静脉补铁联合还原性谷胱甘肽对维持性血液透析患者氧化应激的影响

Effect of The combination of intravenous iron with reduced glutathione hormone supplementation on oxidative stress in hemodialysis patients

目的观察维持性血液透析(MHD)患者在静脉补铁治疗肾性贫血的过程中,联合应用还原性谷胱甘肽(GSH)对体内氧化应激(OS)的影响。方法选择MHD患者40例,随机分为静脉补铁组(Fe组)20例,静脉补铁联合GSH组(Fe+GSH组)20例,治疗8周后观察用药前后血红蛋白(Hb)、红细胞比容(Hct)、血清铁蛋白(SF)、转铁蛋白饱和度(TAST)以及血浆中丙二醛(MDA)、过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-px)等指标的变化。结果治疗8周后,Fe组和Fe+GSH组Hb,Hct水平均较治疗前明显升高(P<0.01),与Fe组相比,Fe+GSH组Hb、Hct水平改善明显,差异有统计学意义(P<0.05);治疗8周后Fe组和Fe+GSH组SF与TAST水平较治疗前显著增高(P<0.01),Fe组和Fe+GSH组之间比较,差异无统计学意义(P>0.05);治疗8周后,Fe组MDA较治疗前显著升高(P<0.05),SOD、GSH-px显著下降(P<0.05),而Fe+GSH组各项氧化应激指标较治疗前无明显改变(P>0.05),Fe组和Fe+GSH组之间比较,差异有统计学意义(P<0.05)。结论静脉补铁可有效改善MHD患者贫血及缺铁,但也加剧了患者体内的氧化应激状态,联合应用GSH可有效抑制患者体内氧化应激状态。

Objective To investigate the influence of the combination of intravenous iron with reduced glutathione hormone(GSH) supplementation on oxidative stress(OS)in patients undergoing maintenance hemodialysis(MHD).Methods 40 MHD patients were enrolled and randomly divided into intra-venous iron group(Fe group =20) and intra-venous iron with GSH group(Fe+GSH group =20).After 8 weeks,their hematocrit(Hct),hemoglobin(Hb),serum ferritin(SF),transferrin saturation(TAST) and their redox markers were measured.These markers of OS included plasma malondialdehyde(MDA),superoxide dismutase(SOD) and glutathione peroxidase(GSH-px).Results After 8 weeks,plasma Hb,HCT,SF and TAST levels increased significantly in Fe group and Fe+GSH group(P<0.01).Hb and Hct levels were significantly higher in Fe+GSH group compared with those in Fe group(P<0.05),but the changes of SF and TAST levels did not reach statistical significance.At the end of the study,MDA were elevated significantly and SOD,GSH-px were decreased markedly in Fe group(P<0.05)while the posameters showed no significant change in Fe+GSH group.But the difference of these OS markers between the two groups was statistically significant(P<0.05).Conclusion Intravenous iron administration is important aspects for managing the anemia of MHD patients.Intravenous iron supplementation also induces increased oxidative stress which is often already present in patients undergoing hemodialysis.GSH can significantly attenuate the OS induced by intravenous iron in patients.