Background. CD40 has been identified on a variety of cell types, and it plays an important role in adaptive immunity and inflammation. Peritoneal mesothelial cells (PMCs) are the main cell layer that line the peritoneal membrane. Previously we found that CD40 ligand (CD154) is functionally expressed on peritoneal macrophages during continuous ambulatory peritoneal dialysis peritonitis. However, there are few studies that have examined both CD40 expression on PMCs and the function of CD40 signalling in peritoneal local defence. The purpose of this study was to determine whether PMCs express CD40 and to investigate potential mechanisms of CD40-CD154 interactions that may be involved in the inflammation of the peritoneal membrane. Methods. Rat PMCs were harvested from the peritoneal cavity and maintained under defined in vitro conditions. We examined expression of CD40 on PMCs under normal culture or stimulation with interferon-γ (IFN-γ), tumour necrosis factor-α (TNFα) or interleukin (IL)-1 by reverse transcription-polymerase chain reaction and fluorescence-activated cell sorting (FACS) analysis. After activation with CD40 monoclonal antibody (mAb), the expression of intercellular adhesion molecule-1 (ICAM-1) on PMCs was analysed by FACS. Results. A portion of rat PMCs cultured in vitro expressed CD40 constitutively. The expression of CD40 mRNA and protein was upregulated markedly following stimulation with IFN-γ, but not following IL-1 or TNF-α. The expression of ICAM-1 on PMCs was significantly increased after activation of CD40 with IFN-γ and with CD40 mAb. Conclusion. PMCs functionally express CD40. The interaction between CD40 on PMCs and CD154-positive cells in the peritoneal cavity may play an important role in peritoneal local defence and may be involved in the inflammation process of the peritoneum.

目的观察不同剂量的川芎嗪加入到4.25%透析液中对腹膜超滤功能的影响。方法：40只SD大鼠随机分为4组，除对照组外，其余3组每日分别腹腔注射25ml 4.25%透析液（HGC），HGC+40mg/L川芎嗪（HGL）和HGC+160mg/L川芎嗪（HGH）。至第45天结束时，以131I标记的白蛋白溶于25ml 4.25%透析液注入腹腔，进行腹膜功能试验。结果：与对照组比较，各透析组4h排液量显著降低，而HGL组排液量显著高于HGC组和HGH组。各透析组腹透液重吸收和直接淋巴吸收均显著高于对照组，各透析组之间则无显著差异。HGL组透析液与血浆尿素浓度之比（D/Purea）与HGC组比较无显著差异，但透出液中葡萄糖浓度与未使用过的4.25%透析液中葡萄糖浓度之比（D/D0）及尿素清除率（Curea）显著高于HGC组和HGH组；HGH组D/Purea显著增加。结论：低剂量川芎嗪加入到腹透液中可减少高渗透析液引起的腹膜功能损伤，增加超滤及透析效能，高剂量川芎嗪则可引起腹膜通透性增高。

持续性不卧床腹膜透析（CAPD）是治疗终末期肾病的主要方法之一。超滤失败和反复腹腔感染是患者退出腹膜透析的主要原因。在卫生部临床学科重点项目等支助下，叶任高教授领导的课题组对腹膜转运及防御机制进行了深入研究，研究结果在国际上首次揭示：①正常大鼠腹膜表面覆盖着一层膜样结构，主要成分有表面蛋白A、磷脂、透明质酸等，该层在腹膜溶质转运中有重要的屏障作用。②透明质酸合成酶（HAS）-2是人腹膜间皮细胞合成HA的关键酶，高分子质量的透明质酸可以防止长期使用含葡萄糖透析液所引起的腹膜超滤下降；而高浓度葡萄糖及炎症介质显著增加与炎症反应相关的HAS-3的表达。③增加腹腔透析液容量并不加重腹膜功能的损害。而高腹腔残余液体量则降低净超滤，从而损害葡萄糖透析液的透析效能。④腹膜间皮细胞可功能性表达CD40，CD40与CD40L相互作用，参与了腹腔局部防御。本成果发表论著36篇，其中国际杂志12篇；SCI收录7篇；被SCI引用共57篇次。获得国际奖项4项及全国优秀博士论文奖1项。

本文从病名、病机、病证三个方面对慢性肾衰研究现状进行了综述及分析，指出病名诊断标准的实施为慢性肾衰病名诊断规范化提供了法规依据，对慢性肾衰病机认识仍存有争议，慢性肾衰辨证诊断有待完善。提示用动态的观点把握慢性肾衰的病证特点，是值得研究的重要课题。