口服维生素C对血液透析患者体内微炎症状态的影响

目的分析维持性血液透析(maintain hemodialysis,MHD)患者口服维生素C对炎症指标的影响,了解维生素C与MHD患者体内炎症状态的关系。方法选择北京大学第一医院血液透析中心病情稳定的MHD患者,入选标准:①未服用维生素C或服用维生素C不超过2周;②年龄20～80岁,病情稳定,规律透析大于3个月;③Kt/V>1.2。排除标准:①急性炎症;②活动性自身免疫病、肝炎、肿瘤及血液病;③妊娠;④HIV阳性。共入选76例(男性26例,女性50例),平均年龄(60.3±13.4)岁,透析龄(63.3±42.4)月。其中服用维生素C者(治疗组)42例,未服用者(对照组)34例,观察时间为6～8个月。比较2组患者血红蛋白、中性粒/淋巴细胞比值、血浆白蛋白、前白蛋白及高敏C反应蛋白(highsensitivity C-reactive protein,hs-CRP)等炎症相关指标的变化。血浆维生素C浓度的测定采用高效液相色谱法测定。结果相比治疗前,治疗组hs-CRP明显降低(P<0.05),而血红蛋白、白蛋白及前白蛋白均明显升高(均P<0.05);对照组血红蛋白、白蛋白及前白蛋白无明显变化,而hs-CRP有升高趋势(P=0.048)。观察结束时,治疗组血浆前白蛋白明显高于对照组(P<0.05),而hs-CRP明显低于对照组(P<0.01)。结论为MHD患者补充维生素C可在一定程度上改善体内炎症指标。

The effects of oral vitamin Con microinflammatory state in hemodialysis patients

Objective To assess the effects of oral vitamin C on inflammation biomarkers,and to better understand the relationship between oral vitamin C and inflammatory status in maintenance hemodialysis（MHD） patients.Method Stable MHD patients treated in the Hemodialysis Center in Peking University First Hospital were selected for this prospective study.The inclusion criteria were（1） not taking vitamin C or taking vitamin C for no more than 2 weeks,（2） 20 ～ 80 years of age and on regular MHD for at least 3 months,and（3） Kt/V 1.2.The exclusion criteria included（1） acute inflammation,（2） active autoimmune diseases,hepatitis,tumor or hematological diseases,（3） pregnancy,and（4） HIV positive.Seventy-six patients（26 men and 50 women） were enrolled in this study,of whom 42 patients were treated with oral vitamin C for 6-8 months as the treated group and 34 patients were followed up without supplemental vitamin C as the control group.Hemoglobin,neutrophil/lymphocyte ratio,plasma albumin,prealbumin and hypersensitive C-active protein（hsCRP） were compared between the 2 groups.Plasma vitamin C was determined by high-performance liquid chromatography（HPLC）.Result At the end of study,the treated group showed a significant reduction of plasma hsCRP（P0.05）,and increases of hemoglobin（P0.05）,albumin（P0.05） and prealbumin（P0.05）.In control group,however,these parameters remained unchanged except a virtually rise tendency of hsCRP（P=0.048）.Plasma prealbumin was much higher in the treated group than in the control group（P0.05）,and hsCRP was much lower in the treated group than in the control group（P0.01）.Conclusion Inflammation status in MHD patients could be partially improved by oral vitamin C supplement.