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血液透析对糖尿病患者动脉粥样硬化加速的影响：颈动脉内膜中层厚度与氧化应激的相关性

The effect of hemodialysis on accelerated atherosclerosis in diabetic patients: correlation of carotid artery intima-media thickness with oxidative stress.

作者信息

Dursun Belda, Dursun Evrim, Suleymanlar Gultekin, Ozben Beste, Capraz Irfan, Apaydin Ali, Ozben Tomris

机构信息

Department of Nephrology, Pamukkale University Medical Faculty, Denizli, Turkey.

出版信息

J Diabetes Complications. 2009 Jul-Aug;23(4):257-64. doi: 10.1016/j.jdiacomp.2007.12.007. Epub 2008 Apr 16.

DOI:10.1016/j.jdiacomp.2007.12.007

PMID:18413174

Abstract

OBJECTIVE

Both diabetes and hemodialysis (HD) are associated with increased oxidative stress. The aim of this study was to clarify the effect of maintenance HD on oxidative stress parameters in diabetic patients and to explore any relation between carotid artery intima-media thickness (CIMT) and oxidative stress markers.

METHODS

Twenty Type 2 diabetic patients undergoing chronic maintenance HD, 20 type 2 diabetic patients with normal renal function, and 20 age- and sex-matched healthy subjects were included. Serum thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCO), and nitrite/nitrate levels were determined as oxidative stress markers. Serum vitamin E, plasma sulfhydryl (P-SH), erythrocyte glutathione (GSH) levels, and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were measured as antioxidants. CIMT was assessed by carotid artery ultrasonography.

RESULTS

Both diabetic patient groups had enhanced oxidative stress indicated by higher levels of TBARS, PCO, and nitrate/nitrite and lower activities of SOD, CAT, and GPx compared to controls. Diabetic patients undergoing HD had significantly higher CIMT (P=.001) and higher levels of nitrite/nitrate (P=.05), PCO (P=.03), and GSH (P=.04) but significantly lower levels of P-SH (P<.001), serum vitamin E (P=.04), SOD (P=.02), CAT (P=.001), and GPx (P=.006) compared to diabetic patients with normal renal functions. There were significant negative correlations between CIMT and SOD (r=-0.50, P<.001), CAT (r=-0.41, P=.003), and P-SH levels (r=-0.51, P<.001) and significant positive correlation between CIMT and nitrite/nitrate levels (r=0.41, P=.003) and TBARS (r=0.35, P=.02). Linear regression analysis showed TBARS was significantly and positively correlated with CIMT (P=.04), while SOD and P-SH were significantly and negatively correlated with CIMT (P=.05 and P=.02, respectively).

CONCLUSIONS

Hemodialysis exacerbates oxidative stress and disturbances in antioxidant enzymes in diabetic patients. Serum nitrite/nitrate and TBARS can be used as positive determinants, while erythrocyte SOD, CAT activities, and P-SH level can be used as negative determinants of atherosclerosis assessed by CIMT in diabetic patients.

摘要

目的

糖尿病和血液透析（HD）均与氧化应激增加有关。本研究的目的是阐明维持性血液透析对糖尿病患者氧化应激参数的影响，并探讨颈动脉内膜中层厚度（CIMT）与氧化应激标志物之间的关系。

方法

纳入20例接受慢性维持性血液透析的2型糖尿病患者、20例肾功能正常的2型糖尿病患者以及20例年龄和性别匹配的健康受试者。测定血清硫代巴比妥酸反应性物质（TBARS）、蛋白质羰基含量（PCO）和亚硝酸盐/硝酸盐水平作为氧化应激标志物。测定血清维生素E、血浆巯基（P-SH）、红细胞谷胱甘肽（GSH）水平以及超氧化物歧化酶（SOD）、过氧化氢酶（CAT）和谷胱甘肽过氧化物酶（GPx）活性作为抗氧化剂指标。通过颈动脉超声评估CIMT。

结果

与对照组相比，两个糖尿病患者组均表现出氧化应激增强，表现为TBARS、PCO和硝酸盐/亚硝酸盐水平升高，以及SOD、CAT和GPx活性降低。接受血液透析的糖尿病患者的CIMT显著更高（P = 0.001），亚硝酸盐/硝酸盐（P = 0.05）、PCO（P = 0.03）和GSH（P = 0.04）水平更高，但与肾功能正常的糖尿病患者相比，P-SH（P < 0.001）、血清维生素E（P = 0.04）、SOD（P = 0.02）、CAT（P = 0.001）和GPx（P = 0.006）水平显著更低。CIMT与SOD（r = -0.50，P < 0.001）、CAT（r = -0.41，P = 0.003）和P-SH水平（r = -0.51，P < 0.001）之间存在显著负相关，与亚硝酸盐/硝酸盐水平（r = 0.41，P = 0.003）和TBARS（r = 0.35，P = 0.02）之间存在显著正相关。线性回归分析显示TBARS与CIMT显著正相关（P = 0.04），而SOD和P-SH与CIMT显著负相关（分别为P = 0.05和P = 0.02）。