血液透析膜质对血液透析患者氧化应激状态及外周血T细胞亚群的影响

Effect of dialyser on oxidative stress and peripheral blood T-cell subsets in chronic renal failure patients undergoing hemodialysis

目的探讨血液透析膜质对维持性血液透析患者氧化应激状态及外周血T细胞亚群的影响。方法慢性肾功能衰竭维持性血液透析患者63例,采用聚甲基丙烯酸甲酯膜31例(PMMA组),采用聚砜膜32例(PS组),选择同期体检健康者33例为对照组。PMMA组和PS组每次血液透析时间、透析液成分、透析液流速均相同。PMMA组与PS组采用分光光度计法检测常规血液透析前、后血红细胞超氧化物岐化酶(erythrocyte superoxide dismutase,e-SOD)、过氧化氢酶(catalase,CAT)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-PX)及血浆丙二醛(plasmamalondialdehyde,p-MDA)水平,采用链霉亲和素碱性磷酸酶共轭法检测常规血液透析前、后外周血单个核细胞中CD3+,CD4+,CD8+百分比的变化。对照组也用相同方法检测上述指标。结果透析前PMMA组与PS组e-SOD,CAT及GSH-PX明显低于对照组(P<0.01),p-MDA明显高于对照组(P<0.01);PMMA组与PS组透析后p-MDA水平明显高于透析前(P<0.01),e-SOD水平与透析前比较差异无统计学意义(P>0.05),PMMA组透析后CAT,GSH-PX水平明显高于透析前(P<0.05);透析前PMMA组与PS组外周血单个核细胞中CD3+,CD4+,CD8+百分比及CD4+/CD8+均明显低于对照组(P<0.05),2组透析前、后差异无统计学意义(P>0.05)。结论血液透析患者呈高氧化应激状态,T细胞免疫功能受抑制,血液透析未能有效改善尿毒症患者T细胞免疫功能,PMMA膜的生物相容性可能较PS膜好。

Objective To explore the influence of hemodialysis membrane on oxidative stress and T-cell subsets in peripheral blood in patients with maintenance hemodialysis. Methods Sixty-three patients with chronic renal failure receiving maintenance hemodialysis were divided into polymethyl methaerylate membrane （PMMA） group （n = 31） and polysulfone membrane （PS） group （n：32）. Another 33 healthy volunteers were as controls （control group）. The time duration of hemodialysis, dialysis fluid composition and dialysate flow rate were the same between PMMA group and PS group. The levels of erythrocyte superoxide dismutase （e-SOD）, catalase （CAT）, glutathione peroxidase （GSH-PX） and plasma malondialdehyde （p-MDA） were detected with spectrophotometer method, and the percentage of CD3^＋ , CD4^＋ and CD8^＋ in peripheral blood mononuclear cells were detected with streptavidin alkaline phosphatase conjugate method in PMMA group and PS group before and after conventional hemodialysis and in control group. Results In comparison with control group, the levels of e-SOD, CAT and GSH-PX were lower, and the level of p-MDA was higher in PMMA group and PS group before hemodialysis （P^0.01）. The level of p-MDA was higher （P〈0.01） and there was no significant difference in e-SOD level （P〉0.05） after hemodialysis in comparison with before hemodialysis in PMMA group and PS group. The levels of CAT and GSH-PX were higher after hemodialysis than those before hemodialysis in PMMA group （P〈0.05）. The percentages of CD3^＋, CD4^＋, CD8^＋ and CD4^＋/CD8^＋ were obviously lower after hemodialysis in PMMA group and PS group than those in control group （P〈0.05）, and there were no significant differences between before and after hemodialysis in PMMA group and PS group （P〉0.05）. Conclusion Hemodialysis patients show a high oxidative stress and inhibition of T-cell immune function. Hemodialysis does not improve T-cell immune function in patients with uremia. The biocompatibility of PMMA is superior to PS.