终末期肾脏病患者脂联素、炎症和氧化应激变化、透析的影响及其机制

Change of serum adiponectin, inflammation and oxidative stress in end-stage renal disease patients, influence of dialysis and its mechanisms

目的:探讨终末期肾脏病(ESRD)患者血清脂联素(ADPN)、炎症因子和氧化应激变化、透析治疗的影响及其机制。方法:选择ESRD患者78例,分为非透析组(26例)、血透组(27例)和腹透组(25例),另择健康体检者30例为对照组。采用酶联免疫吸附法(ELISA法)测定血清ADPN、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平,比色法检测黄嘌呤氧化酶(XO)和髓过氧化物酶(MPO)活性,黄嘌呤氧化酶法检测超氧化物歧化酶(SOD)活性,硫代巴比妥酸法检测血清丙二醛(MDA)含量。结果:3组ESRD患者的ADPN、hs-CRP、TNF-α、IL-6、XO、MPO和MDA均明显高于对照组,而SOD均明显低于对照组,差异有统计学意义(均P<0.01)。两透析组分别与非透析组相比,ADPN差异均无统计学意义(均P>0.05),而它们的hs-CRP、TNF-α、IL-6、XO、MPO和MDA皆显著高于非透析组(P<0.05或P<0.01),SOD均明显低于非透析组(均P<0.01)。相关性分析显示,ADPN与hs-CRP、TNF-α、IL-6、XO、MPO、MDA皆呈显著正相关(分别为r=0.584、r=0.517、r=0.461、r=0.477、r=0.563、r=0.492,均P<0.01),与SOD呈显著负相关(r=-0.508,P<0.01)。结论:ESRD患者血清ADPN水平显著升高,其主要原因可能是肾功能下降、炎症状态和氧化应激状态相互诱导,协同作用所致。血液透析和腹膜透析不能降低ADPN,炎症状态和氧化应激状态反而加重。

Objective： To explore change of the serum adiponectin（ADPN） levels, inflammation factor and oxidative stress in patients with end-stage renal disease（ESRD）, influence of maintenance dialysis treatment and its mechanisms. Methods： Seventy-eight cases of patients with ESRD were selected and divided into non dialysis group（26 cases）, hemodialysis group（27 cases） and peritoneal dialysis group（25 cases）, another health check-up 30 cases were chosen as control group. By the methods of enzyme-linked immunosorbent assay（ELISA） serum adiponectin（ADPN）, high-sensitivity C-reactive protein（hs-CRP）, tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） levels were detectd, the xanthine oxidase（XO） and myeloperoxidase（MPO） activity were detected with colorimetric method, superoxide dismutase（SOD） activity was detected with xanthine oxidase method, melondialdehyde（MDA） content was detected with glucosinolates barbituric acid method. Results： Three groups of patients with ESRD ADPN, hs-CRP, TNF-α, IL-6, XO, MPO and MDA were significantly higher than that of control group, and SOD were significantly lower than that of the control group, the difference was statistically significant（all P〈0.01）. Two dialysis groups, respectively, compared with non dialysis group, ADPN had no statistical difference（all P〈0.05）, and their hs-CRP, TNF-α, IL-6, XO, MPO and MDA were significantly higher than that of non dialysis group（P〈0.05 or P〈0.01）, SOD were significantly lower than that of the non dialysis group（all P〈0.01）. Correlation analysis showed that ADPN with hs-CRP, TNF-α, IL-6, XO, MPO and MDA was significantly positive correlation（r=0.584, r=0.517, r=0.461, r=0.477, r=0.563, r=0.492, respectively, all P〈0.01）, and SOD was significantly negative correlation（r=-0.508, P〈0.01）. Conclusion： A significant rise in ESRD patients serum ADPN level, the main reason may be a decline in kidney function, inflammation and oxidative stress state mutual induction, synergy. Hemodialysis and peritoneal dialysis can not reduce the ADPN, while inflammation and oxidative stress aggravate.