甲基强的松龙与环磷酰胺冲击治疗对狼疮肾炎患儿抗氧化功能的影响

Effect of Methylprednisolone and Cyclophosphamide Impulsive Therapy on the Anti-Oxidation Function in Children with Lupus Nephritis

目的 探讨狼疮肾炎 (LN)患儿血中一氧化氮 (NO)、脂质过氧化物 (LPO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶 (GSH - px)和谷胱甘肽 (GSH)的变化及甲基强的松龙 (MP)与环磷酰胺 (CTX)冲击治疗对它们的影响。方法 采用化学分析法检测 18例活动期LN患儿MP和CTX冲击治疗前、后血中上述 5项指标 ,对其中经治疗后达稳定期的 16例LN患儿及健康儿童 2 3例也检测了上述 5项指标。结果 稳定期LN患儿仅GSH低于对照组 (P <0 .0 5 ) ,NO ,LPO ,SOD和GSH - px与正常对照组比较差异无显著性。活动期LN患儿 5项指标与对照组及稳定期比较差异有显著性 (P <0 .0 5或 0 .0 1)。NO ,LPO与抗ds -DNA抗体、2 4h尿蛋白定量、尿素氮 (BUN)、血肌酐 (Scr)和血沉 (ESR)呈显著正相关 (P <0 .0 1) ;与补体C3、C4、内生肌酐清除率 (Ccr)呈显著负相关 (P <0 .0 5或 0 .0 1) ;而SOD ,GSH -px和GSH、抗ds -DNA抗体、2 4h尿蛋白定量、BUN、Scr和ESR呈显著负相关 (P <0 .0 5或 0 .0 1) ;与C3、C4、Ccr呈显著正相关 (P <0 .0 5或 0 .0 1)。肾功能不全组 5项指标水平与肾功能正常组及对照组比较均有显著性差异 (P <0 .0 5或 0 .0 1)。结论 MP和CTX冲击治疗能显著降低NO ,LPO水平 ,升高SOD ,GSH - px和GSH水平。NO ,LPO ,SOD ,GSH -

Objective To study the changes of blood nitric oxide (NO), lipid peroxide (LPO), superoxide dismutase (SOD), glutathione peroxidase (GSH-px) and glutathione (GSH) levels and the effect of impulsive therapy of methylprednisolone (MP) and cyclophosphamide (CTX) on children with lupus nephritis (LN). Methods The blood levels of NO, LPO, SOD, GSH-px and GSH were detected by chemical analysis in 18 active patients with this disorder (the active group) before and after MP and CTX impulsive therapy. Of the 18 cases, 16 who had become to inactive after treatment were recruited in this study. Twenty three healthy children were served as the control group. Results Except the decreased GSH level, the levels of NO, LPO, SOD and GSH-px in the inactive group did not differ from those of the control group. The levels of NO and LPO in the active group were significantly higher, SOD, GSH px and GSH were significantly lower than those of the control group and the inactive group (P< 0.05 or 0.01 ). NO and LPO in the active group were positively correlated with anti-dsDNA antibody, 24-hour proteinuria, blood urea nitrogen, serum creatinine and erythrocyte sedimentation rate, negatively correlated with complement C 3, complement C 4 and endogenous creatinine clearance rate. SOD, GSH-px and GSH were negatively correlated with anti-dsDNA antibody, 24-hour proteinuria, blood urea nitrogen, serum creatinine and erythrocyte sedimentation rate, positively correlated with compliment C 3, compliment C 4 and endogenous creatinine clearance rate. The levels of the five parameters (NO, LOP, SOD, GSH px and GSH) in children with LN complicated by renal damage were significantly different from those in the control group and those patients without renal damage. Conclusions The levels of NO and LPO would decrease and the levels of SOD, GSH-px GSH would elevate after treatment with MP and CTX. NO, LPO, SOD, GSH-px and GSH may take part in the pathogenesis of LN. Detecting the above five parameters may help in monitoring the progress, the extent of renal damage of LN and therapeutic effect for LN patients.