，腹膜透析和血液透析患者都顯著高於一般非尿毒症的族群，但在兩族群中並無顯著差異；至於發生急性闌尾炎的風險，則是腹膜透析患者低於血液透析患者。在罹癌風險部分的研究結果則顯示肝癌、膀胱癌、腎臟及膀胱以外之泌尿道癌症機率在血液和腹膜透析族群皆顯著高於非尿毒患者，而腎臟癌和甲狀腺癌只在血液透析患者較高。
此外，由於上述的研究結果顯示腹膜變性及纖維化所導致之腸阻塞及腸沾黏為腹膜透析患者的一個重要的併發症。且由於許多研究皆指出腹膜細胞之上皮細胞間質轉化現象在此病理機轉中佔有重要角色。所以在研究的第二部份，我們也嘗試透過抑制此機轉之研究，來發展相關治療腹膜變性及纖維化的策略。
由於近年來由其他範疇的研究發現活性維他命D3具有抑制細胞發生上皮細胞間質轉化的效果。所以我們將之驗證於細胞實驗和大鼠腹膜纖維化模型實驗中，用以探討活性維他命D3是否可以經由提前腹膜給藥的方式抑制腹膜細胞發生上皮細胞間質轉化的現象來達到避免腹膜纖維化及透析功能的惡化。結果顯示在葡萄糖酸氯己定誘發之腹膜纖維化大鼠模型中，活性維他命D3可有效的抑制腹膜纖維化的程度及減少腹膜功能損失;此機轉也在細胞實驗中證明了可能是經由活性維他命D3抑制腹膜上皮細胞間質轉化相關蛋白所達成。
總結來說，我們的研究結果顯示透析患者罹患某些腸胃道疾患及癌症的風險較非尿毒症族群要高，而腹膜透析或血液透析其各自好發的腸胃道疾患則各有所不同。在此當中，腹膜變性及纖維化所導致之腸阻塞及腸沾黏為腹膜透析患者的一個重要且常見的併發症。而提前經腹膜給予活性維他命D3是未來臨床上可能做為抑制患者腹膜變性及纖維化的新療法。

Peritoneal dialysis (PD) is one type of renal replacement therapy that has its own novel advantages. The characteristics of this therapy include increases in patients’ intraabdominal pressure and long-term exposure of both the peritoneum and gastrointestinal (GI) organs to bio-incompatible dialysate directly or indirectly all of which may induce potential peritoneum or GI organ adverse effects. Studies have shown that some GI diseases common occur in PD patients, but whether the risk of common GI diseases and cancers differs among PD, hemodialysis (HD), and non-uremic groups, remains uncertain. Therefore, in the first part of our study, we conducted a large-scale, retrospective cohort study using data from a nationwide database from the Taiwan National Health Insurance Research Database (NHIRD), which enrolled almost all the dialysis patients in the country. Subsequently, we investigated whether PD therapy was an independent risk factor for common GI diseases and GI cancers. The main findings of our study were that the risk of gastroesophageal reflux (GERD), intestinal obstruction or adhesions, and abdominal hernia was significantly higher in the PD group, whereas the risk of peptic ulcer disease and lower GI diverticula and bleeding was significantly greater in the HD group. Meanwhile, the risk of mesenteric ischemia, liver cirrhosis, and acute pancreatitis was higher in dialysis patients, but this risk was not significantly different between the PD and HD groups. Moreover, the risk of appendicitis in the PD group appeared to be lower than that in the HD group. Our cancer risk study showed that the risk of hepatocellular carcinoma, bladder cancer, and extra kidney and bladder urinary tract cancer was higher in both HD and PD patients, while the risk of both kidney and thyroid cancers was only higher in the HD group. In summary, our results indicated that dialysis patients had a higher risk of some types of GI disease and cancers and different dialysis modalities affected the clinical results differently.
The above study demonstrated that peritoneal damage related intestinal obstruction or adhesion is one of the most common complications in PD patients. Therefore, in the second part of our study, we focused on this common and important complication and tried to investigate a novel therapy for this complication.
There is substantial evidence that the epithelial-mesenchymal transition (EMT) of mesothelial cells (MCs) plays an important role in the peritoneal damage process, and some studies in the cancer field have proved that vitamin D can inhibit the EMT process in cancer cells. Consequently, we investigated if vitamin D can ameliorate peritoneal damage by inhibiting the EMT of MCs both in vitro and in vivo. The results showed that 1α, 25(OH)2D3 inhibited chlorhexidine gluconate (CG)-induced peritoneal morphological and functional deterioration in an animal model, along with CG-induced upregulation of α-SMA and downregulation of E-cadherin expression. Meanwhile, 1α, 25(OH)2D3 also inhibited the transforming growth factor-β1-induced decrease in E-cadherin expression, increase in both Snai1 and α-SMA expression, redistribution of intracellular F-actin, and migration activity in vitro.
In conclusion, our study proved that dialysis patients have a higher risk of the most common GI diseases and some types of cancer, while both PD and HD modalities are associated with the incidence of different GI diseases and cancers. Besides, peritoneal damage-related intestinal obstruction or adhesion was an important and common complication in PD patients. Intraperitoneal supply of 1α, 25(OH)2D3 seems to be one of the potential novel solutions to this complication.

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