复用透析器对维持性透析患者氧化应激状态影响的研究

目的探讨复用透析器对慢性透析(CHD)患者氧化应激(OS)状态的影响及临床意义.方法 55例首次血液透析的慢性终末期肾病(ESRD)患者在采用新纤维素膜透析器透析治疗4周后,随机分为两组,Ⅰ组(n=27)继续使用新透析器维持透析,Ⅱ组(n=28)使用复用一次的透析器维持透析4周,同时设正常对照组22例,对比ESRD患者与正常对照组、单次血液透析前后以及采用新透析器和复用透析器维持血液透析四周前后血浆和红细胞丙二醛(MDA)、红细胞超氧化物歧化酶(e-SOD)及血谷胱甘肽过氧化酶(GSH-px)水平.结果 ESRD患者血浆和红细胞MDA较正常对照组显著增高,红细胞SOD及GSH-px显著降低(P＜0.05).单次血液透析前后OS指标无显著变化,使用新透析器透析4周后,红细胞MDA显著增高(P＜0.05);使用复用透析器透析4周后红细胞MDA改变无显著性差异(P＞0.05),两组病例维持血液透析4周后SOD均显著增高,而GSH-px无显著改变(P＞0.05).结论 ESRD患者氧化应激加强,新透析器CHD可能加剧这一改变,而复用透析器有利于降低氧化应激反应.

Effect of reusing dialyzer on oxidative stress status in chronic hemodialysis patients

Objective To study the effects of reusing dialyzer on oxidative stress status in chronic hemodialysis (CHD) patients. Methods Fifty-five end stage renal disease (ESRD) patients who received hemodialysis therapy with cellulose menbrane for 4 weeks were divided into two groups randomly. Group I received hemodialysis with new cellalose membrane. While the patients in group II reused dialyzer for four weeks. Twenty-two healthy adults were regarded as normal controls. MDA, e-SOD and GSH-px levels were compared between ESRD patients and normal controls, before and after asingle hemodialysis session and the two groups with new dialyser and reused dialyzer. Results The levels of MDA in plasma and erythrocyte in ESRD patients were significantly higher while the levels of SOD in erythrocyte and GSH-px in plasma were lower than those of normal controls (P<0.05). The marker of oxidative stress did not change significantly after primary hemodialysis, but the MDA level in erythrocyte increased significantly in group I, while deceased gently in group II. The SOD level in erythrocyte increased significantly in both two groups. Conclusion Oxidative stress is increased in patients with ESRD, which might be accelerated by chronic hemodialysis, but decreased by reuse dialyzer.