Peritoneal dialysis solution and preparation method thereof
Technical field
The present invention relates to a kind of peritoneal dialysis solution.
Background technology
CKD is the another major disease that after cardiovascular and cerebrovascular disease, tumor, diabetes, threatens human health.Wherein a lot of patients are developed to uremia.
At present, peritoneal dialysis is one of uremic main means of treatment.This method is to be the semipermeable membrane abdomen with the peritoneum, through carrying out the exchange of water and solute between film blood capillary and the dialysis solution.Electrolyte and small-molecule substance produce diffusion from the high low side shifting of a side direction concentration of concentration; Hydrone produces osmosis then from the low high side shifting of a side direction osmotic concentration of osmotic concentration.Through the solute concentration gradient difference urotoxy material and moisture in the blood are removed from dialysis solution, and kept electrolyte and acid-base balance, replace the partial function of kidney.
Peritoneal dialysis owing to little to the glomerular filtration influence when treating, can better be protected residual renal function as one of main means of treating chronic renal failure; And little to the cardiovascular system influence, the body function good stability; Easy and simple to handle, price is relatively cheap, and sufferer returns the characteristics such as chance height of society, and abdomen passes through dialysis treatment and more and more comes into one's own in recent years.Simultaneously, along with developing rapidly of peritoneal dialysis, the clinical indication scope is also enlarging, like acute renal failure (ARF), chronic renal failure (CRF), acute drug or toxic poisoning, obstinate edema, electrolyte disturbance, acid base imbalance etc.
At present, traditional is that penetrating agent, lactate system are that the peritoneal dialysis liquid of buffer remains clinical the most frequently used preparation with the glucose.The advantage of such peritoneal dialysis liquid is clear and definite, be easy to doctors and patients accept, but for the life-time service person, its defective is obvious day by day.Roughly can be divided into the following aspects: syndrome, glucose load increase, hyperlipemia, cardiovascular complications, backache, abdominal hernia, peritoneal dialysis liquid seepage are filtered, lost to the peritoneum quench
[4-7]Wherein following problem is the most serious:
At first, dialysis patient protein loss amount is very big.According to statistics, abdomen passes through patient and loses protein 25~40g every day.Amount lost is bigger when having peritonitis.Meanwhile, exist protein catabolism to strengthen and the utilization minimizing.The factor that causes this variation is from uremia and dialysis treatment itself.The malnutrition that this peritoneal dialysis process causes, to a great extent with blood in nutritional labeling such as protein " leak outside " that to get into peritoneal dialysis liquid relevant.Because clinical employed peritoneal dialysis liquid belongs to traditional mostly at present; Be osmotic pressure regulator promptly, be the electrolyte solution of buffer system with the lactate with the glucose; Wherein lack high score subclass osmotic pressure regulator, cause the body internal protein bigger Concentraton gradient to occur in the peritoneum both sides thus.Although this type macromole can not appear from complete capillary membrane, when the patient was attended by peritonitis in various degree, the peritoneum permeability increased, and possibly cause macromole to exosmose.In addition, the peritoneal tissues lymph distributes abundant, and the lymphatic vessel membrane aperture is obviously greater than capillary membrane, be main macromolecular substances (the about 6.6kD of molecular weight) with the albumin with the Long contact time process of peritoneal dialysis liquid in also possibly see through peritoneum, cause the interior PD of body.
