维生素C透析液对维持性血液透析静脉补铁患者微炎症因子表达的影响

Ascorbic acid dialysate attenuates oxidative stress and microinflammation induced by intravenous iron administration in patients with maintenance hemodialysis

目的观察维生素C透析液对维持性血液透析(MHD)静脉补铁患者的微炎症因子hs-CRP、TNF-a、IL-6、MDA、GHS-px等表达的影响,探讨其抗氧化应激反应的作用。方法选择病情稳定、透析时间3个月以上、静脉补铁纠正贫血的MHD患者52例,按随机数字表法分为常规透析液组(A组)和维生素C透析液组(B组),每组26例。共进行3次血hs-CRP、TNF-a、IL-6、MDA、GHS-px因子的测定,第1次为补铁前,第2次为补铁第5周,第3次为补铁第7周。结果两组患者在补铁前各项微炎症因子的差异无统计学意义(P>0.05)。补铁第5周,两组患者hs-CRP、TNF-a、GSH-px因子的差异有统计学意义(P<0.01),IL-6、MDA因子差异有统计学意义(P<0.05)。补铁第7周,两组患者TNF-a、IL-6、MDA、GHS-px因子的差异有统计学意义(P<0.01),而hs-CRP因子的差异无统计学意义(P>0.05);两组患者均未见恶心、呕吐、过敏和腹泻等不良反应。结论静脉补铁可诱发微炎症反应,加重氧化应激反应,使用维生素C透析液可明显改善静脉补铁MHD患者的微炎症和氧化应激反应。

Objective To investigate effect of ascorbic acid dialysate on oxidative stress and microinflammation induced by intravenous iron administration in patients with maintenance hemodialysis （MHD）. Methods Forty-eight MHD patients with intravenous iron administration for 〉3m were randomly assigned to use regular dialysate （group A, n=24） or ascorbic acid dialysate （group B, n=24）. The serum hypersensitive C reactive protein（hs-CRP）, tumor necrosis factor-α（TNF-α）, interleukin-6 （IL-6）, malon-dialdehyde （MDA） and glutathione peroxidase （GHS-px） were measured before 5 and 7 weeks after iron adminis-tration. Results There was no significant difference in the inflammatory factors before iron administration between two groups. The serum TNF-a, GSH-px, IL-6 and MDA levels were lower in group B than those in group A 5 and 7 weeks after iron adminis-tration （P〈0.01 or 0.05）; how the lower hs-CRP level only detected in group B at 5 weeks after iron administration （P〈0.01）. No side effects including nausea, vomiting, hypersensitivity or diarrhea were observed in both groups. Conclusion Intravenous iron administration can induce microinflammatory reaction and oxidative stress, which may be attenuated by using ascorbic acid dialysate in MHD patients.