轻中度肾功能减退患者血清中氧化应激水平及其与肾小球滤过率的关系

Correlation between oxidative stress and glomerular filtration rate in patients with mild-moderate renal hypofunction

目的观察氧化应激反应对轻中度慢性肾脏疾病（cKD）患者的影响，并从理论上探讨能否通过抑制氧化应激延缓CKD的进展。方法选取CKD2～4期的患者86例，分入原发性慢性肾小球肾炎（PCGN）组和糖尿病肾病（DN）组，每组43例。同时选择36例年龄和性别匹配的健康者作为对照组。所有研究对象均采用酶联免疫吸附试验（EusA）检测血清脂质过氧化产物——前列腺素（PGF）2a水平，采用分光光度法测定血清晚期氧化蛋白产物（AOPP）和抗氧化应激指标维生素E水平。结果校正年龄、性别构成比后，PCGN组与DN组间血清肌酐（sCr）水平、估算肾小球滤过率（eGFR）的差异均无统计学意义（P值均〉0．05）；PCGN组和DN组的sCr水平均显著高于对照组（P值均〈0．05），eGFR均显著低于对照组（P值均〈0．05）。PCGN组和DN组的PGF2a、AOPP水平均显著高于对照组（P值均〈O．05），维生素E水平均显著低于对照组（P值均〈o．05）。PCGN组与DN组间PGF2a、维生素E的差异均无统计学意义（P值均〉0．05），但DN组的AOPP水平显著高于PCGN组（P〈0．05）。随着eGFR下降，CKD患者的PGF2a和AOPP水平均呈上升趋势，但PGF2a、AOPP与eGFR均不相关（R值分别为-0．132和-0．179，P值均〉0．05）；而随着eGFR下降，维生素E水平呈下降趋势，维生素E水平与eGFR亦不相关（R=0．035，P〉0．05）。结论CKD患者体内存在氧化应激状态，CKD2～4期患者体内氧化应激水平与肾小球滤过率不相关，CKD患者能否通过抗氧化治疗来延缓cKD的进展需进一步研究。

[Abstract] Objective To investigate the effect of oxidative stress on patients with chronic kidney disease （CKD） and the possibility of delaying CKD progression by oxidative stress. Methods We selected 86 patients with CKD （2-4 stage） in the study, including 43 patients with primary chronic glomerulonephritis （PCGN） and 43 patients with diabetic nephropathy （DN）. Another 36 healthy volunteers were taken as controls （control group）. The levels of 8-isoprostane F 2c~ （PGF2a） in serum was measured by enzyme linked immunosorbent assay （ELISA）. Advanced oxidation protein products （AOPP） and vitamin E （VitE） in serum were measured by spectrophotometry. Results After adjustment of age and gender, there were no significant differences in serum creatinine （sOt） and estimated glomerular filtration rate （eGFR） between PCGN group and DN group （both P〈 0.05）, but the level of sOr in CKD patients was significantly higher than that in healthy controls （P〈0.05） and eGFR in CKD patients was significantly lower than that in healthy controls （P〈0.05）. The serum levels of PGF2cx and AOPP in CKD patients were significantly higher than those of healthy controls, but the serum level of VitE in OKD patients was lower than that in healthy controls Call P〈0.05）. There were no significant differences in the levels of PGF2a or VitE between PCGN group and DN group （both P〉0.05）. The serum level of AOPP in DN group was significantly higher than that in PCGN group （P〈0.05）. With the decrease of eGFR, the serum PGF2aand AOPP levels were increased, while VitE was decreased. But glomerular filtration rate （GFR） was not correlated with PGF2a, AOPP or VitE （R = -0. 132, -0. 179, 0. 035, all P〉O. 05）. Conclusion Oxidative stress presents in CKD patients. The parameters of oxidative stress in serum, such as PGF2a, AOPP and VitE, are not correlated with GFR in CKD 2 to 4 stage. So we need to further study the effect of antioxidation on the progress of CKD.