肺结核合并低氧血症或呼吸衰竭患者氧化／抗氧化特点的观察

The Observation of Characteristics of Oxidative/Anti-Oxidative in the TB Patients Accompanied by Hypoxemia or Respiratory Failure

目的观察肺结核合并低氧血症或呼吸衰竭患者氧化，抗氧化的特点，并探讨可能的作用机制。方法采用比色法对20例正常对照者和120例肺结核患者血清超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GPX）、丙二醛（MDA）进行测定。结果①与正常对照者相比，氧合正常的肺结核患者血清SOD、GPX降低，MDA增加（P〈0．01或0．05）。②与氧合正常的肺结核患者相比，合并低氧血症或呼吸衰竭患者的SOD、GPX降低（P〈0．01），MDA相接近（P〉0．05）；此外，呼吸衰竭组SOD、GPX和MDA与低氧血症组相接近（P〉0．05）。③Ⅰ型和Ⅱ型呼吸衰竭组SOD、GPX和MDA相接近（P〉0．05）。④当肺结核患者SOD测定值低于正常平均值减2倍标准差、GPX测定值低于正常平均值减1倍标准差、MDA测定值高于正常平均值加2倍标准差时，低氧血症或呼吸衰竭的发生率分别为60％（P〈0．01）、61％（P〈0．01）和59％（P=0．05）。logistic回归分析显示GPX降低与低氧血症或呼吸衰竭的发生最为密切相关（P〈0．01）。结论血清抗氧化酶括性降低、氧化代谢产物增高是肺结核合并低氧血症或呼吸衰竭患者氧化／抗氧化的特点，而且是导致此合并症的重要机制之一。

Objective To observe the characteristics of oxidative/anti-oxidative in the TB patients accompanied by hypoxemia or respiratory failure and research its possible mechanisms. Methods The superoxide dismutase（SOD）, glutathione （GPX） and malonaldehyde（MDA） were measured with chromometry in 20 healthy persons and 120 TB patients. Results （1） Compared with the healthy persons, SOD and GPX decreased and MDA increased （P〈0.01 or 0.05） in the TB patients with normal oxygenation. （2） Compared with the TB patients with normal oxygenation, SOD and GPX decreased （P〈0.01） and MDA did not change（P〉0.05） in the TB patients with hypoxemia or respiratory failure. In addition, SOD, GPX and MDA were not different between the hypoxemia group and respiratory failure group. （3）SOD, GPX and MDA in the TB patients with Ⅰ type of respiratory failure were close to Ⅱ type of respiratory failure （P〉0.05）.（4）The morbidity of hypoxemia or respiratory failure were 60%, 61% and 59% separately in the patients whose SOD were lower than normal -↑Х-2SD or GPX lower than normal -↑Х-ISD or MDA were more than normal -↑Х＋2SD. Logistic regression analysis showed that GPX was regressive to hypoxemia or respiratory failure. Conclusions The characteristics of oxidative/anti-oxidative were that the activity of anti-oxidative enzyme decreased and oxidative products increased in the TB patients accompanied by hypoxemia or respiratory failure, which also was the one of the mechanisms resulting of hypoxemia and respiratory failure.