还原型谷胱甘肽对使用静脉铁治疗肾性贫血的MHD患者微炎症状态的影响

目的：观察还原型谷胱甘肽对使用静脉铁治疗肾性贫血的维持性血液透析（MHD）患者微炎症状态的影响。方法：选择2009-2011年于我院就诊的MHD患者60例，采用前瞻性、随机对照研究，随机分为口服补铁组（I组，20例）、静脉补铁组（Ⅱ组，20例）、静脉补铁＋还原型谷胱甘肽组（Ⅲ组，20例），观察各组用药前后血红蛋白浓度（Hb）、红细胞压积（Hct）、血清铁、血清铁蛋白（SF）等疗效指标以及血清中丙二醛、过氧化物歧化酶等氧化指标，以及血清c反应蛋白、白介素6、肿瘤坏死因子q等炎症指标的变化，并监测不良反应。结果：用药8周后，3组患者的Hb、Hct、SF水平较用药前均有显著升高（P〈0．01），且Ⅱ组较I组升高更显著（P〈0．05），Ⅲ组较Ⅱ组升高更显著（P〈0．01）。应用铁剂后I、Ⅱ组的氧化应激和炎症指标均较治疗前显著升高（P〈0．05），但Ⅲ组升高不明显（P〉0.05），用药后3组组间比较有显著性差异（P〈0．01）。结论：静脉补铁较口服补铁可有效改善MDH患者贫血及缺铁，但在一定程度上增加了体内的氧化应激和微炎症反应，使用还原型谷胱甘肽能有效改善使用静脉铁注射的MHD患者的氧化应激和微炎症状态。

Effects of Reduced Glutathione on Micro-inflammatory State in Patients with MHD of Intravenous Iron Supplement

OBJECTIVE： To observe the effects of reduced glutathione on micro-inflammatory state in patients with maintenance hemodialysis （MHD） of intravenous iron supplement. METHODS： 60 MHD patients visiting our hospital were involved in retrospective randomized controlled trial and were randomized into 3 groups, i.e. oral iron supplement group （group I , 20 cases） and intravenous iron supplement （group 11 , 20 cases） and intravenous iron supplement＋ （group IU, 20 cases）. The hemoglobin （Hb） concentration, hematocrit （Hct）, serum iron, serum ferritin （SF）, and other indicators as well as serum malondialdehyde, superoxide dismutase, and the levels of C-reactive protein, interleukin-6 and tumor necrosis factor-a in plasma were measured be- fore and after treatment. RESULTS： After 8 weeks of treatment, Hb, Hct and SF levels of 3 groups were significantly increased af- ter treatment （P〈0.01） ; the increase of Hb, Hct and SF levels in group I/ were more significant than in group I , and group lU were more significant than in group 1I （P〈0.05）. The levels of oxidation index and inflammation index had statistical significance of group I and II before and after treatment（P〈0.05）, but no statistical significance in group III （P〉0.05）. CONCLUSION： Compared with oral iron supplement, Intravenous iron supplement can be effective in improving patients with anemia and iron deftciency, but also exacerbate the state of oxidative stress and microinflammatory reaction. Reduced glutathione could improve oxidaive stress and microinflammatory state in MHD patients receiving Iron sucrose injection.