维持性血液透析患者氧化应激、微炎症状态及其与透析时间的临床分析  

Clinical analysis on relationship between hemodialysis age and the markers of oxidative stress and micro-inflammatory state in maintenance hemodialysis patients

作　　者：缪世梅[1] 范亚平[2] 徐学康[1] 钱桐荪[2] 

机构地区：[1]江苏省南通市第三人民医院血液净化中心,226006 [2]南通大学附属医院肾内科

出　　处：《临床肾脏病杂志》2016年第6期345-349,共5页Journal Of Clinical Nephrology

摘　　要：目的探讨维持性血液透析（maintenance hemodialysis，MHD）患者氧化应激（oxidative stress，OS）、微炎症状态（micro-inflammatory state，MIS）指标与透析时间的关系。方法选择2012年12月在南通市第三人民医院血液净化中心稳定血液透析治疗3个月以上的慢性肾衰竭患者144例作为维持性血液透析组（MHD组），根据透析时间不同分为4个亚组：MHD-1亚组45例，透析时间3-24个月；MHD-2亚组41例，透析时间25-60个月；MHD-3亚组37例，透析时间61-120个月；MHD-4亚组21例，透析时间〉120个月。另选择健康体检者29名为对照组。人选对象均清晨空腹取外周静脉血标本。采用酶联免疫吸附法检测血清晚期氧化蛋白产物（advanced oxidation protein products，AOPP）、白细胞介素6（interleukin-6，IL-6）与肿瘤坏死因子α（tumor necrosis factor-α，TNF-α），散射比浊法测定血清C反应蛋白（C-reactive protein，CRP）。采用单因素方差分析、t检验、Pearson相关分析比较MHD组与对照组各指标及其与透析时间的相关性。结果①MHD各亚组患者血清AOPP水平均明显高于对照组（P〈0．05）；②MHD各亚组患者血清CRP水平明显高于对照组（P〈0．05），IL-6、TNF-α在透析治疗24个月后与对照组比较差异有统计学意义（P〈0．05）；③AOPP与CRP、IL-6、TNF-α呈正相关（r=0．810，P〈0．01；r=0．876，P〈0．01；r=0．919，P〈0.01）；④AOPP、CRP、IL-6、TNF-α与透析时间均呈正相关（r=0．823，P〈0.01；r=0．894，P〈0．01；r=0．940，P〈0．01；r=0．929，P〈0．01）。结论MHD患者体内存在明显的氧化应激和微炎症状态，二者关系密切，且均随透析时间延长而呈逐渐加重趋势。Objective To explore the relationship between hemodialysis age and the markers of oxidative stress and micro＂inflammatory state in maintenance hemodialysis （MHD） patients. Methods 144 MHD patients （MHD group） and 29 normal cases （control group） were enrolled. Ac-cording to hemodialysis age, MHD group was divided into four subgroups.. MHD-1 subgroup （n = 45, hemodialysis age of 3-24 months）; MHD-2 subgroup （n = 41, hemodialysis age of 25-60 months） ; MHD-3 subgroup （n = 37, hemodialysis age of 61-120 months）, and MHD-4 subgroup （n = 21, hemodialysis age of over 120 months）. Serum AOPP, IL-6, TNF-a and CRP levels were measured. The relationship between the markers of oxidative stress and micro-inflammatory state, and the relation- ship between all these markers and hemodialysis age were analyzed. Statistical analysis was conducted with one-way ANOVA, t test and pearsorrs correlation. Results （1） Serum AOPP in MHD patients was significantly higher than in controls （P〈0. 05）; （2） Serum CRP in MHD patients was significantly higher than in controls too （P〈0. 05）, and IL-6 and TNF-α levels in MHD-2-4 subgroups weresignificantly higher than those in controls （P〈0. 05）; （3）AOPP was positively correlated with CRP, IL-6, and TNF-α（P〈0. 01）; （4）AOPP and CRP, IL-6, TNF-α in MHD patients were positively cor- related to their hemodialysis age（P〈0. 01）. Conclusions There are oxidative stress and micro-inflam- matory states in MHD patients. There is a intimate relationship between oxidative stress and micro-in- flamrnation in MHD patients. With hemodialysis age prolonged, the levels of oxidative stress and micro-inflammation in MHD patients became more severer.

关 键 词：维持性血液透析 氧化应激 微炎症 

分 类 号：R692.5[医药卫生—泌尿科学]