王雪
WANG Xue

• 1:哈尔滨医科大学附属第一医院门诊静点科室

摘要(Abstract)：

目的:研究α-硫辛酸对终末期肾病(ESRD)血液透析(HD)患者血清微炎性因子、部分营养学指标以及血清同型半胱氨酸(Hcy)、甲状旁腺激素(PTH)、血清β2-微球蛋白(β2-MG)的影响。方法:进行HD的68例ESRD患者,随机分为对照组和观察组;对照组患者入院后给予ESRD肾内科常规治疗以及血液透析,观察组患者在对照组的基础上外加领给予α-硫酸锌600 mg/d,每日分3次服,疗程8周;比较两组患者治疗前后血清微炎性因子超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α),营养指标血红蛋白(Hb)、白蛋白(Alb)、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)以及血清Hcy、PTH、β2-MG的变化。结果:与治疗前比较,治疗后两组患者血清hs-CRP、IL-6、IL-8、TNF-α、Hcy、PTH和β2-MG水平明显降低,且观察组下降更明显,差异有统计学意义(P<0.05);与治疗前比较,治疗后观察组患者血清Hb和Alb水平明显增高,且高于对照组,差异有统计学意义(P<0.05)。结论:α-硫辛酸用于治疗的ESRD患者,可降低肾脏的炎症反应,改善患者的营养状况,增加Hcy、PTH和β2-MG的清除。
Objective: To study the effects of alpha-lipoic acid on serum inflammatory factors,nutritional parameters,serum Hcy,PTH and β2-MG in ESRD patients received hemodialysis. Methods:A total of 68 patients with end-stage renal disease( ESRD) undergoing hemodialysis in our hospital from September 2013 to September 2015 were recruited in our study and randomly divided into control group( n = 34) and observation group( n = 34). The control group received routine ESRD treatment and hemodialysis,while patients in the observation group or in the control group also received zinc sulfate treatment of 600mg/d on the basis of the control group for 8 weeks. The serum levels of inflammatory factors( hs-CRP,IL-6,IL-8,TNF-α),nutritional parameters( Hb、Alb、TC、TG、HDL-C and LDL-C),as well as serum Hcy,PTH,β2-MG in the two groups before and after treatment were collected and compared. Results: After treatment,the serum levels of hs-CRP,IL-6,IL-8 and TNF-α in the two groups were significantly lower than those before treatment,and the patients in the observation group decreased more significantly,so the difference was statistically significant( P < 0. 05). Aftertreatment,the levels of serum Hb and Alb were significantly increased before treatment( P < 0. 05),and significantly higher than the levels of serum Hb and Alb( P < 0. 05) in control group patients,and the levels of serum TC,TG,HDL-C and LDL-C did not change significantly( P > 0. 05); After treatment,the serum levels of Hcy,PTH and beta 2-MG in the two groups were significantly lower than those before treatment,and the observation group decreased more significantly. The difference was statistically significant( P < 0. 05). Conclusion: Alpha-lipoic acid as the treatment of ESRD patients received hemodialysis can effectively reduce the inflammation of kidney,improve the nutritional status of patients,increase the clearance of virulence factors of Hcy,PTH and β2-MG,which has good clinical value and worthy of promotion.

关键词(KeyWords)： 终末期肾病;血液透析;α-硫辛酸;血清;白细胞介素;C-反应蛋白
end-stage renal disease;hemodialysis;alpha-lipoic acid;serum;interleukin;C reactive protein

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81202189)

作者(Author): 王雪
WANG Xue

DOI: 10.19367/j.cnki.1000-2707.2017.06.018

参考文献(References)：

• [1]孙续禄.尿毒症患者维持性血液透析对氧化应激及免疫功能的影响[J].中国医疗前沿,2013(12):56-20.
• [2]丛军,高弼虎.维持性血液透析对尿毒症患者氧化应激及免疫功能的影响[J].中华实用诊断与治疗杂志,2013(3):209-211.
• [3]Safa J,Ardalan MR,Rezazadehsaatlou M,et al.Effects of alpha lipoic acid supplementation on serum levels of IL-8 and TNF-alpha in patient with ESRD undergoing hemodialysis[J].International Urology and Nephrology,2014(8):1633-1638.
• [4]杨松涛,覃莲香,孙克冰,等.维持性血液透析患者营养不良、炎症、心血管疾病及MIA综合征的发生情况及其对预后的影响研究[J].中国全科医学,2013,32(18):1617-1619,1622.
• [5]贾愚.维持性血液透析患者营养状况及氧化应激状态的研究[D].北京:中国协和医科大学,2010.
• [6]许光远.维持性血液透析患者微炎症反应与中医证候的关系[D].北京:北京中医药大学,2014.
• [7]李文斌,朱竹先,魏勇,等.维持性血液透析患者心血管并发症与炎症反应及氧化应激的相关性研究[J].南京医科大学学报(自然科学版),2010(3):409-411,425.
• [8]Yu X,Liu H,Zou J,et al.Oxidative stress in 5/6 nephrectomized rat model:effect of alpha-lipoic acid[J].Renal failure,2012(7):907-914.
• [9]代新华,张志利,王文萍.α-硫辛酸降低糖尿病大鼠氧化应激及对肾脏的保护作用[J].当代医学,2011(10):15-16.
• [10]谢翠松.α-硫辛酸与丹参治疗糖尿病下肢血管病变的疗效比较及可能机制探讨[D].广州:南方医科大学,2012.
• [11]张金彦,吉绍长.药物硫辛酸的研究进展[J].现代化工,2012(5):32-34,36.
• [12]Iciek M,Marcykiewicz B,Bilska-Wilkosz A,et al.The effect of lipoate on anaerobic cysteine metabolism in erythrocytes of patients treated with peritoneal dialysis[J].Pharmacological Reports,2014(2):325-328.
• [13]Ergur BU,Cilaker Micili S,Yilmaz O,et al.The effects of alpha-lipoic acid on aortic injury and hypertension in the rat remnant kidney(5/6 nephrectomy)model[J].Anatolian Journal of Cardiology,2015(6):443-439.
• [14]El-Nakib GA,Mostafa TM,Abbas TM,et al.Role of alpha-lipoic acid in the management of anemia in patients with chronic renal failure undergoing hemodialysis[J].International Journal of Nephrology and Renovascular Disease,2013(16):1-8.
• [15]Chang JW,Lee EK,Kim TH,et al.Effects of alpha-lipoic acid on the plasma levels of asymmetric dimethylarginine in diabetic end-stage renal disease patients on hemodialysis:a pilot study[J].American Journal of Nephrology,2007(1):70-74.
• [16]Khabbazi T,Mahdavi R,Safa J,et al.Effects of alphalipoic acid supplementation on inflammation,oxidative stress,and serum lipid profile levels in patients with endstage renal disease on hemodialysis[J].Journal of Renal Nutrition,2012(2):244-250.
• [17]Ramos LF,Kane J,Mcmonagle E,et al.Effects of combination tocopherols and alpha lipoic acid therapy on oxidative stress and inflammatory biomarkers in chronic kidney disease[J].Journal of Renal Nutrition,2011(3):211-218.

文章评论(Comment)：