In addition, the peritoneum quench filter that causes thoroughly of long-term abdomen.With the prolongation of peritoneal dialysis time, peritoneum does not change micromolecule solute permeability, but the macromolecular substances permeability is reduced, and promptly the internal memory permeability of peritoneum reduces.The factor that influences ultrafiltration is a lot
[8], like osmotic dosage form, the groundwater increment of dialysis solution, put and stay time, drug influence and peritoneum transport function or the like, wherein the peritoneum transport function is to influence the basis that ultrafiltration and solute are removed.The method that detects the peritoneum transport function commonly used has: peritoneal equilibrium test (PET), standard osmotic property analysis (SPA), individual dialysis ability test (PDC) etc.Through measuring, the high sugared dialysis solution of life-time service passes through the patient with the abdomen that peritonitis takes place repeatedly, and substance transportation area coefficient (MTAC) increases, strides that impaired, the effective lymph of cellular water transport function absorbs (ELAR) increase, the peritoneum effective surface area extremely reduces
[9], be prone to peritoneal adhesion and fibrosis take place, thereby blood capillary blood plasma flow, peritoneum permeability and the effective area of peritoneum are reduced, reduce the removing of peritoneum to liquid and solute, it is insufficient depleted with ultrafiltration to cause dialysing
[10]During its mechanism is further being studied; Have the result to show: the mesothelial cell is playing the part of important role aspect the peritoneal membrane function depletion; Epithelial cell one mesenchymal cell transforms can cause peritoneum angiogenesis and fibrosis, finally causes the peritoneum fibrosis, ultrafiltration depleted (UFF).
To above problem, peritoneal dialysis liquid and Therapeutic Method that some are novel arise at the historic moment.As merely with bicarbonate do buffer agent dialysis solution (Bicavera), amino acid dialysis, icodextrin dialysis solution, carnitine dialysis solution, contain the dialysis solution etc. that taurine dialysis solution, pyruvate are buffer agent
[12]What wherein comparatively attract people's attention is based on the dialysis solution (trade name: extraneal) that icodextrin is an osmotic pressure regulator.On the one hand, the icodextrin peritoneal dialysis liquid has been avoided the use of glucose fully, and the hypertonic glucose osmotic pressure that solution is provided can be provided; On the other hand, find in the clinical use that such dialysis solution is prone to cause that about 15% abdomen passes through patient's anaphylaxis, wherein 2/3 can not continue to use.So in recent years; The multiple material that improves peritoneal membrane function is studied and is used for peritoneal dialysis liquid; Like Low molecular heparin, aspergillus niger glycosyl 3-O-alpha-D-Glucopyranosyl-D-glucose, ring malt-base maltose, taurine, acetylation or deacetylated amino sugar and/or its conjugate etc., wherein the glycosaminoglycans compounds becomes new focus.
Summary of the invention
The purpose of this invention is to provide a kind of peritoneal dialysis solution and preparation method thereof,, satisfy the needs of clinical practice to overcome the defective that prior art exists.
Peritoneal dialysis solution of the present invention with the stereometer of said peritoneal dialysis solution, contains the Stichopus japonicus polysaccharide of 8~12g/1000ml;
Said Stichopus japonicus polysaccharide is by Stichopus japonicus body wall one or more glycosaminoglycans through the alkaline hydrolysis enzymolysis and extraction, can adopt the enzyme of enzymolysis that carase, pancreatin etc. are arranged.Or by application for a patent for invention number: CN200510067956.4,200410038284.X, CN200410054773.4, CN03112345.7, CN03111925.5, CN200610155464.5, the method that provides prepares.The chemical composition of Stichopus japonicus polysaccharide, total sugar content are 40.33%~62.11%, and sulfate radical content is 19.54%~29.95%, glucuronic acid content 9.85%~13.38%.The Stichopus japonicus polysaccharide relative molecular weight is 30000~100000 dalton;
Preferably, with the stereometer of said peritoneal dialysis solution, contain the Stichopus japonicus polysaccharide of 10g/1000ml; Preferably, with the stereometer of the said peritoneal dialysis solution of 1000ml, components contents is:
Stichopus japonicus polysaccharide 8~12g
Glucose (C
6H
12O
6H
2O) 4~15g
Sodium chloride 5~6g
Calcium chloride 0.2~0.3g
Magnesium chloride 0.1~0.2g
Sodium lactate 4.0~6.0g
Sodium pyrosulfite 0.03~0.05g
Water for injection adds to 1000ml
Most preferred, with the stereometer of the said peritoneal dialysis solution of 1000ml, components contents is:
Stichopus japonicus polysaccharide 10g
Glucose 15g
Sodium chloride 5.4g
Calcium chloride 0.26g
Magnesium chloride 0.15g
Sodium lactate 5.0g
Sodium pyrosulfite 0.03g
Water for injection adds to 1000ml
Most preferred, with the stereometer of the said peritoneal dialysis solution of 1000ml, components contents is:
Stichopus japonicus polysaccharide 10g
Glucose 42.5g
Sodium chloride 5.4g
Calcium chloride 0.26g
Magnesium chloride 0.15g
Sodium lactate 5.0g
Sodium pyrosulfite 0.05g
Water for injection adds to 1000ml.
