腹膜透析液添加尿激酶对尿毒症并发脑梗死患者保护作用及机制

Protective effects of peritoneal dialysis solution adding urokinase in uremia complicated with cerebral infarction and its mechanism

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)及血浆内皮素(ET)、一氧化氮(NO)的影响。方法将60例尿毒症并发脑梗死患者随机分为腹膜透析液添加尿激酶治疗组(30例)和常规治疗组(30例),同时选择同期年龄在40岁以上的正常人30例为健康对照组(无肝肾脑等疾病),两治疗组基础干预相同,尿激酶治疗组在常规治疗基础上在腹膜透析液添加尿激酶,治疗8周后观察两组患者SOD、MDA、ET、NO及临床症状的变化。用比色法测定血清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①治疗前与健康对照组比较,尿激酶治疗组和常规治疗组血清SOD活性降低(P<0.05),NO降低(P<0.05),MDA含量升高(P<0.05),血浆内ET水平升高(P<0.01)。②治疗8周后,常规治疗组和尿激酶治疗组可降低血浆ET水平和升高NO;与常规治疗组比较,尿激酶治疗组在降低ET和升高NO方面疗效更为显著(P<0.01)。③常规治疗组未见SOD、MDA的变化,尿激酶治疗组能够回升SOD活性,降低MDA含量,与健康对照组及常规治疗组有明显差别(P<0.05,P<0.05)。结论腹膜透析液添加尿激酶可降低氧化应激反应,降低血浆ET和升高NO水平,对尿毒症并发脑梗死患者有治疗作用。

Objective To explore the effects of peritoneal dialysate adding urokinase on the serum superoxide dismutase （SOD）, malondialdehyde （MDA）, plasma endothelin （ET） and nitric oxide （NO） in uremia patients with cerebral infarction. Methods Sixty uremia patients with cerebral infarction, were randomly divided into normal treatment group （receiving baseline treatment, n = 30） and urokinase treatment group （receiving urokinase treatment with adding urokinase into peritoneal dialysis solution besides baseline treatment, n = 30）, and 30 healthy individuals at age of 40 and older were selected as control. The changes of SOD, MAD, ET and NO and clinical symptoms were observed after 8 weeks of administration of medicine. The levels of SOD and MDA were measured by colorimetry, the alterations of ET were measured by radiation immunological test and NO were measured by nitrate reduction method. Results （~） Pretreatment compared with control group, the activity of SOD （ P 〈 0.05 ） and the level of NO （ P 〈 0.05 ） were decreased while the contents of MDA （ P 〈 0.05 ） and ET （ P 〈 0.01 ） was increased in normal treatment group and urokinase treatment group（P 〈0.01 ）. （~） The level of NO was increased and the level of ET was decreased in normal treatment and urokinase treatment groups after treatment for 8 weeks. The urokinase treatment group has more significant effects on ET decreasing and NO elevating than the normal treatment group （ P 〈 0.01 ）. （~） No obvious changes were observed on SOD and MDA in the normal treatment group. The activity of SOD was elevated and the amount of DA was droped in the urokinase group as compared with the normal group and control significantly（ P 〈 0. 05, P 〈 0.01 ）. Conclusion The method of adding urokinase into peritoneal dialysis solution can benefit to uremia patients with cerebral infarction by reducing the reaction of oxidative stress, lowering the level of plasma ET and elevating nitric Oxide.