慢性肾脏病患者氧化应激状态及其相关影响因素

Oxidative stress in patients with chronic kidney diseases and the related factors

目的研究慢性肾脏病(CKD)患者的氧化应激状态及其相关影响因素。方法选择2008年7—12月在复旦大学附属中山医院肾内科诊断为CKD1～5期的住院患者73例(CKD组)以及10例同期在骨科住院行择期手术的无肾脏疾病患者(对照组),测定血浆晚期氧化蛋白产物(AOPP)、丙二醛(MDA)水平以及谷胱甘肽过氧化物酶(GSH-PX)、过氧化物歧化酶(SOD)活力。结果①与对照组相比,CKD组的血浆AOPP、MDA均显著增高(P值均<0.05),血浆GSH-PX、SOD显著降低(P值均<0.05)。按CKD分期分为5个亚组,5个CKD亚组间血浆AOPP、MDA、GSH-PX、SOD水平的差异均有统计学意义(P值均<0.05),其中AOPP、MDA随着肾功能减退而显著升高,GSH-PX、SOD随着肾功能减退而显著降低。②血浆AOPP水平与血总胆固醇呈正相关(r=0.897,P<0.05);血浆SOD活力与血总胆固醇(r=-0.985)、脂蛋白(a)(r=-0.90)呈负相关(P值均<0.05),与血红蛋白呈正相关(r=0.954,P<0.05);血浆GSH-PX活力与血总胆固醇(r=-0.954)、脂蛋白(a)(r=-0.935)呈负相关(P值均<0.05),与血红蛋白呈正相关(r=0.911,P<0.05);血浆MDA水平与血总胆固醇(r=0.763)及脂蛋白(a)(r=0.718)呈正相关(P值均<0.05)。③超敏C反应蛋白(hs-CRP)与血浆AOPP(r=0.961)、MDA(r=0.901)呈正相关(P值均<0.05),与SOD(r=-0.903)、GSH-PX(r=-0.875)呈负相关(P值均<0.05)。结论CKD患者存在过度氧化应激。氧化应激的强度随着肾功能的减退、血红蛋白水平的下降及脂代谢紊乱的加重而增加。CKD患者体内氧化应激与微炎症状态密切相关。

Objective To investigate the oxidative stress in patients with chronic kidney disease （CKD） and to evaluate the relationship between increased oxidative stress and decreased kidney function, etc. Methods According to the definition of CKD in K/DOQI （2006）, 73 OKD patients, who were treated in our department during July 2008 and Dec. 2008, were enrolled in the present study. Ten patients who were to receive elective operation in the orthopeadic department during the same period were taken as controls. The hemoglobin, blood lipid profile, C-reactive protein, albumin, glutathione peroxidase （GSH-PX）, superoxide dismutase （SOD）, malonaldehyde （MDA） and advanced oxidative protein product （AOPP） were investigated. Results （1） Plasma AOPP and MDA were significantly higher in CKD group compared with those in control group （both P〈0.05）. Plasma GSH-PX and SOD were significantly lower in OKD group compared with those in control group （both P 0.05）. There were significant differences in the plasma AOPP, MDA, GSH-PX and SOD among five CKD stages （all P 〈0.05）. Plasma AOPP and MDA increased with the progression of kidney function. Plasma SOD and GSH- PX decreased with the progression of kidney function. （2） Plasma AOPP correlated well with total cholesterol （r = 0. 897, P〈0.05） ; plasma SOD correlated well with total cholesterol （ r = - 0. 985）, LP（a） （ r = 0.90） and HB （ r = 0. 954）, （all P〈0.05） ; plasma GSH-PX correlated well with total cholesterol （ r = -- 0. 954）, LP （a） （ r = - 0. 935）and HB （ r = 0.911, all P〈0.05）. Plasma MDA correlated well with total cholesterol （ r = 0. 763） and LP（a） （r=0.718, both P〈O.05）. （3） hs-CRP correlated well withAOPP （r=0.961）, SOD （r=-0.903）, GSH-PX （r=-0.875）, andMDA（r=0.901, alIP〈0.05）. Conclusion Oxidative stress widely exists in CKD patients, and it aggravates with the worsening of kidney function, anemia and disorder of lipid metabolism. The oxidative stress is closely related to micro-inflammation status of patients. （Shanghai Med J, 2009, 32： 787-790）