Method for preparing of the present invention comprises the steps:
Other component except that Stichopus japonicus polysaccharide is dropped in the water for injection, make into the concentrated solution that weight concentration is 50-60%, 115 ℃ of pressure sterilizing 45min; 0.02~0.08% needle-use activated carbon of enriching solution weight is as impurity absorption agent and filter aid; Mixing filters, and gets solution A;
The injection Stichopus japonicus polysaccharide adds water for injection, makes into weight concentration and be 20~30% solution, in the impouring solution A, adds the injection water to capacity, at last through the filtering with microporous membrane of 0.22 μ m, divides the three-layer co-extruded peritoneal dialysis liquid of packing into promptly getting in the bag.
The method for using of peritoneal dialysis solution of the present invention is identical with conventional peritoneal dialysis solution, and like the method for the of 2 ones 3 of health drug standard promulgated by the ministries or commissions of the Central Government, intraperitoneal infusion, dosage are generally 2000ml one time;
Animal experiment proves, peritoneal dialysis solution of the present invention owing to adopted Stichopus japonicus polysaccharide, can significantly improve the caused ultrafiltration of high concentration glucose dialysis solution and descend.
The present invention adds Stichopus japonicus polysaccharide having now on the clear and definite prescription basis of peritoneal dialysis solution, improvement prescription and technology.Because the Stichopus japonicus polysaccharide biocompatibility is good, the peritoneum that the especially long-term abdomen of peritoneum is passed through the patient has protective effect, can help to keep the ultrafiltration function of peritoneum, and intravital metabolism toxin of renal prostration disease people and water effective are discharged.Simultaneously, Stichopus japonicus polysaccharide has very big contribution to keeping the peritoneal dialysis liquid colloid osmotic pressure, can stop leaking outside of macromolecular substances such as albumen etc. in the peritoneum blood capillary through back-diffusion, improves the underfed effect of patient thereby play.
Description of drawings
Fig. 1 is intraperitoneal volume-time changing curve in the peritoneal membrane function experiment.
The specific embodiment
Among the embodiment, the Stichopus japonicus polysaccharide relative molecular weight is 50000.
Embodiment 1
Prescription:
Stichopus japonicus polysaccharide 10g
Glucose 15g
Sodium chloride 5.4g
Calcium chloride 0.26g
Magnesium chloride 0.15g
Sodium lactate 5.0g
Sodium pyrosulfite 0.03g
Water for injection adds to 1000ml.
Wherein glucose is an osmotic pressure regulator, and sodium lactate uses as buffer agent in prescription, and magnesium chloride, calcium chloride are all used as electrolyte components in the simulated body fluid, and sodium pyrosulfite uses as antioxidant.Raw material is injection in the prescription, and osmotic pressure is about 370mOsm/L.
Pressing recipe quantity drops into other component except that Stichopus japonicus polysaccharide in the water for injection; Make into the concentrated solution of weight concentration 55%, 115 ℃ of pressure sterilizing 45min, 0.05% needle-use activated carbon of enriching solution amount is as impurity absorption agent and filter aid; Mixing is crossed through No. 4 glass sand hourglasses and to be filtered solution A.Stichopus japonicus polysaccharide adds water for injection, makes into the solution of weight concentration 25%, in the impouring solution A, adds the injection water to capacity, stirs, and at last through the filtering with microporous membrane of 0.22 μ m, divides the three-layer co-extruded peritoneal dialysis liquid of packing into promptly getting in the bag.
