维持性血液透析患者炎症、氧化应激状态与心血管并发症的关系

目的研究尿毒症维持性血液透析(MHD)患者炎症、氧化应激状态与心血管并发症的关系。方法对67例尿毒症患者(非透析尿毒症19例,MHD48例)和12例健康对照者采用黄嘌呤氧化酶法测定血清超氧化物歧化酶(SOD),分光光度法测定丙二醛(MDA)、谷光甘肽过氧化物酶(GSHPx),免疫比浊法测定C反应蛋白(CRP)水平,分析炎症、氧化应激状态与心血管并发症的关系。结果与健康对照比较,尿毒症患者炎症和氧化应激状态异常,表现为血清CRP、MDA增高,血清白蛋白(ALB)、SOD、GSHPx降低(P均<0.01);MHD患者炎症和氧化应激状态变化更明显,且随血透时间延长而加重;与无心血管事件发生的MHD患者比较,心血管事件发生的MDH患者炎症和氧化应激状态变化更明显(P<0.01)。相关性分析显示:CRP与MDA呈正相关(r=0.740),与GSHPx、SOD、ALB呈负相关(r=-0.684,-0.688,-0.924);ALB与GSHPx、SOD呈正相关(r=0.744,0.728),与MDA呈负相关(r=-0.779),P均<0.01。Logistic回归分析显示:对心血管事件发生与否具影响和预测性的指标是CRP(回归系数b=-1.054,OR=0.348,P<0.05)。结论MHD患者存在明显的炎症和氧化应激状态;这种状态随MHD时间的延长而加重,可能是心血管事件发生的危险因素。

Relationship Between Cardiovascular Complication and Inflammatoin, Oxidative Stress of Patient with Maintenance Hemodialysis

Objective To evaluate and analyze relationships between states of inflammation,oxidative stress and complicatedly cardiovascular diseases in patients with maintenance hemodialysis(MHD).Methods The analytical method for xanthine oxidase was used to measure the serum superoxide dismutase(SOD),spectrophotometry was used to measure the serum MDA,GSHPx.The immune turbidimetry was used to measure the serum levels of C-reactive protein(CRP)in patients with chronic renal failure.Results Compared with normal control group,the uremia groups had lower serum GSHPx,SOD and ALB levels,but higher CRP and MDA levels(P<0.01).The MHD patients exhibited more serious disturbance of inflammation and oxidative stress which were aggravated as MHD time extended.CRP and MDA were significantly increased but GSHPx,SOD and ALB decreased in patients with cardiovascular events compared with the patients without them(P<0.01).The results of Pearson correlation analysis showed:CRP was correlated with MDA positively(r=0.740,P<0.01),while with GSHPx,SOD,ALB negatively(r=-0.684,-0.688,-0.924,P<0.01).ALB was correlated with GSHPx,SOD positively(r=0.744,0.728,P<0.01),while with MDA negatively(r=-0.779,P<0.01).The results of Logistic regression analysis showed that CRP contributed to the predictability of incidence of CVD(regression coefficient b=-1.054,Wald chi-square=5.251,OR=0.348,P<0.05).Conclusion MHD patients are in the states of inflammation and oxidative stress which are aggravated with the prolonging of hemodialysis time.Inflammation and oxidative stress may be the risk factors for occurrence of cardiovascular events.