不同腹膜转运特性的腹膜透析患者炎症和氧化应激状态的研究

Evaluation of inflammation and oxidative stress in uremic patients on peritoneal dialysis(PD)with different peritoneal transport status

目的研究维持性腹膜透析(PD)患者腹膜转运特性对炎症和氧化应激状态的影响。方法选取2005年1月至12月四川大学华西医院肾内科门诊和住院的36例行腹膜透析的尿毒症患者,根据腹膜平衡试验分为高转运和高平均转运组(HPD)18例,低转运和低平均转运组(LPD)18例,选取同期未透析尿毒症患者18例及正常对照11例以分光光度法及免疫比浊法测定患者血清超氧化物歧化酶(SOD)、维生素E、维生素C、丙二醛(MDA)、C-反应蛋白(CRP)。结果非透析尿毒症患者血中维生素C、维生素E及SOD均低于维持性腹膜透析患者(P<0.05),CRP和MDA高于维持性腹膜透析患者(P<0.05);HPD组维生素C及SOD低于LPD组(P<0.05),MDA及CRP高于LPD组(P<0.05)。结论腹膜透析患者体内反映氧化应激状态和炎症状态的因子表达较非透析尿毒症者高;不同腹膜转运特性对尿毒症患者的氧化应激状态和炎症状态有不同的影响;较高转运特性者的氧化应激状态和炎症状态高于较低转运特性者。

Objective To evaluate the states of inflammation and oxidative stress in uremic patients on PD with different transport status. Methods Based on the dialysate-to-plasma ratio of creatinine（D/P） in peritoneal equilibration tests,36 stable patients on peritoneal dialysis in West China Hospital, Sichuan University, were divided into higher transport PD group （ D/P 〉 0. 65,18 cases） and lower transport PD group （ D/P ≤0. 65,18 cases ） in 2005. Meanwhile, the non-dialysis uremic（ 18 cases）patients and normal people（ 11 cases）were also included in the control groups. The serum superoxide, dismutase （ SOD）, Vitamin C and E, malondialdehyde （MDA） and C reactive protein （CRP） levels were tested by spectro- photometry and immune turbidimetry in all the groups. SPSS software was used to analyse these data. Results Compared with non-dialysis uremic group, there was higher blood SOD, Vitamin C, Vitamin E, and lower MDA and CRP level in PD patients（P 〉 0. 05 ）. Compared with lower transport PD group （LPD group）, there was higher CRP and MDA level, lower SOD and Vitamin C level in higher transport PD group （HPD group） （P 〉 0.05 ）, but there were no differences in Vitamin C, and Vitamin E levels （P 〉0.05 ）. Conclusion Peritoneal dialysis may lead to lower inflammatory and oxidative stress state than the non-dialysis uremic. HPD patients may be in higher oxidative stress and inflammatory state than LPD patients.