维持性血液透析患者不同初始剂量静脉铁剂治疗前后炎症、氧化应激的变化及对主要不良心血管事件的影响  

Changes in inflammation and oxidative stress before and after treatment with different initial doses of intravenous iron agents in maintenance hemodialysis patients and the impact on major adverse cardiovascular events

作　　者：顾铜 张健美 方倩 李慧妍[1] Gu Tong;Zhang Jianmei;Fang Qian;Li Huiyan(Hemodialysis Room,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]河北省秦皇岛市第一医院血液透析室,066000

出　　处：《心脑血管病防治》2024年第7期31-34,57,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：河北省秦皇岛市科学技术研究与发展计划(202004A097)。

摘　　要：目的探讨维持性血液透析(MHD)患者应用不同初始剂量静脉铁剂治疗前后炎症、氧化应激的变化及对主要不良心血管事件(MACE)的预测价值。方法回顾性分析2017年8月至2019年8月在秦皇岛市第一医院血液透析室行MHD治疗的158例患者的临床资料,根据初始静脉铁剂用量的不同分成高剂量组(每月400 mg蔗糖铁,78例)和低剂量组(每月200 mg蔗糖铁,80例)。两组用药2.5个月后所有患者均1次/2周静脉滴注100 mg蔗糖铁,维持此方案24个月以上。比较两组治疗前、治疗12个月及24个月血红蛋白(Hb)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、炎症因子[C-反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)]及氧化应激因子[超氧化物歧化酶(SOD)、丙二醛(MDA)、髓过氧化物酶(MPO)]指标,观察两组3年内MACE发生情况,并通过ROC分析有关指标对MACE发生的预测价值。结果治疗12个月及24个月两组Hb、SF、TSAT水平及血清CRP、IL-6、TNF-α、MDA、MPO水平均较治疗前增高差异有统计学意义(P<0.05),血清SOD水平均较治疗前降低差异有统计学意义(P<0.05)。治疗24个月,两组Hb、SF、TSAT水平及血清CRP、IL-6、TNF-α、MDA、MPO水平均较治疗12个月增高,血清SOD水平均较治疗12个月降低,差异有统计学意义(P<0.05)。高剂量组MACE发生率与低剂量组比较差异无统计学意义(χ^(2)=0.396,P>0.05)。MACE组血清IL-6、MDA水平高于非MACE组,差异有统计学意义(t=5.352、8.584,P<0.05)。MACE组血清SOD水平低于非MACE组,差异有统计学意义(t=2.467,P<0.05)。血清IL-6、SOD、MDA水平预测MHD患者发生MACE的ROC曲线下面积分别为0.741、0.691、0.887,敏感度分别为57.80%、64.40%、84.40%,特异度分别为81.40%、69.00%、79.60%。结论静脉铁剂200 mg/月和400 mg/月两种给药方法均可有效纠正MHD患者铁缺乏,均加重患者炎症及氧化应激状况;血清IL-6、SOD、MDA水平可预测MHD患者MACE的发生。Objective To explore the changes in inflammation and oxidative stress before and after treatment with different initial doses of intravenous iron agents in maintenance hemodialysis(MHD)patients and their predictive value for major adverse cardiovascular events(MACE).Methods Clinical data of 158 patients who underwent MHD treatment in the hemodialysis room of the First Hospital of Qinhuangdao from August 2017 to August 2019 were retrospectively analyzed.According to the initial dosage of intravenous iron agents,patients were divided into a high-dose group(400 mg iron sucrose per month,78 cases)and a low-dose group(200 mg iron sucrose per month,80 cases).After 2.5 months of medication in both groups,all patients received intravenous infusion with 100 mg iron sucrose once every 2 weeks,maintaining this regimen for more than 24 months.The levels of hemoglobin(Hb),serum ferritin(SF),transferrin saturation(TSAT),inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and oxidative stress factors[superoxide dismutase(SOD),malondialdehyde(MDA),myeloperoxidase(MPO)]before treatment,after 12 months and 24 months of treatment were compared between the two groups.The occurrence of MACE in both groups within 3 years was observed,and the predictive value of relevant indicators for the occurrence of MACE was analyzed through receiver operating characteristic(ROC)curve.Results After 12 and 24 months of treatment,the levels of Hb,SF,TSAT,serum CRP,IL-6,TNF-α,MDA and MPO in both groups were increased compared with before treatment,the differences were statistically significant(P<0.05),while the levels of serum SOD were decreased compared with before treatment(P<0.05).After 24 months of treatment,the levels of Hb,SF,TSAT,serum CRP,IL-6,TNF-α,MDA and MPO in two groups were increased compared with 12 months of treatment,and the level of serum SOD was decreased compared with 12 months of treatment,with statistically significant differences(P<0.05).There was no significant difference in the

关 键 词：静脉铁剂 维持性血液透析 炎症 氧化应激 心血管事件 

分 类 号：R692.5[医药卫生—泌尿科学]