静脉补铁对腹膜透析患者氧化应激状态的影响

Effects of intravenous iron supplementation on oxidative stress in peritoneal dialysis patients

目的:探讨静脉铁剂对腹膜透析患者氧化应激状态的影响.方法:选择持续性不卧床腹膜透析(CAPD)患者31例,随机分为静脉组(Ⅰ组,11例),口服组(Ⅱ组,10例),和未补铁组(Ⅲ组,10例),观察用药前后血红蛋白浓度(Hb),红细胞压积(Hct),血清铁(SI),血清铁蛋白(SF),转铁蛋白饱和度(TSAT)等指标以及血清C-反应蛋白(CRP)和丙二醛(MDA),谷胱苷肽过氧化物酶(GSH-Px),晚期糖基化终产物(AGE),晚期氧化蛋白产物(AOPP)等炎症和氧化应激指标.结果:①治疗4wk时,Ⅰ,Ⅱ两组患者Hb,Hct,SI,SF,TSAT均较治疗前上升,且高于Ⅲ组;SI,SF,TSAT值Ⅰ组高于Ⅱ组,差异有统计学意义(P<0.05).②治疗8wk时,3组患者Hb,Hct,SI,SF,TSAT均较治疗前上升,Ⅰ组不仅高于同组治疗4wk时且高于Ⅱ,Ⅲ两组;Ⅱ组高于Ⅲ组,差异有统计学意义(P<0.05).③Ⅰ组患者使用静脉铁剂后1h,MDA,AOPP水平升高,GSH-px水平下降;AGEs,CRP水平升高,在4wk时较治疗前及1h差异有统计学意义且较Ⅱ,Ⅲ组水平上升;Ⅱ组CRP水平高于Ⅲ组,差异有统计学意义.④4wk时Ⅱ组AOPP水平升高,与治疗前相比差异有统计学意义且高于Ⅰ,Ⅲ两组.结论:①静脉补铁可有效改善CAPD患者贫血及缺铁状态.②CAPD患者接受静脉铁剂治疗时,可能会诱导炎症及氧化应激反应的加剧.③口服补铁4wk后可引起CAPD患者AOPP水平的升高.

AIM： To investigate the influence of intravenous iron therapy on oxidative stress in peritoneal dialysis patients. METHODS： Thirty-one continuous ambulatory peritoneal dialysis （CAPD） patients were randomly divided into 3 groups： intravenous iron group（ group Ⅰ , n = 11 ） ,oral iron group（ group Ⅱ , n =10） , and non-iron group（groupⅢ, n = 10）. The indices of hemoglobin（Hb） , hematocrit （ Hct ） , serum iron （ SI ） , serum ferrintin（ SF）, transferrin saturation （ TSAT）, C-reactive protein （ CRP）, advanced oxidation protein products （AOPP） , malondialdehyde（MDA） ,advanced glycation end products （AGEs） , and glutathione peroxidase （GSH-Px） were evaluated before and after the iron administration. Twenty healthy volunteers were taken as normal controls. RESULTS： ① Four weeks after treatment, the Hb, Hct, SI, SF and TSAT levels increased significantly in group Ⅰ and group Ⅱ , which were also significantly higher than those in group Ⅲ. The SI, SF and TSAT levels in group Ⅰ were significantly higher than those in group Ⅱ （P 〈 0.05 ）. ② Eight weeks after treatment, the Hb, Hct, SI, SF, TSAT levels elevated significantly in all patients. The levels of these indices were significantly higher in group Ⅰ than in group Ⅱ and group Ⅲ, and higher in groupⅡ than in groupⅢ （P〈0.05）. ③ After the infusion of iron, the levels of MDA and AOPP increased significantly and reached the peak level at 1 h; while the level of GSH-Px decreased significantly; the levels of AGEs and CRP increased in group Ⅰ , and were higher at 4 weeks than at 1 h and before treatment, and were higher than in group Ⅱand group Ⅲ （P〈0.05） ; but the level of CRP was significantly higher in group Ⅱ than in group Ⅲ, and the difference was statistically significant. ④ Four weeks after treatment, the AOPP level in group Ⅱ was higher than that before treatment and than that in group Ⅰ and group Ⅲ. CONCLUSION： ① Erythropoietin and iron administration is efficient for treating anemia of CAPD patients. ② Iron supplementation may also aggravate the status of oxidative stress and inflammation. ③ The AOPP level in CAPD would increase significantly after oral iron administration for 4 weeks.