肾衰竭患者静脉铁剂诱导的氧化应激状态及硫辛酸干预作用的研究

目的 观察慢性肾衰竭患者由静脉铁剂诱导的氧化应激,探讨硫辛酸对其的预防作用.方法 慢性肾衰竭非透析患者20例,每位患者均先后接受单纯静脉铁剂治疗(Fe组)及硫辛酸预防性处理(LA Fe组).测定并分析静脉铁剂滴注前(0小时)和滴注后1小时、2小时及3小时血清中超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-px)、丙二醛(MDA)水平的变化.结果 Fe组血清SOD、GSH-px水平下降,在1小时时达谷值(P<0.01,P<0.05),血清MDA水平明显升高,在1小时时达峰值(P<0.01).LA Fe组血清SOD、GSH-px及MDA水平变化趋势与Fe组相似,但与Fe组比较,血清SOD、GSH-px水平在各时间点均有显著性升高(P<0.01),MDA水平在各时间点均显著下降(P<0.01).结论 慢性肾衰竭患者接受静脉铁剂治疗时,可以诱导氧化应激反应在短期内急性加剧.静脉铁剂应用前静脉滴注硫辛酸可在一定程度上减轻这种氧化应激状态.

Effects of lipoic acid on oxidative stress induced by intravenous iron infusion

Objective To observe oxidative stress induced by intravenous iron and its prevention by intravenous lipoic acid in chronic renal failure patients.Methods Twenty cases of chronic renal failure patients without dialysis were recruited in the study.Each of them received simple intravenous iron therapy(Fe group),with lipoic acid just before iron infusion(LA Fe group).The levels of serum superoxide dismutase(SOD),glutathione peroxidase(GSH-px) and malondialdehyde(MDA) were measured before(0h) and 1,2,3 hours after intravenous iron infusion.Results In Fe group,compared with the baseline(0h),the levels of SOD and GSH-px decreased and reached the bottom value(P<0.01 or P<0.05) after 1 hour,the levels of MDA increased significantly and reached the peak value(P<0.01) after 1 hour.In LA Fe group,the dynamic changes of redox markers were similar to those in Fe group.Meanwhile,the levels of SOD and GSH-px were higher than those in Fe group(P<0.01) ,and the levels of MDA were lower than those in Fe group(P<0.01) at various time points.Conclusions Intravenous iron therapy could induce acute aggravation of oxidative stress in chronic renal failure patients,which could be alleviated by intravenous lipoic acid.