Fxclass高通量血液透析器对尿毒症透析患者氧化应激反应影响的临床研究

目的 探讨Fxclass高通量血液透析器对尿毒症透析患者氧化应激反应的影响.方法 将60例血液透析患者按随机数字表法分成3组,每组20例.Fxclass 60高通量组采用Fxclass 60高通量血液透析器治疗；F60HPS高通量血液透析组采用F60HPS高通量血液透析器治疗；F6HPS低通量血液透析器组:采用F6HPS低通量血液透析器治疗；20名健康体检者为正常对照组.所有患者分别在治疗前,治疗第4、8、12周检测血浆晚期氧化蛋白产物、丙二醛水平以及谷胱甘肽过氧化物酶、过氧化物歧化酶活力,检测治疗前及治疗12周后血清补体C3a及白细胞介素1受体拮抗剂的水平,通过检测结果来分析不同膜材料及超滤系数不同的透析器对维持性血液透析患者氧化应激水平的影响.结果 Fxclass 60高通量组、F60HPS高通量血液透析组、F6HPS低通量血液透析组患者治疗前血丙二醛、晚期氧化蛋白产物、补体C3a、白细胞介素1受体拮抗剂、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与正常对照组比较差异有统计学意义(P均＜ 0.01)；各组患者血丙二醛、晚期氧化蛋白产物、补体C3a、白细胞介素1受体拮抗剂水平之间呈正相关(r =0.45,P＜ 0.05).与过氧化物歧化酶、谷胱甘肽过氧化物酶水平之间呈负相关(r=0.38,P＜0.05).治疗4周后Fxclass 60高通量组、F60HPS高通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与治疗前比较差异有统计学意义(P＜0.01)；而F6HPS低通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与治疗前比较差异无统计学意义(P均＞0.05)；治疗第8周时,Fx-class 60高通量组、F60HPS高通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与第4周时比较差异有统计学意义(P均＜0.05)；而F6HPS低通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与治疗前及治疗第4周时比较差异无统计学意义(P均＞0.05)；治疗第8周时,Fxclass 60高通量组和F60HPS高通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平比较差异有统计学意义(P均＜0.05)；而治疗第12周时,Fxclass 60高通量组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与第8周时比较差异有统计学意义(P均＜0.05)；而F60HPS高通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与第8周时比较差异无统计学意义(P＞ 0.05)；F6HPS低通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平与治疗前及治疗第8周时比较差异无统计学意义(P＞0.05)；治疗第12周时,Fxclass 60高通量组和F60HPS高通量血液透析组患者血丙二醛、晚期氧化蛋白产物、过氧化物歧化酶、谷胱甘肽过氧化物酶水平组间比较差异有统计学意义(P均＜0.05)；治疗第12周时,Fxclass 60高通量组患者血清补体C3a、白细胞介素1受体拮抗剂水平与治疗前比较差异有统计学意义(P均＜0.01); F60HPS高通量血液透析组及F6HPS低通量血液透析组患者血清补体C3a、白细胞介素1受体拮抗剂水平与治疗前比较差异无统计学意义(P＞0.05).结论 Fxclass高通量血液透析器可明显降低尿毒症透析患者的氧化应激反应.

Clinical investigation of oxidative stress in plasma from uremic patients by fxclass high-flux hemodialyser

Objective Our aim was to investigate the effect of oxidative stress in plasma from uremic patients by Fxclass high-flux hemo-dialyser.Methods Sixty hemodialysis patients were randomly divided into three groups.Fxclass 6 0 high- flux hemodialyer,F 6 0 HPS high- flux hemodialyer and F 6 HPS Low- flux hemodialyer.were used for the patient groups and the healthy individuals were the controls.Advanced oxidation protein products (AOPP) and malondialdehyde (MDA) levels,glutathione peroxidase (GSH-PX) and supero-xide dismutase (SOD) activity were tested before and after 4,8 and 12 week hemodialysis,respectively.Serum complement component C3a and interleukin-1 receptor antagonist (IL-1Ra) were detected before and after 12-week treatment.These data could reflect the serum oxidative stress level in uremic patients using hemodialyers made of different distributors.Results Before hemodialysis,serum MDA,AOPP,C3a and IL-1Ra levels in uremic patients were significantly higher,while SOD and GSH-PX levels were lower than the controls (all P ＜ 0.01).In each testing group,MDA,AOPP,C3a and IL-1Ra levels showed a positive correlation but SOD and GSH-PX activity showed a negative correlation.Compared with the controls,MDA and AOPP levels decreased while SOD and GSH-PX activity increased after 4-week treatment using Fxclass 60 high-flux hemodialyer and F60HPS high-flux hemodialyer (all P ＜ 0.01 ) but F60HPS low-flux hemodialyer group showed no change (all P ＞ 0.05).After 8-week treatment,MDA and AOPP levels declined further while SOD and GSH-PX activity increased compared with the 4-week treatment using Fxclass 60 high-flux hemodialyer and F60HPS high-flux hemodialyer ( all P ＜ 0.05) but F60HPS low-flux hemodialyer group showed no change ( P ＞ 0.05).After 12-week treatment,compared with patients using F60HPS high-flux hemodialyer,patients using Fxclass 60 high-flux hemodialyer gained lower MDA and AOPP levels,and higher SOD and GSH-PX activity (all P ＜ 0.01 ).Also there was a significant difference between the level of MDA,AOPP,SOD and GSH-PX in patients using Fxclass 60 high-flux hemodialyer and F60HPS high-flux hemodialyer (all P ＜0.05).The levels of C3a and IL-1Ra obviously decreased after 12-week treatment by Fxclass 60 High-flux hemodialyer ( P ＜ 0.01 ).The levels of MDA and AOPP and the activity of SOD and GSH-PX in patients showed no changes before and after treatment by F6HPS low-flux hemodialyer( P ＞0.05).Conclusion Fxclass high-flux hemodialysis could significantly decreased serum oxidative stress of uremic patients.