维生素C透析液血液透析滤过对氧化应激和血管内皮功能的影响

Effect of hemodiafiltration with VitC dialysate on the oxidative stress and endothelial function

目的探讨维生素C透析液在血液透析滤过（HDF）中的应用对改善患者的氧化应激状态及对血管内皮功能的影响。方法选择本院血液净化中心稳定的维持性血液透析（MHD）患者10例进行自身交叉对照研究,分别测定常规透析液和VitC透析液HDF治疗前后血浆总抗坏血酸（TAA）、维生素E（VitE）、高级蛋白质氧化产物（AOPP）、血浆和红细胞丙二醛（MDA）等氧化还原指标。应用B超检测流量依赖的血管内皮舒张功能（FDD）。ELISA法检测治疗前后血清孵育体外培养的人脐静脉内皮细胞（HUVEC）分泌或表达可溶性细胞间黏附分子1（sICAM-1）、单核细胞趋化分子1（MCP-1）的水平。结果常规HDF治疗后,血浆TAA、VitE水平较治疗前显著下降（P〈0.01）。VitC透析液HDF治疗后,血浆TAA较治疗前显著升高[（39.48±27.63）比（222.18±90.09）μmol/L,P〈0.01],但VitE水平仍较治疗前显著下降[（6.80±2.08）比（4.54±2.39）μmol/L,｜P〈0.05]。常规HDF治疗后,肱动脉反应性舒张最大直径增长率（%）和最大流量增长率（%）均较治疗前显著下降（14.3±5.35比8.96±2.66,P〈0.01;67.82±32.32比33.34±15.23,P〈0.05）。VitC透析液HDF治疗后,上述指标与治疗前差异无统计学意义（10.44±5.49比11.42±8.61,60.29±38.15比70.53±56.05,P均〉0.05）。常规HDF治疗后的血清孵育HUVEC 24 h上清液中,sICAM-1、MCP-1浓度显著高于治疗前（P〈0.01）,而VitC透析液HDF治疗对HUVEC分泌sICAM-1、MCP-1无显著影响。结论常规HDF治疗由于大量抗氧化剂VitC的丢失,对MHD患者的内皮细胞功能有一定程度损伤。VitC透析液HDF治疗可减轻氧化应激对内皮细胞功能的损伤。

Objective To explore the effect of VitC dialysate HDF on the oxidative stress and endothelial function. Methods Ten stable maintenance hemodialysis patients were enrolled in the research. The efficency of VitC dialysate HDF was compared with the regular HDF in prospective, self-cross way. Their plasma levels of total ascorbic acid （TAA）, atocopherol, advanced oxidative protein products （AOPP） and malondialdehydea （MDA） were detected pre- and post-treatment of regular HDF or VitC dialysate HDF. The flow dependent vascular dilation （FDD） was measured by high-resolution B-mode uhrasonograph. The pre- and post-treatment serum was incubated with HUVEC, and then the levels of sICAM-1 and MCP-1 in the supernate were tested respectively. Results After regular HDF, the plasma levels of TAA and α-tocopherol decreased significantly[（39.78±21.52） vs. （21.51±13.88） μmol/L, （7.77±2.33） vs. （5.28±1.87） μmol/L, P〈 0.01], except for AOPP, MDA. After treated with VitC dialysate HDF, plasma TAA was significantly higher than before [（39.48±27.63） vs, （222.18±90.09） μmol/L, P〈0.01], and α- tocopherol was significantly lower [（6.80±2.08） vs, （4.54±2.39） μmol/L, P〈0.05]. FDD was markedly impaired after regular HDF（ 14.3±5.35 vs. 8.96±2.66, P〈0.01; 67.82±32.32 vs. 33.34± 15.23, P〈0.05）, but no obvious change was found after VitC dialysate HDF （10.44±5.49 vs. 11.42±8.61, 60.29±38.15 vs. 70.53±56.05, P〉0.05）. The post-treatment serum of regular HDF significantly stimulated the HUVEC secreting sICAM-1 and MCP-1, but such stimulation was not found by VitC dialysate HDF. Conclusions Regular HDF impairs the endothelial function probably for the VitC losing and high oxidative stress. The VitC dialysate HDF may be a good way to dissolve the problem partly.