骨化三醇冲击治疗对维持性血液透析患者微炎症及氧化应激状态的影响被引量：2

Effect of calcitriol pulse therapy on maintenance hemodiulysis patients＂ microinflammation and oxidative stress

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摘要目的探讨骨化三醇冲击治疗对维持性血液透析患者微炎症及氧化应激状态的影响。方法选取106例维持性血液透析的终末期肾病患者,按就诊的先后顺序随机分为观察组和对照组,每组各53例。两组均口服骨化三醇治疗：观察组2.0μg/次,每周2次,于透析后当晚顿服;对照组0.5μg/次,每天1次。两组均治疗12周。比较两组治疗前后血全段甲状旁腺激素、钙、磷指标,并计算钙磷乘积;比较两组治疗前后微炎症指标及氧化应激指标的改善情况。结果治疗前两组血全段甲状旁腺激素差异无统计学意义（t=0.354,P〉0.050）;治疗后两组全段甲状旁腺激素均逐渐下降（t=6.685、4.289、7.678,均P〈0.001;t=4.067、3.341、2.130,均P〈0.050）,且观察组比对照组下降更明显（t=3.251,P=0.002;t=4.279,P〈0.001;t=10.326,P〈0.001）。治疗4周、8周时,两组血钙水平、钙磷乘积均未见明显变化（t=1.354、0.128、0.992、0.879,均P〉0.050;t=0.777、1.310、1.210、1.957,均P〉0.050）,且两组间差异均无统计学意义（t=0.390、0.643、0.100、0.490,均P〉0.050）;仅在治疗12周时,对照组血钙水平及钙磷乘积较治疗前明显升高（t=2.805,P=0.006;t=3.070,P=0.002）。治疗前两组超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、转化生长因子-β1（TGF-β1）、丙二醛（MDA）、髓过氧化氢酶（MPO）、谷胱甘肽过氧化物酶（GSH-PX）的水平差异均无统计学意义（t=0.624、0.649、0.857、1.178、1.549、1.365,均P〉0.050）;治疗后两组hs-CRP、IL-6、TGF-β1、MDA、MPO均明显下降（t=7.417、13.663、25.709、16.114、9.940,均P〈0.001;t=3.006、5.945、12.961、7.367、4.567,均P〈0.010）,GSH-PX明显升高（t=13.173,P〈0.001;t=4.815,P〈0.001）,且两组间差异均有统计学意义（t=3.601、9.263、11.094、8.262、3.693、9.289,均P〈0.001）。结论骨化三醇冲击治疗维持性血液透析患者,有利于改善微炎症状态,增强抗氧化能力。 Objective To investigate the effect of calcitriol pulse therapy on maintenance hemodialysispatients＇microinflammation and oxidative stress. Methods The clinical data of 106 patients with maintenance hemodialysis were retrospectively analyzed. 106 patients were randomly divided into two groups, each group had 53 cases.The observation group was treated with high dose pulse oral calcitriol therapy（ 2. 0μg, twice a week） , while the controlgroup received conventional calcitriol therapy（ 0. 5μg, qd） . Both two groups were treated for 12 weeks. Then, thelevels of iPTH, serum calcium and phosphorus, microinflammation and oxidative stress before and after treatment werecompared. Results There was no difference between the two groups in iPTH indicators（ t =0. 354, P 〉0. 05） . Aftertreatment, the levels of iPTH, hs - CRP, IL - 6, TGF - β1, MDA, MPO in both two groups all decreased（ t = 7. 678,7 417, 13. 663, 25. 709, 16. 114, 9. 940, all P 〈 0. 001; t = 2. 130, 3. 006, 5. 945, 12. 961, 7. 367, 4. 567, all P 〈0 01） , the levels of GSH - PX all increased（ t =13. 173, P 〈0. 001; t = 4. 815, P 〈 0. 001） , and there were significant differences between the two groups （ t = 10. 326, P 〈 0. 001; t = 3. 601, P 〈 0. 001; t = 9. 263, P 〈 0. 001; t =11 094, P 〈0. 001; t =8. 262, P 〈0. 001; t =3. 693, P 〈0. 001; t =9. 289, P 〈0. 001） . The levels of serum calciumand Ca × P remained unchanged in 4 and 8 weeks（ t =1. 354, 0. 128, 0. 992, 0. 879, all P 〉0. 05; t =0. 777, 1. 310,1. 210, 1. 957, all P 〉 0. 05） , which of the observation group were significantly higher than the control group in12 weeks（ t =2. 805, P = 0. 006; t = 3. 070, P = 0. 002） . Conclusion For treatment of patients with maintenancehemodialysis, calcitriol pulse therapy can reduce systemic microinflammatory response and enhance antioxidant capacity.

作者李春明

机构地区北京市房山区第一医院肾内科

出处《中国基层医药》 CAS 2016年第9期1357-1361,共5页 Chinese Journal of Primary Medicine and Pharmacy

关键词血液透析滤过骨化三醇炎症氧化性应激 Hemodiafiltration Calcitriol Inflammation Oxidative stress

分类号 R692.5 [医药卫生—泌尿科学]

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