曲美他嗪对维持性血液透析患者氧化应激状态的影响  

Effects of trimetazidine on the oxidative stress in maintenance hemodialysis patients.

作　　者：张黎明[1] 邬碧波[1] 唐琦[1] 俞勇[1] 郝晓萍[1] 

机构地区：[1]上海市闸北区中心医院肾内科,200070

出　　处：《中国综合临床》2010年第3期242-245,共4页Clinical Medicine of China

基　　金：上海市卫生局青年科研项目（2007Y71）;上海市卫生局科技发展基金项目（2009255）;上海市闸北区卫生局医学科研课题（2009ZBMXK02）

摘　　要：目的探讨口服曲美他嗪对维持性血液透析（MHD）患者氧化应激状态的影响及其临床意义。方法选择透析龄超过3个月的MHD患者86例，已排除急性感染及其他活动性疾病，随机分为患者治疗组46例，患者对照组40例。患者治疗组口服曲美他嗪20mg，3次／d，治疗并观察随访24周；患者对照组不用曲美他嗪。分别检测治疗前后患者的血清谷胱甘肽过氧化物酶（GSHPx）、超氧化物歧化酶（SOD）、血清丙二醛（MDA）、血清晚期氧化蛋白产物（AOPP）等。另选健康对照者30名（健康对照组）。分析曲美他嗪对MHD患者氧化应激状态的影响。结果治疗前，2组MHD患者的GSHP】【水平[（584．37±215．70）、（580．87±309．12）μzmol／L]显著低于健康对照组[（769．064±302．46）μzmol／L]（P均〈0．01），SOD水平[（347．87±82．09）、（348．16±75．33）kU／L]显著低于健康对照组[（428．34±15．23）kU／L]，差异有统计学意义（P均〈0．01），MDA水平[（4．94±1．32）、（4．97±1．61）nmol／L]显著高于健康对照组[（3．56±0．46）nmol／L]，差异有统计学意义（P均〈0．01），AOPP水平[（120．95±59．24）、（121．76±69．12）μg／L]显著高于健康对照组[（47．69±20．15）μg／L]，差异有统计学意义（P均〈0．05）；治疗后，患者治疗组的GSHPx、SOD水平均较治疗前明显升高，差异有统计学意义（P〈0．05，P〈0．01），MDA水平较治疗前明显下降（P〈0．01），AOPP水平也下降，但差异无统计学意义（P〉0．05）；患者对照组以上各项指标治疗前后均无明显变化（P均〉0．05），但患者治疗组与对照组上述指标比较差异有统计学意义（P均〈0．01）。结论MHD患者普遍存在氧化应激状态，使用口服曲美他嗪可明显改善患者的抗氧化能力，从而提高机体对氧化应激的防御功能。Objective To investigate the effects of trimetazidine on the oxidative stress in maintenance he- modialysis （MHD） patients. Methods Eighty-six MHD patients and 30 healthy volunteers were recruited in the study. The activity of glutathione peroxidase （GSHPx） was measured by colorimetry and superoxide dismutase （SOD） in serum was measured by hydrexylamine method. The levels of serum malondialdehyde （MDA） were meas- ured by thiobarbituric acid reaction. Serum advanced oxidation protein products （AOPP） levels were measured by enzyme-linked immunosorbent assay （ELISA）. All MHD patients were randomly divided into two groups, treatment group （n = 46） and control group （n = 40）, who had undergone hemodialysis for at least three months before the study and were in a stable clinic status without signs of infection or disease activity. In the treatment group,20 mg of trimetazidine was taken orally three times each day for twenty-four weeks, when the parameters for oxidative stress were studied. The levels of GSHPx, SOD, MDA and AOPP in serum were measured before and after the treatment. Results At the initiation of the investigation, the serum levels of GSHPx [ （584.37 ± 215.70） tzmol/IS, （580.87 ±309.12） μmol/L vs （769.06 ± 302.46） μmol/L] and SOD [ （347.87 ± 82.09） kU/L, （348.16 ± 75.33）kU/L vs （428.34 ± 15.23）kU/L] in the MHD patients were significantly lower than those in the normal control group （ P 〈 0.01 ）, whereas the content of MDA [ （4.94 ± 1.32） nmol/L, （4.97 ± 1.61 ） nmol/L vs （3.56 ± 0.46） nmol/L] and AOPP [ （ 120.95 ± 59.24） μg/L, （ 121.76 ± 69.12） μg/L vs （47.69 ± 20.15 ） μg/L] in MHD patients was higher than those in the control group （P 〈 0.05 and P 〈 0.01, respectively）. After treatment for twelve weeks, the scores of GSHPx and SOD were significantly increased in the treatment group compared to that before treatment （P 〈0.01 ）. However, the contents of the MDA and AOPP decreased. There were

关 键 词：血液透析 氧化性应激 曲美他嗪 

分 类 号：R459.5[医药卫生—治疗学]