Embodiment 2
Stichopus japonicus polysaccharide 10g
Glucose 42.5g
Sodium chloride 5.4g
Calcium chloride 0.26g
Magnesium chloride 0.15g
Sodium lactate 5.0g
Sodium pyrosulfite 0.05g
Water for injection adds to 1000ml
Raw material is injection in the prescription, and osmotic pressure is about 510mOsm/L.Method for preparing is with embodiment 1.
Embodiment 3, pharmacological evaluation
Stichopus japonicus polysaccharide is to the influence of rat peritoneum dialysis model abdominal cavity ultrafiltration
Test material:
1.II the level male SD rat, body weight 250~300g, Shanghai medicine institute of Chinese Academy of Sciences experimental animal center provides;
2. [
125I]-human serum albumin, radiochemicsl purity>99%, basic nuclear medicine teaching and research room of Zhongshan Medical Univ. provides;
Method:
1. 24 the II level male SD rats that divide into groups are divided into 3 groups at random: high sugar group (n=8), Stichopus japonicus polysaccharide group (n=6), normal control group (n=6).
2. handle high sugar group (HP) intraperitoneal injection every day 25ml 4.25% glucose peritoneal dialysis solution, altogether 7d; The Stichopus japonicus polysaccharide group, the peritoneal dialysis solution of employing embodiment 1, intraperitoneal injection every day contains 4.25% glucose peritoneal dialysis solution 25ml of 0.01% Stichopus japonicus polysaccharide, altogether 7d; Normal control group (control group) is not done intraperitoneal injection.Lumbar injection all carries out under slight etherization.Injection needle is No. 6 syringe needles of band sheath pipe, and sheath pipe far-end can reduce syringe needle damage internal organs from needle point 6mm, and leaning on the groin midpoint with the bottom right abdomen is point of puncture, the inserting needle towards the upper left side, and pin H/A plane is 30 degree angles.Per injection is all with conventional iodine tincture, alcohol disinfecting and wipe away dried (preventing that disinfectant solution from getting into the abdominal cavity with syringe needle).In the injection process, need be careful and wrongly be expelled to stomach wall and have or not anus, urethra leakage.
3. peritoneum dynamic experiment 8d carries out muscle anesthesia with phenobarbital 50mg/kg body weight dosage to 3 groups of rats, inserts venous detaining needle through the abdominal cavity, then through keep somewhere needle tubing to the abdominal cavity inject [
125I]-human serum albumin's 4.25% glucose dialysis 25ml; Respectively 0,3,15,30,60,90,120,180,240min gets dialysis solution sample 0.35ml; Disconnected neck is put to death rat during 240min, cuts off stomach wall along hunter's line, accurately measures intraperitoneal and goes out water inventory (IVP value).
4. the volume determination method of calculating abdominal cavity solution adopts the method for list of references: Waniewski J; Heimb ü rger O; Park MS.et; Al.Methods for estimation of peritionealdialysate volume and reabsorption rate using macromolecular markers [J] .Perit Dial Int, 1994,14 (1): 8-16;
Zakaria?ER,Rippe?B.Intraperitoneal?fluid?volume?changes?duringperitoneal?dialysis?in?the?rat.Indicator?dilution?us?volumetricmeasurements[J].Blood?Purif,1995,13(5):255-270;
Waniewski?J,Heimbürger?O,Park?MS,et,al.Bidirectional?solutetransport?in?peritoneal?dialysis[J].Perit?Dial?Int,1994,14(4):327-337。
The result shows: through the lumbar injection of 7d, and the significantly normal matched group of the intraperitoneal solvent of high sugar group and Stichopus japonicus polysaccharide group low (P is all<0.01), however the IVP of Stichopus japonicus polysaccharide group is significantly higher than high sugar group (P<0.01).Each organizes intraperitoneal volume-time changing curve such as Fig. 1 in the peritoneal membrane function experiment.