摘要
目的:探讨补充维生素D对终末期肾病患者氧化应激的改善作用.方法:选取 2021 年 6 月至 2023 年 5 月于该院肾内科治疗的血液透析患者 152 例,根据随机数字表法分为维生素D组(n=76)和对照组(n=76).所有患者均采用常规血液透析治疗,维生素D组患者服用骨化三醇软胶囊,所有患者均连续治疗 12 周.比较维生素D组与对照组患者治疗前后维生素D状态及血清 25 羟基维生素D[25(OH)D]水平,治疗前后丙二醛(MDA)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)和超氧化物歧化酶(SOD)等氧化应激指标,治疗前后主观综合性营养评估量表(SGA)评分和健康调查简表(SF-36)评分;采用Spearman相关分析,评价患者血清 25(OH)D水平与MDA、CAT、GSH-Px和SOD水平的相关性.结果:治疗后,维生素D组中维生素D缺乏患者所占比例较对照组显著降低(χ2=16.473,P<0.001),维生素D正常患者所占比例较对照组显著升高(χ2=26.621,P<0.001),血清 25(OH)D水平较对照组显著升高(t=4.580,P<0.001),差异均有统计学意义.治疗后,维生素D组患者MDA水平较对照组显著降低(t=5.453,P<0.001),CAT(t=11.068,P<0.001)、GSH-Px(t=15.129,P<0.001)和SOD(t=4.976,P<0.001)水平较对照组显著升高,差异均有统计学意义.治疗后,维生素D组患者SGA评分较对照组显著降低(t=6.482,P<0.001),SF-36 评分较对照组显著升高(t=7.015,P<0.001),差异均有统计学意义.Spearman相关分析表明,患者血清 25(OH)D水平与MDA水平呈负相关(r=-0.332,P=0.015),与CAT(r=0.392,P=0.030)、GSH-Px(r=0.673,P=0.047)和SOD(r=0.288,P=0.026)水平呈正相关.结论:补充维生素D可以提高终末期肾病患者的血清GSH-Px、CAT和SOD水平,降低血清MDA水平,改善患者氧化应激状态和营养状况,提高患者生活质量.终末期肾病患者维生素D缺乏症的发病率较高,患者血清25(OH)D水平与MDA、CAT、GSH-Px和SOD等氧化应激指标密切相关.
Abstract
OBJECTIVE:To probe into the improvement of oxidative stress in patients with end-stage nephropathy by vitamin D supplementation.METHODS:A total of 152 hemodialysis patients who were treated in the nephrology department of the First Affiliated Hospital of Xi'an Jiaotong University from Jun.2021 to May 2023 were extracted to be divided into the vitamin D group(n=76)and control group(n=76)via the random number table method.All patients received routine hemodialysis treatment,while the vitamin D group was given Calcitriol soft capsules.All patients received continuous treatment for 12 weeks.The vitamin D status and serum 25-hydroxyvitamin D[25(OH)D]levels were compared between the vitamin D group and control group before and after treatment.The oxidative stress indicators such as malondialdehyde(MDA),catalase(CAT),glutathione peroxidase(GSH-PX)and superoxide dismutase(SOD),subjective global assessment(SGA)scores and medical outcomes study 36-item short-form health survey(SF-36)scores were compared between two groups before and after treatment.The correlation between serum 25(OH)D and MDA,CAT,GSH-PX,SOD was evaluated by using Spearman correlation analysis.RESULTS:After treatment,the proportion of patients with vitamin D deficiency in the vitamin D group decreased significantly compared with the control group(χ2 =16.473,P<0.001),the proportion of patients with normal vitamin D in the vitamin D group increased significantly compared with the control group(χ2 =26.621,P<0.001),and the 25(OH)D value increased significantly compared with the control group(t = 4.580,P<0.001),with statistically significant differences.After treatment,MDA in the vitamin D group decreased significantly compared with the control group(t= 5.453,P<0.001),while CAT(t=11.068,P<0.001),GSH-PX(t=15.129,P<0.001)and SOD(t=4.976,P<0.001)increased significantly compared with the control group,with statistically significant differences.After treatment,the SGA scores of vitamin D group were significantly lower than those of the control group(t=6.482,P<0.001),while the SF-6 scores was significantly higher than those of the control group(t=7.015,P<0.001),with statistically significant differences.Spearman correlation analysis showed that serum 25(OH)D level in patients was negatively correlated with MDA(r =-0.332,P = 0.015),and positively correlated with CAT(r = 0.392,P = 0.030),GSH-PX(r = 0.673,P = 0.047),and SOD(r = 0.288,P = 0.026).CONCLUSIONS:Vitamin D supplementation can increase the serum GSH-PX,CAT and SOD of patients with ESRD,reduce the serum MDA level,improve the oxidative stress and nutritional status,and enhance the quality of life in patients.The incidence rate of vitamin D deficiency in patients with ESRD is high,serum 25(OH)D level is closely related to oxidative stress indicators such as MDA,CAT,GSH-PX and SOD.
基金项目
2021年陕西省卫生健康委员会卫生健康科研项目(2021JQ592)
国家科技期刊平台
NSTL
万方数据