【作者】 朱冬菊；

【导师】 张玲；

【作者基本信息】 重庆医科大学 ， 内科学， 2007， 硕士

【摘要】 目的:分析维持性血液透析(MHD)患者中伴心血管疾病者体内的氧化应激状态,探讨氧化应激状态与其动脉粥样硬化病变之间的关系。方法:MHD患者53例,分为两组,A组:21例,患者合并心血管疾病(包括急性心肌梗死、缺血性心脏病、脑血管疾病和闭塞性周围动脉粥样硬化);B组:32例,患者无心血管疾病。健康对照者20例。检测血中丙二醛(MDA)、晚期氧化蛋白产物(A0PP)、过氧化物歧化酶(SOD)、氧化低密度脂蛋白(ox-LDL)、C反应蛋白(CRP)的水平;同时测患者的血脂,血压。观察MHD中,A、B两组患者与健康对照组,及A、B两组患者间,是否存在氧化应激状态的差异。并给予MHD患者口服VitE400mg/d,服用6周,观察MHD两组患者上述指标的变化,并进行统计学分析。结果:MHD两组患者的氧化指标MDA、AOPP、ox-LDL均显著高于正常对照组(P<0.01), VitE及抗氧化指标SOD活性均明显低于正常对照组(P<0.01),炎症指标CRP水平明显高于正常对照组(P<0.01)。MHD患者中,A组的氧化指标MDA、AOPP明显高于B组(P<0.05),抗氧化指标SOD明显低于B组(P<0.05),并且A组的动脉粥样硬化指标ox-LDL也明显高于B组(P<0.05)。其它与动脉粥样硬化发生有关的传统因素:如血脂、血压、年龄及糖尿病的发生率在MHD两组患者间无显著性差异。给予VitE治疗后,MHD两组患者,MDA、AOPP均较治疗前降低(P<0.05), VitE、SOD活性较治疗前增高(P<0.01),CRP水平较治疗前降低(P<0.05)。MHD两组患者的ox-LDL的水平治疗后较治疗前下降,但差异无统计学意义(P>0.05)。结论:MHD伴有心血管疾病的患者其体内的氧化应激状态显著高于无心血管并发症的患者,而其它与动脉粥样硬化病变发生的相关因素在MHD两组患者间无显著性差异,提示体内氧化应激与MHD患者动脉粥样硬化病变的发生有一定关系。抗氧化剂VitE使氧化应激相关的各项指标均得到改善,因而MHD患者通过抗氧化治疗可能减少或改善的动脉粥样硬化病变。更多还原

【Abstract】 Objective: To analyze the levels of several markers of oxidative stress in MHD patients with cardiovascular disease, and then to characterize the relationship between oxidative stress and atherosclerosis in MHD patients,Methods: 53 MHD patients were entered into study. The patients were divided into two groups, group A: the patients with positive history of atherosclerotic disease (n=21), group B: the patients without positive history of atherosclerotic disease (n=32).There are 20 health persons in control group. Serum levels of Vitamin E, malondialdehyde(MDA), advanced oxidation protein product(AOPP), superoxide dismutase(SOD), oxidized low-density lipoprotein(ox-LDL), and microinflammation cytokines C-reactive protein(CRP) were measured in A, B and control groups . All serum markers of oxidative stress and CRP noted above were measured again in patients by oral VitE(400mg/d ) after 6 weeks and the results were analyzed.Results: Levels of MDA、AOPP、ox-LDL、CRP were significantly higher in MHD patients than in healthy controls(p<0.01). VitE concentration and the activity of SOD in MHD patients were dramatically lower than those in controls respectively. MDA,AOPP,ox-LDL and CRP significantly increased in group A Compared to group B. Serum VitE levels and the activity of SOD in group A were lower than group B(p<0.05).There were no significant difference about the other correlation factors: blood fat, blood pressure, age, the incidence rate of diabetes. AOPP,MDA,and CRP in all MHD patients were decreased by oral VitE after 6 weeks (p<0.05) and VitE、SOD were increased(p<0.05).There was no significant change on ox-LDL.Conclusions: The level of oxidative stress in MHD patients with cardiovascular disease is higher than those without, and there were no significant difference about the other correlation factors of cardiovascular disease. These results indicate the oxidative stress may be a factor in accelerated atherosclerotic disease in MHD patients. Oxidative stress in MHD patients was ameliorate by VitE.更多还原