腹膜透析液添加尿激酶对尿毒症合并急性脑梗死患者治疗机理研究

Peritoneal dialysis solution adding urokinase in patients with acute cerebral infarction uremia combined with therapeutic effect

目的探讨腹膜透析液添加尿激酶对尿毒症并发脑梗死患者血清超氧化物歧化酶(SOD)、丙二醛(MDA)、血浆内皮素(ET)及一氧化氮(NO)的影响。方法将健康体检者30人设为健康组,60例尿毒症并发脑梗死患者随机分为治疗组(30例)和观察组(30例),两组基础治疗相同,治疗组在观察组基础治疗上加用腹膜透析液添加尿激酶,治疗8w后观察两组患者超氧化物歧化酶、丙二醛、内皮素及一氧化氮的变化。用比色法测定健康组、观察组、治疗组血清MDA和SOD水平,用放射免疫法测定血浆ET的变化,NO采用硝酸还原法测定。结果与健康组比较,观察组、治疗组血清SOD活性降低(P<0.05),NO降低(P<0.05),MDA含量升高(P<0.05),血浆ET水平升高(P<0.01)。观察组虽能够降低血浆ET水平和升高NO,但未见SOD、MDA的变化,治疗组能够回升SOD活性,降低MDA含量,与健康组及观察组有明显差别(P<0.05,P<0.05),与观察组比较,治疗组在降低ET和升高NO方面疗效更为显著(P<0.01)。结论腹膜透析液添加尿激酶可能通过降低氧化应激反应,降低血浆ET和升高NO水平,对30例尿毒症并发脑梗死患者有治疗作用。

Objective To explore the effects of peritoneal dialysate add urokinase on the serum superoxide dismutase（ SOD）, malondialdehyde（ MDA）, plasma endothelin and nitric oxide in patients with uremia complicated by cerebral infarction. Methods Sixty patients with uremia complicated by cerebral infarction were divided into experimental group （ n = 30） and Observation group（ n = 30） randomly, and basal treatment was given to both groups. The experi - mental group was treated with peritoneal dialysate add urokinase, changes of superoxide dismutase, malondialdehyde, plasma ehdothelin, nitric oxide, proteinuria and clinical symptom were observed after administration of the medicine for 8 weeks, The levels of SOD and MDA were measured by colorimetry, the alterations of plasma endothelin（ET） were measured by radiation immunological test and nitric Oxide （NO） were measured by nitrate reduction method in Health observation group, Observation group and peritoneal dialysate add urokinase treatment group. Results Compared with Health observation group, the activity of SOD and nitric Oxide were decreased while the content of MDA was increased in observation group and treatment group, moreover, the level of plasma endothelin was increased in observation group and treatment group. （ P 〈 0.01 ）, the elevated plasma endothelin was decreased in eobservation group with nimodipine（P 〈 0.01 ）, but no obvious changs of SOD and MDA. The low activity of SOD and nitric Oxide were increased（P 〈 0.05） while the big content of MDA was decreased（P 〈 0.05 ）, and lower level of plasma endothelin was induced（P 〈 0.05 ） in peritoneal dialysate add urokinase, treatment group as compared with experimental group and observation group（P 〈 0.05, P 〈 0.01 ）. Conclusion peritoneal dialysate add urokinase improves the blood volume by lowering the reaction of oxidative stress and by lowreing the level of plasma endothelin and elevating nitric oxide in patients with uremia complicated by cerebral infarction.