慢性肾脏病时的氧化应激评价指标研究

目的：研究慢性肾脏病（CKD）时氧化应激的评价指标,以确定可以稳定反映氧化应激水平的指标。方法：选择2008年7月—12月在复旦大学附属中山医院诊断为CKD1~5期的住院患者73例,以10例同期在骨科住院行择期手术的无肾脏疾病患者为对照组,测定其血浆晚期氧化蛋白产物（AOPP）、丙二醛（MDA）以及谷胱甘肽过氧化物酶（GSH-PX）、过氧化物歧化酶（SOD）和过氧化氢（CAT）的活力。结果：血浆AOPP和MDA水平CKD组显著高于对照组（P〈0.05）,其中血浆AOPP水平随着肾功能减退逐渐升高,在CKD1~5期各组之间均有显著差异（P〈0.05）。血浆GSH-PX、SOD和CAT水平CKD组显著低于对照组（P〈0.05）,其中前两者在CKD患者随着肾功能减退呈逐渐降低的趋势（P〈0.05）。结论：CKD患者存在过度氧化应激。血浆AOPP水平随着肾功能的减退逐渐升高,它是反映机体氧化应激水平的的稳定指标,并可较好地区别CKD不同肾损伤阶段氧化应激反应的变化;GSH-PX和SOD是较好的抗氧化指标。

Evaluation on Makers of Oxidative Stress in Chronic Kidney Disease

Objective：To investigate how markers of oxidative stress changed in chronic kidney disease（CKD）.Efforts were made to establish a series of methods to reflect the real situation of oxidative stress.Methods： According to the definition of CKD in K/DOQI（2006）,73 patients with CKD,who were treated in our department during July 2008 to Dec.2008,were enrolled in the present study.Ten patients received elective operation in the orthopeadic department during the same period were enrolled as controls.The advanced oxidative protein product（AOPP）,malonaldehyde（MDA）,glutathione peroxidase（GSH-PX）and superoxide dismutase（SOD）were investigated.Results： Plasma AOPP and MDA levels were significantly higher in CKD group compared with those in control group（P0.05）.AOPP increased with the progression of kidney function.Plasma GSH-PX,SOD and CAT were significantly lower in CKD group compared with those in control group（P0.05）.Plasma GSH-PX and SOD decreased with the progression of kidney function（P0.05）.Hs-CRP increased with the progression of kidney function.But there was no significant difference in CKD stage 1 to 5.Hs-CRP correlated well with plasma AOPP,SOD,GSH-PX and MDA（all P0.05）.Conclusions： Oxidative stress widely exists in CKD patients.AOPP increases with the worsening of kidney function.It can reflect changes of oxidative stress in different CKD stages.Plasma AOPP might be more reliable than MDA and GSH-PX to delineate the status of oxidative stress.The oxidative stress is closely related to micro-inflammation status of patients.