静脉补铁对腹膜透析患者氧化应激状态的影响作者：杜艺李宓罗杏英刘德慧【摘要】目的：探讨静脉铁剂对腹膜透析患者氧化应激状态的影响.方法：选择持续性不卧床腹膜透析（CAPD）患者31例，随机分为静脉组（Ⅰ组，11例），口服组（Ⅱ组，10例），和未补铁组（Ⅲ组,10例），观察用药前后血红蛋白浓度（Hb），红细胞压积(Hct)，血清铁(SI)，血清铁蛋白（SF），转铁蛋白饱和度（TSAT）等指标以及血清C反应蛋白(CRP)和丙二醛（MDA），谷胱苷肽过氧化物酶（GSHPx），晚期糖基化终产物(AGE)，晚期氧化蛋白产物(AOPP)等炎症和氧化应激指标.结果：①治疗4wk时，Ⅰ，Ⅱ两组患者Hb,Hct,SI,SF,TSAT均较治疗前上升，且高于Ⅲ组；SI,SF,TSAT值Ⅰ组高于Ⅱ组,差异有统计学意义(P<0.05).②治疗8wk时，3组患者Hb,Hct,SI,SF,TSAT均较治疗前上升，Ⅰ组不仅高于同组治疗4wk时且高于Ⅱ，Ⅲ两组；Ⅱ组高于Ⅲ组，差异有统计学意义(P<0.05).③Ⅰ组患者使用静脉铁剂后1h,MDA，AOPP水平升高，GSHpx水平下降；AGEs，CRP水平升高,在4wk时较治疗前及1h差异有统计学意义且较Ⅱ，Ⅲ组水平上升；Ⅱ组CRP水平高于Ⅲ组，差异有统计学意义.④4wk时Ⅱ组AOPP水平升高，与治疗前相比差异有统计学意义且高于Ⅰ，Ⅲ两组.结论：①静脉补铁可有效改善CAPD患者贫血及缺铁状态.②CAPD患者接受静脉铁剂治疗时，可能会诱导炎症及氧化应激反应的加剧.③口服补铁4wk后可引起CAPD患者AOPP水平的升高.【关键词】腹膜透析；贫血；氧化性应激；注射，静脉内；铁【Abstract】AIM:Toinvestigatetheinfluenceofintravenousirontherapyonoxidativestressinperitonealdialysispatients.METHODS:Thirtyonecontinuousambulatoryperitonealdialysis(CAPD)patientswererandomlydividedinto3groups:intravenousirongroup(groupⅠ,n=11),oralirongroup(groupⅡ,n=10),andnonirongroup(groupⅢ,n=10).Theindicesofhemoglobin(Hb),hematocrit(Hct),serumiron(SI),serumferrintin(SF),transferrinsaturation(TSAT),Creactiveprotein（CRP）,advancedoxidationproteinproducts(AOPP),malondialdehyde（MDA）,advancedglycationendproducts(AGEs),andglutathioneperoxidase(GSHPx)wereevaluatedbeforeandaftertheironadministration.Twentyhealthyvolunteersweretakenasnormalcontrols.RESULTS:①Fourweeksaftertreatment,theHb,Hct,SI,SFandTSATlevelsincreasedsignificantlyingroupⅠandgroupⅡ,whichwerealsosignificantlyhigherthanthoseingroupⅢ.TheSI,SFandTSATlevelsingroupⅠweresignificantlyhigherthanthoseingroupⅡ(P<0.05).②Eightweeksaftertreatment,theHb,Hct,SI,SF,TSATlevelselevatedsignificantlyinallpatients.ThelevelsoftheseindicesweresignificantlyhigheringroupⅠthaningroupⅡandgroupⅢ,andhigheringroupⅡthaningroupⅢ(P<0.05).③Aftertheinfusionofiron,thelevelsofMDAandAOPPincreasedsignificantlyandreachedthepeaklevelat1h;whilethelevelofGSHPxdecreasedsignificantly;thelevelsofAGEsandCRPincreasedingroupⅠ,andwerehigherat4weeksthanat1handbeforetreatment,andwerehigherthaningroupⅡandgroupⅢ(P＜0.05);butthelevelofCRPwassignificantlyhigheringroupⅡthaningroupⅢ,andthedifferencewasstatisticallysignificant.④Fourweeksaftertreatment,theAOPPlevelingroupⅡwashigherthanthatbeforetreatmentandthanthatingroupⅠandgroupⅢ.CONCLUSION:①ErythropoietinandironadministrationisefficientfortreatinganemiaofCAPDpatients.②Ironsupplementationmayalsoaggravatethestatusofoxidativestressandinflammation.③TheAOPPlevelinCAPDwouldincreasesignificantlyafteroralironadministrationfor4weeks.【Keywords】peritonealdialysis;anemia;oxidativestress;injectious,intravenous;iron0引言终末期肾病(endstagerenaldisease,ESRD)的大多远期并发症与尿毒症患者体内存在的“氧化应激”这一病理生理反应有关［1］.维持性血透患者普遍存在肾性贫血，主要由于促红细胞生成素(erythrop...