Boulanger Eric, Moranne Olivier, Wautier Marie-Paule, Witko-Sarsat Véronique, Descamps-Latscha Béatrice, Kandoussi Abdelmejid, Grossin Nicolas, Wautier Jean-Luc
Laboratory of Vascular and Cellular Biology, National Institute of Blood Transfusion, France.
Perit Dial Int. 2006 Mar-Apr;26(2):207-12.
The high incidence of cardiovascular disease in uremic patients makes it a major cause of morbidity and mortality in those patients. Uremia is associated with carbonyl and oxidative stress, which result in the enhanced formation of glycation and oxidation products respectively. In the present study, the blood levels of advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs) were investigated in uremic patients prior to and after initiation of peritoneal dialysis (PD).
22 patients [11 nondiabetic (G1) and 11 diabetic (G2) subjects] were enrolled in a single-center prospective study. Prior to starting PD (TO) and 6 and 12 months later, changes in AGE and AOPP levels were analyzed in the total study population and in each group (Friedman test, intragroup). At each time point, a comparison was made between the levels of the above-mentioned products in G1 and G2 (Mann-Whitney test, intergroup). Correlations between AGE or AOPP levels and residual renal function, peritoneal creatinine clearance, glucose peritoneal equilibration test, or daily dextrose exposure were analyzed using the Pearson test.
At TO, no significant difference was found between the two groups for AGE or AOPP levels. Initiation of PD was followed by an increase in AGE levels in all patients (p < 0.01 at 6 and 12 months). AGE Levels were higher in G2 than in G1 at 12 months after the start of PD (p < 0.05). In contrast to G2 results, initiation of PD in G1 led to reduced AOPP Levels (at 6 and 12 months, p = 0.01 and p < 0.05 respectively). However, no correlation between AGE or AOPP levels and residual renal function, peritoneal creatinine clearance, glucose peritoneal equilibration test, or daily dextrose exposure could be established.
This study demonstrates that PD is associated with an increase in levels of blood glycation end products, particularly in diabetic patients, but also with a decrease in oxidative products such as AOPPs, especially in nondiabetic subjects.
心血管疾病在尿毒症患者中高发，是这些患者发病和死亡的主要原因。尿毒症与羰基应激和氧化应激相关，分别导致糖基化产物和氧化产物的生成增加。在本研究中，对尿毒症患者开始腹膜透析（PD）前后血液中晚期糖基化终末产物（AGEs）和晚期氧化蛋白产物（AOPPs）的水平进行了研究。
22例患者[11例非糖尿病患者（G1组）和11例糖尿病患者（G2组）]纳入一项单中心前瞻性研究。在开始PD前（T0）以及6个月和12个月后，分析了总研究人群及每组中AGE和AOPP水平的变化（Friedman检验，组内）。在每个时间点，对G1组和G2组上述产物的水平进行比较（Mann-Whitney检验，组间）。使用Pearson检验分析AGE或AOPP水平与残余肾功能、腹膜肌酐清除率、葡萄糖腹膜平衡试验或每日葡萄糖暴露之间的相关性。
在T0时，两组间AGE或AOPP水平无显著差异。开始PD后，所有患者的AGE水平均升高（6个月和12个月时p<0.01）。开始PD 12个月后，G2组的AGE水平高于G1组（p<0.05）。与G2组结果相反，G1组开始PD导致AOPP水平降低（6个月和12个月时，分别为p=0.01和p<0.05）。然而，未发现AGE或AOPP水平与残余肾功能、腹膜肌酐清除率、葡萄糖腹膜平衡试验或每日葡萄糖暴露之间存在相关性。
本研究表明，PD与血液中糖基化终末产物水平升高有关，尤其是在糖尿病患者中，但也与AOPPs等氧化产物水平降低有关，特别是在非糖尿病患者中。
