静脉铁剂对维持性血液透析患者微炎症反应和氧化应激状态的影响

Influence of intravenous iron on micro inflammation reaction and oxidative stress state in patients with maintenance hemodialysis

目的观察静脉铁剂对维持性血液透析(MHD)患者微炎症反应和氧化应激状态的影响。方法检测48例病情稳定、透析时间3个月以上、行静脉补铁的肾性贫血MHD患者补铁前,补铁1、3、5、7及10周血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-(TNF-)、白介素-6(IL-6)、脂质过氧化物丙二醛(MDA)及谷胱甘肽过氧化物酶(GSH-px)水平,评价经静脉补铁对MHD患者并发症发生的诱导作用。结果补铁1周后,hs-CRP、TNF-、IL-6及MDA升高,GSH-px降低(均<0.01)。3周后,hs-CRP、TNF-、IL-6及MDA仍上升,至5周时达最高峰,而GSH-px在5周时达最低水平,但与1周时差异均无统计学意义(均>0.05)。与5周比较,补铁7周后hs-CRP、TNF-、IL-6及GSH-px有所降低,MDA继续升高,但各组间差异无统计学意义(均>0.05)。补铁10周后各指标逐渐恢复,但与7周时差异均无统计学意义(均>0.05)。结论静脉补铁早期就可促进MHD患者微炎症反应,并加重其氧化应激,但在中后期逐渐减弱而趋于稳定。

Objective To observe the influence of intravenous iron on micro inflammation reaction and oxidative stress state in patients with maintenance hemodialysis（MHD）. Methods Serum high-sensitivity C-reactive protein （hs- CRP）, tumor necrosis factor-a（TNF-α）, interleukin-6（IL-6）, malondialdehyde （MDA） and glutathione peroxidase （GSH- px） level were detected among 48 renal anemia MHD patients with stable condition and dialysis time more than three months before intravenous iron supplementation and one, three, five, seven and ten weeks after intravenous iron supplementation to evaluate the complications induced by intravenous iron. Results One week after intravenous iron supplementation, hs-CRP, TNF-α, IL-6 and MDA increased, GSH-px decrease （P 〈 0.01）. After three weeks, the hs-CRP, TNF-α, IL-6 and MDA still rise, peaked at the fifth week; GSH-px reached the lowest level in the fifth week, but there no significant difference compared with the first week. Compared with the fifth week, hs-CRP, TNF-α, IL - 6, GSH -px decreased at the seventh week; MDA continue to rise, but there was no statistically significant difference between the groups （P 〉 0.05）. Ten weeks later, each index gradually restored, but the differences had no statistical significances compared to those of the seventh week （P 〉 0.05）. Conclusion Intravenous iron can promote the inflammatory reaction in MHD patients in the early period and increase the oxidative stress, but in the later period gradually reduce and tends to be stable.