不同剂型铁剂对腹膜透析患者氧化应激状态的影响

Different dosage forms of iron supplementation links to oxidative stress in peritoneal dialysis patients

目的:探讨不同剂型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(AGEs),晚期氧化蛋白产物(AOPP)等炎症和氧化应激指标。结果:①3组患者治疗前AGEs,MDA,AOPP,CRP水平差异无显著性(P>0.05)但均高于健康对照组(P<0.05),GSH-px水平差异无显著性(P>0.05)但低于健康对照组(P<0.05)。②Ⅰ组患者使用静脉铁剂后1h,MDA,AOPP水平升高、GSH-px水平下降差异有显著性(P<0.05)。4周时MDA,AOPP时恢复至治疗前水平;GSH-px水平较1h时上升但仍显著低于治疗前及Ⅱ、Ⅲ2组,差异有显著性(P<0.05),8周时恢复至治疗前水平。③4周时Ⅰ组患者AGEs,CRP水平升高,较治疗前及1h差异有显著性(P<0.05)且高于Ⅱ、Ⅲ组。8周时AGEs水平与4周相比差异无显著性(P>0.05),但CRP水平已恢复至治疗前。Ⅱ、Ⅲ2组4周及8周时AGEs水平差异无显著性(P>0.05);Ⅱ组患者CRP水平在4周及8周时均高于Ⅲ组,差异有显著性(P<0.05)。④MDA水平4周及8周时Ⅱ、Ⅲ2组与治疗前变化差异无显著性(P>0.05);Ⅰ、Ⅱ、Ⅲ3组之间差异无显著性(P>0.05)。⑤4周时Ⅱ组AOPP水平升高,与治疗前相比差异有显著性(P<0.05)且高于Ⅰ、Ⅲ2组,8周时与4周相比差异无显著性(P>0.05)。Ⅲ组无变化(P>0.05)。结论:①CAPD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。②口服补铁4周后可引起CAPD患者AOPP水平的升高。③口服补铁4周后CAPD患者血清CRP水平高于未补铁患者。

OBJECTIVE To investigate the influence of different dosage forms of iron therapy on oxidative stress in peritoneal dialysis patients. METHODS Thirty-one continuous ambulatory peritoneal dialysis（CAPD） patients were randomly divided into intravenous iron group（group I , n = 11 ）, oral iron group（group Ⅱ, n=10）, and non-iron group（group Ⅲ, n=10）. Their serum C-reactive protein （CRP）, advanced oxidation protein products （AOPP） , malondialdehyde （MDA）, advanced glycation end products（AGEs）, glutathione peroxidase（GSH-Px） were measured at the different times of the study. Twenty healthy volunteers were as normal controls. RESULTS ①Before treatment there were no difference in three groups in AGEs, MDA, AOPP, CRP and GSH-px（P〉0. 05）. The AGEs, MDA, AOPP, CRP were higher than contral group （P〈0.05）, and the GSH-px was lower than contral group also（P〈0.05）. ②After the infusion of intravenous iron, the MDA, AOPP levels in group I increased significantly and reached peak level after 1 hour, the levels of GSH-px decreased significantly in the meantime（P〈0.05） ,but after four-week MDA,AOPP decreased significantly to the level of before treatment（P〈0. 05）; although the GSH- px levels increased after four weeks but were lower than those before treatment , the levels of lh,group Ⅱ and groupⅢ and returned to the previous after eight weeks（P〈0.05）.③The AGEs,CRP levels in group I at the 4^th week of trial were higher than those before treatment , lh, group Ⅱ and group Ⅲ（P〈0.05）; Although at the end of study the levels of CRP returned to the previous but the levels of AGEs is not quite different compared with the 4^th week（P〉0.05）, Comparison of the AGEs levels in the group I and group Ⅱ showed insignificant difference（P〉0.05）at the 4^th week and 8^th week. but the levels of CRP on group was significantly higher than groupⅢ at 4^th week week 4 and 8^th week（P〈0.05）. ④After eight-week observation period, the MDA levels was no significantly change in group Ⅱ and groupⅢ（P〉0.05）, there were no significantly difference among group I ,group Ⅱ and group Ⅲ（P〉0.05）.⑤After four-week observation period, the AOPP levels of group Ⅱ were higher than those before treatment and group I and group Ⅲ （P〈0.05）. there were no significantly difference between the the levels of week 4 and week 8（P〉0.05） . There was no any change in groupⅢ（P〉0.05）. CONCLUSION ①Maybe intravenous iron supplementation also aggravates the status of oxidative stress and inflammation. ②The AOPP levels in CAPD increased signifi-cantly when oral iron administration for 4 weeks. ③When oral iron supplementation for 4 weeks the levels of CRP were higher than no iron group.