维生素C透析液对维持性血液透析患者动脉钙化的干预作用

摘要

Objective To study the effect and possible mechanism of Vitamin C dialysate intervention on aintenance hemodialysis ( MHD ) patients with arterial calcification.Methods Ninety - four stable MHD patients from Center for Blood Purification, First Affiliated Hospital of Zhengzhou University were enrolled in this study, and they were randomized into group A and group B.Patients in group A ( 47 cases ) were given regular dialysate, while those in group B ( 47cases ) were given dialysate containing vitamin C for MHD for three months.Levels of serum calcium, phosphorus, alkaline phosphatase ( ALP ), vitamin C ( VitC ), serum albumin ( ALB ), serum C - reactive protein ( CRP ), high oxidation protein products ( AOPP ), fetuin A were measured before and after maintenance hemodialysis.And with spiral CT the scores of coronary artery calcification were tested before and after the treatment.Results CD Levels of serum calcium, phosphorus, ALB, vitamin C, ALP, CRP, AOPP, coronary artery calcification scores and fetuin A showed no significant difference between the two groups before the treatment ( P ＞ 0.05 ).(2)After given regular dialysate for 3 months, levels of serum calcium, phosphorus, alkaline phosphatase ( ALP ), CRP, AOPP and coronary artery calcification score of patients in group A increased slightly, while fetuin A decreased slightly, but showing no significant difference compared with those before the treatment ( P ＞ 0.05 ).The levels of serum vitamin C and ALB decreased significantly ( P ＜ 0.05 ); For the patients in group B, after given dialysate containing vitamin C for 3 months, levels of serum calcium, phosphorus, vitamin C and ALB increased slightly, showing no statistically significant difference compared with those before the treatment ( P ＞0.05 ).Levels of serum ALP, CRP, AOPP and coronary artery calcification score decreased significantly, while fetuin A levels increased significantly compared with those before the treatment ( P ＜0.05 ).Conclusion MHD using regular dialysate may cause large amount loss of vitamin C.MHD using dialysate containing vitamin C may result in the decrease of the inflammation and oxidative stress, improving nutritional status as well as the status of MHD patients with arterial calcification.%目的 探讨维生素C透析液对维持性血液透析(MHD)患者动脉血管钙化的干预作用及其可能的机制.方法 选择在郑州大学第一附属医院血液净化中心长期透析的患者94例,随机分成两组,分别使用常规透析液(A组47例)和含维生素C透析液(B组47例)进行MHD,周期为3个月,治疗前及治疗后抽取血液检测血清钙、磷、碱性磷酸酶(ALP)、维生素C(VitC)、血清清蛋白( ALB)、血清C反应蛋白(CRP)、晚期氧化蛋白产物(AOPP)、胎球蛋白A的水平,并用螺旋CT检查治疗前后冠状动脉钙化积分.结果 (1)治疗前两组患者的钙、磷、ALB、维生素C、ALP、CRP、AOPP、冠状动脉钙化积分、胎球蛋白A水平间差异均无统计学意义( P ＞0.05).(2)治疗3个月后A组患者的血清钙、磷、ALP、CRP、AOPP、冠状动脉钙化积分轻度升高,胎球蛋白A水平轻度降低,但与治疗前比较差异无统计学意义( P ＞0.05);维生素C、ALB明显降低,与治疗前比较差异有统计学意义( P ＜0.05).治疗3个月后B组患者的血清钙、磷、维生素C、ALB轻度升高,与治疗前比较差异无统计学意义( P ＞0.05).ALP、CRP、AOPP、冠状动脉钙化积分明显降低,胎球蛋白A水平明显升高,与治疗前比较差异有统计学意义( P ＜0.05).结论 常规透析使大量维生素C丢失;维生素C可以减轻炎症与氧化应激状态,改善营养状态,进而改善MHD患者的动脉钙化状况.