Martinez-Vea Alberto, Marcas Luis, Bardají Alfredo, Romeu Marta, Gutierrez Cristina, García Carmen, Compte Teresa, Nogues Rosa, Peralta Carmen, Giralt Montserrat
Nephrology Service, Hospital Universitari de Tarragona Joan XXIII, IISPV, Tortosa, Spain.
Clin Nephrol. 2012 Mar;77(3):171-81. doi: 10.5414/cn107309.
BACKGROUND/AIM: Oxidative stress (OS) is involved in left ventricular hypertrophy (LVH). Short-term treatment with erythropoietin (EPO) in chronic kidney disease (CKD) complicated by anemia and LVH is associated with a reduction in left ventricular mass (LVM). We proposed to assess whether the pro-oxidant status of CKD influences these outcomes.
Predialysis patients (n = 76) with CKD and hemoglobin (Hb) levels < 11 g/dl received EPO for 6 months. The effects of this anemia correction on LVH regression were evaluated using echocardiography. Patients with LVM decrease > 10% were considered "responders" (n = 25) to treatment and those with LVM change < 10% were considered "non-responders" (n = 24). Measurement of OS included plasma and erythrocyte oxidized (GSSG) and reduced (GSH) glutathione, GSH redox ratio (GSSG/GSH), erythrocyte glutathione peroxidase (GPx) and oxidized LDL (Ox- LDL).
49 patients completed the study. With EPO therapy, mean Hb levels increased from 9.9 ± 0.6 to 12.8 ± 1.5 g/ dl (p < 0.0001) and LVM index decreased from 69.2 ± 17.7 to 64.1 ± 19.6 g/m2.7 (p = 0.01). At 6 months, "non-responders" had higher systolic blood pressure, pulse pressure, GSSG and GSH redox ratio and lower GSH than "responders". In multivariate analysis, and following adjustment for confounding variables, systolic blood pressure and GSH redox ratio independently predicted LVH regression.
Blood pressure and plasma GSH redox ratio (a marker of OS) are important predictors of LVH regression in anemic predialysis patients treated with EPO.
背景/目的：氧化应激（OS）与左心室肥厚（LVH）有关。在合并贫血和LVH的慢性肾脏病（CKD）患者中，短期使用促红细胞生成素（EPO）治疗与左心室质量（LVM）降低有关。我们旨在评估CKD的促氧化状态是否会影响这些结果。
76例透析前CKD患者，血红蛋白（Hb）水平<11 g/dl，接受EPO治疗6个月。使用超声心动图评估这种贫血纠正对LVH消退的影响。LVM降低>10%的患者被视为治疗“反应者”（n = 25），LVM变化<10%的患者被视为“无反应者”（n = 24）。OS的测量包括血浆和红细胞氧化型（GSSG）和还原型（GSH）谷胱甘肽、GSH氧化还原比（GSSG/GSH）、红细胞谷胱甘肽过氧化物酶（GPx）和氧化型低密度脂蛋白（Ox-LDL）。
49例患者完成了研究。EPO治疗后，平均Hb水平从9.9±0.6增加至12.8±1.5 g/dl（p<0.0001），LVM指数从69.2±17.7降至64.1±19.6 g/m2.7（p = 0.01）。6个月时，“无反应者”的收缩压、脉压、GSSG和GSH氧化还原比高于“反应者”，而GSH低于“反应者”。在多变量分析中，在对混杂变量进行校正后，收缩压和GSH氧化还原比独立预测LVH消退。
血压和血浆GSH氧化还原比（OS的一个标志物）是接受EPO治疗的贫血透析前患者LVH消退的重要预测因素。
