终末期肾病透析患者氧化应激水平的变化  

The changes of oxidative stress in patients with end-stage renal disease undergoing dialysis

作　　者：龚颖[1] 李正荣[1] 巫江[1] 欧阳南[1] 钟清[1] 

机构地区：[1]重庆医科大学附属第一医院肾病科,400016

出　　处：《江苏医药》2012年第17期2049-2052,共4页Jiangsu Medical Journal

摘　　要：目的探讨终末期肾病(ESRD)透析患者血浆总丙二醛(tMDA)和游离丙二醛(fMDA)的浓度变化。方法 ESRD患者79例分为ESRD保守治疗(ESRD组,26例)、血液透析(HD组,30例)和腹膜透析(PD组,23例)三组;另设正常对照组30例。采用同位素稀释GC-MS法检测患者fMDA和tMDA浓度,计算结合丙二醛(bMDA)值(bMDA=tMDA-fMDA)。结果 ESRD组、HD组和PD组血浆tMDA和bMDA浓度均高于对照组[(6.94±1.50)μmol/L,(5.70±1.20)μmol/L和(4.40±1.00)μmol/L vs.(1.70±0.50)μmol/L和(6.49±1.70)μmol/L,(4.43±1.20)μmol/L和(3.21±1.00)μmol/L vs.(1.26±0.30)μmol/L](P<0.01)。PD组和HD组fMDA水平均高于ESRD组[(1.22±0.60)μmol/L和(1.31±0.60)μmol/L vs.(0.48±0.30)μmol/L](P<0.01)。多元统计分析结果显示,tMDA和bMDA水平与残余肾功能(γ=-2.160,P<0.05)和白蛋白水平(γ=-2.049,P<0.05)呈负相关。促红细胞生成素(EPO)剂量与fMDA水平呈负相关(γ=-2.178,P<0.05)。结论 fMDA浓度的变化可提示近期的肾脏损伤,而bMDA则可提示肾脏的陈旧损伤。ESRD未透析患者不能将bMDA从肾脏中清除;透析尤其是血液透析,加剧了患者肾脏的氧化损伤。Objective To investigate the changes of oxidative stress in patients with end-stage renal disease（ESRD） undergoing dialysis. Methods Seventy-nine ESRD patients were assigned into three groups of ESRD （26 cases, undergoing conservative therapy）, HD （30 cases, undergoing haemodialysis） and PD（23 cases, undergoing peritoneal dialysis）. Plasma levels of free MDA（{MDA） and total MDA（tMDA） malondialdehyde were measured by gas chromatography-mass spectrometry. The bound MDA（bMDA） was calculated（bMDA= tMDA-fMDA）. The results were compared to those in normal subjects（group C, 30 cases）. Results Plasma concentrations of tMDA and bMDA were significantly higher in ESRD groups than those in group C[（6.94± 1.5） μmol/L, （5.70±1.2） μmaol/L and （4. 40±1. 0） μmol/L vs. （1.70±0. 5） μmaol/L, （6. 49±1.7） μmol/L, （4. 43±1. 2） μmol/L and （3. 21±1.0）/μmol/L vs. （1.26±0. 3） μmol/L] （P〈0. 01）. Plasma fMDA was significantly higher in groups of PD and HD than that in group ESRD[（1.22±0.6）/μmol/L and （1.31±0. 6）/μmol/L vs. （0. 48 ± 0. 3） μmol/L] （P〈0. 01）. Multivariate analysis showed that tMDA and bMDA were negatively correlated to the residual renal function（7=-2. 160, P〈0. 05） and albumin（r=-2. 049, P〈0. 05）. The dose of erythropoietin was negatively correlated to {MDA（r=-2. 178, P〈0. 05）. Conclusion fMDA is an indicator for recent renal damage, while bMDA is a marker of an older injury. ESRD patients could not excrete bMDA efficiently. The renal oxidative injury is aggravated by dialysis, especially HD.

关 键 词：终末期肾病 丙二醛 透析 氧化应激 

分 类 号：R692[医药卫生—泌尿科学]