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

摘要

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α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.%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 Ⅱ , 20 cases) and intravenous iron supplement + (group Ⅲ, 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-α in plasma were measured before and after treatment. RESULTS: After 8 weeks of treatment, Hb, Hct and SF levels of 3 groups were significantly increased after treatment (P<0.01); the increase of Hb, Hct and SF levels in group Ⅱwere more significant than in group Ⅰ , and group Ⅲ were more significant than in group Ⅱ(P<0.05). The levels of oxidation index and inflammation index had statistical significance of group Ⅰ and Ⅱbefore 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 deficiency , but also exacerbate the state of oxidative stress and microinflammatory reaction. Reduced glutathione could improve oxid-aive stress and microinflammatory state in MHD patients receiving Iron sucrose injection.