维生素C透析液对维持性血液透析患者动脉钙化的干预作用

The Effect of Dialysate Containing Vitamin C Intervention on Arterial Calcification of Patients of Maintenance Hemodialysis

目的探讨维生素C透析液对维持性血液透析(MHD)患者动脉血管钙化的干预作用及其可能的机制。方法选择在郑州大学第一附属医院血液净化中心长期透析的患者94例,随机分成两组,分别使用常规透析液(A组47例)和含维生素C透析液(B组47例)进行MHD,周期为3个月,治疗前及治疗后抽取血液检测血清钙、磷、碱性磷酸酶(ALP)、维生素C(V itC)、血清清蛋白(ALB)、血清C反应蛋白(CRP)、晚期氧化蛋白产物(AOPP)、胎球蛋白A的水平,并用螺旋CT检查治疗前后冠状动脉钙化积分。结果 (1)治疗前两组患者的钙、磷、ALB、维生素C、ALP、CRP、AOPP、冠状动脉钙化积分、胎球蛋白A水平间差异均无统计学意义(P>0.05)。(2)治疗3个月后A组患者的血清钙、磷、ALP、CRP、AOPP、冠状动脉钙化积分轻度升高,胎球蛋白A水平轻度降低,但与治疗前比较差异无统计学意义(P>0.05);维生素C、ALB明显降低,与治疗前比较差异有统计学意义(P<0.05)。治疗3个月后B组患者的血清钙、磷、维生素C、ALB轻度升高,与治疗前比较差异无统计学意义(P>0.05)。ALP、CRP、AOPP、冠状动脉钙化积分明显降低,胎球蛋白A水平明显升高,与治疗前比较差异有统计学意义(P<0.05)。结论常规透析使大量维生素C丢失;维生素C可以减轻炎症与氧化应激状态,改善营养状态,进而改善MHD患者的动脉钙化状况。

Objective To study the effect and possible mechanism of Vitamin C dialysate intervention on aintenance hemodialysis（MHD） patients with arterial calcification.Methods Ninety-four stable MHD patients from Center for Blood Purification,First Affiliated Hospital of Zhengzhou University were enrolled in this study,and they were randomized into group A and group B.Patients in group A（47 cases） were given regular dialysate,while those in group B（47cases） were given dialysate containing vitamin C for MHD for three months.Levels of serum calcium,phosphorus,alkaline phosphatase（ALP）,vitamin C（VitC）,serum albumin（ALB）,serum C-reactive protein（CRP）,high oxidation protein products（AOPP）,fetuin A were measured before and after maintenance hemodialysis.And with spiral CT the scores of coronary artery calcification were tested before and after the treatment.Results ①Levels of serum calcium,phosphorus,ALB,vitamin C,ALP,CRP,AOPP,coronary artery calcification scores and fetuin A showed no significant difference between the two groups before the treatment（P0.05）.②After given regular dialysate for 3 months,levels of serum calcium,phosphorus,alkaline phosphatase（ALP）,CRP,AOPP and coronary artery calcification score of patients in group A increased slightly,while fetuin A decreased slightly,but showing no significant difference compared with those before the treatment（P0.05）.The levels of serum vitamin C and ALB decreased significantly（P0.05）;For the patients in group B,after given dialysate containing vitamin C for 3 months,levels of serum calcium,phosphorus,vitamin C and ALB increased slightly,showing no statistically significant difference compared with those before the treatment（P0.05）.Levels of serum ALP,CRP,AOPP and coronary artery calcification score decreased significantly,while fetuin A levels increased significantly compared with those before the treatment（P0.05）.Conclusion MHD using regular dialysate may cause large amount loss of vitamin C.MHD using dialysate containing vitamin C may result in the decrease of the inflammation and oxidative stress,improving nutritional status as well as the status of MHD patients with arterial calcification.