维生素E对维持性血液透析患者静脉补铁诱导的氧化应激及脂代谢紊乱的影响

目的 探讨口服维生素E对静脉补铁诱导的氧化应激及脂质代谢紊乱的影响.方法 选择维持性血液透析合并肾性贫血患者40例,按随机数字表法分为静脉补铁组及静脉补铁+维生素E组,每组20例.健康对照组20名.静脉补铁组所有患者行血液透析治疗时由静脉输入100 mg蔗糖铁注射液,起始为每周2～3次,完成总剂量1000 mg后改为每周或2周1次,使患者的铁蛋白维持在100～300μg/L之间.静脉补铁+维生素E组:除按上述方法补铁外同时口服维生素E 200 mg,每日2次.两组患者同时每周使用促红素治疗(每周100～150 U/kg)并检测三组治疗前和补铁组、补铁+维生素E组治疗1、6个月血脂及氧化应激指标.结果 治疗1个月后,补铁组丙二醛(MDA)、终末氧化蛋白产物(AOPP)、总胆固醇(TCH),脂蛋白Lp(a)、载脂蛋白B(ApoB)含量与治疗前比较差异有统计学意义(P＜0.05);超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、ApoAl含量比较差异也有统计学意义(P＜0.05);而甘油三脂(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、极低密度脂蛋白(VLDL)比较则无明显变化.补铁+维生素E组TCH水平与补铁组比较差异有统计学意义(P＜0.05);而SOD、GSH-Px、AOPP、MDA、TG、LDL、HDL、VLDL载脂蛋白Al(ApoAl)、ApoB、Lp(a)比较差异均无统计学意义(P＞0.05).治疗6个月后,补铁+维生素E组SOD、GSH-Px、ApoAl与补铁组比较比较差异有统计学意义(P＜0.05);AOPP、MDA、TCH、Lp(a)、ApoB比较差异也有统计学意义(P＜0.05);而TG、LDL、HDL、VLDL则无明显变化(P＞0.05).结论 静脉补铁可以加重维持性血液透析患者体内的氧化应激水平及脂代谢紊乱.长时间口服维生素E可以改善维持性血液透析患者静脉补铁诱导的氧化应激及脂代谢紊乱.

Effects of vitamin E on oxidative stress and disturbance of lipid metabolism induced by intravenous iron infusion in maintenance hemodialysis patients

Objective To examine the effects of vitamin E as an antioxidant on oxidative stress and disturbance of lipid metabolism induced by intravenous iron sucrose infusion in treatment of anemia of MHD patient.Methods 40 MHD patients were selected and randomly divided into intravenous iron group(n = 20)and intravenous iron + vitamin E group( n = 20) compared with 20 healthy people.Intravenous iron group:100 mg iron sucrose rejections were used while the patients accepted hemodialysis.At the beginning patients received iron two or three times every week until complete the total dose of 1000 mg,later the patients reeived iron treatment every one or two weeks made the serum ferritin maintained at between 100 μg/L to 300 μg/L.Intravenous iron + vitamin E group :same with the first group and add oral vitE 200 mg,two times one day,Erythropoietin(EPO) was used at a dose of 100 - 150 U/kg-w by hypodermic in each group.TG.,TCH,LDL,VIDL,HDL,Lp(a),ApoB,SOD,MDA,AOPP,GSH- Px were test in each group at the beginning and with treatment of 1 and 6 monthes later.Results Iron treatment for 1 month MDA,AOPP,TCH,Lp(a),ApoB increased (P＜0.05) but GSH-Px,SOD,ApoAl activity decreased (P＜0.05) than those pretherapy in iron group.No significant changes in TG,LDL,VLDL,HDL.(P＞0.05) Vitamin E treatment for 1 month serum SOD,GSH-Px of intravenous iron + vitamin E group increased slightly compared with iron group (P＞0.05),AOFP、MDA activity were slightly lower than that in controls.But there were no significant difference both.TG,LDL,HDL,VLDL,ApoAl,ApoB,Lp(a)have no significant changes also.(P＞0.05).But TCH decreased obviously( P＜0.05).Vitamin E treatment for 6 monthes serum SOD,GSH - Px and ApoAl become higher significantly,AOPP,MDA TCH,Lp(a),and ApoB activity were obviously lower (P＜0.05) compare with iron group.No significant changes in TG,LDL,HDL,VLDL(P＞0.05).Conclusions MHD patients with higher levels of oxidatives and Lipid metabolism disorders Compared with the normal.Intravenous iron can aggravate the situation.Oral of 200 mg vitamin E for long term can attenuate oxidative stress and lipid metabolism disorders induced by Intravenous iron.