Ertan Nesrin Zeynep, Bozfakioglu Semra, Ugurel Elif, Sinan Mukaddes, Yalcin Ozlem
Department of Physiology, Istanbul University, Istanbul, Turkey.
Department of Nephrology, Istanbul University, Istanbul, Turkey.
PLoS One. 2017 Feb 3;12(2):e0171371. doi: 10.1371/journal.pone.0171371. eCollection 2017.
In this study, we investigated the effects of peritoneal dialysis on hemorheological and hematological parameters and their relations with oxidant and antioxidant status of uremic patients. Hemorheological parameters (erythrocyte deformability, erythrocyte aggregation, osmotic deformability, blood and plasma viscosity) were measured in patients with renal insufficiency undergoing peritoneal dialysis (PD) and volunteers. Erythrocyte deformability, osmotic deformability and aggregation in both autologous plasma and 3% dextran 70 were measured by laser diffraction ektacytometry. Enzyme activities of glutathione peroxidase, superoxide dismutase and catalase were studied in erythrocytes; lipid peroxidation was studied by measuring the amount of malondialdehyde in both erythrocytes and plasma samples. Blood viscosity at native hematocrit was significantly lower in PD patients at all measured shear rates compared to controls, but it was high in PD patients at corrected (45%) hematocrit. Erythrocyte deformability did not show any difference between the two groups. Osmotic deformability was significantly lower in PD patients compared to controls. Aggregation index values were significantly high in PD patients in plasma Catalase and glutathione peroxidase activities in erythrocytes were decreased in PD patients whereas superoxide dismutase activity was increased compared to controls. Malondialdehyde was significantly increased in erythrocytes and plasma samples of PD patients which also shows correlations with aggregation parameters. It has been concluded that erythrocytes in PD patients are more prone to aggregation and this tendency could be influenced by lipid peroxidation activity in patient's plasma. These results imply that uremic conditions, loss of plasma proteins and an increased risk of oxidative stress because of decreasing levels of antioxidant enzymes affect erythrocyte rheology during peritoneal dialysis. This level of distortion may have crucial effects, impairing the blood flow dynamics and causing inadequate microcirculatory perfusion.
在本研究中，我们调查了腹膜透析对尿毒症患者血液流变学和血液学参数的影响，以及它们与氧化和抗氧化状态的关系。对接受腹膜透析（PD）的肾功能不全患者和志愿者测量了血液流变学参数（红细胞变形性、红细胞聚集性、渗透变形性、血液和血浆粘度）。通过激光衍射血细胞变形仪测量自体血浆和3%右旋糖酐70中的红细胞变形性、渗透变形性和聚集性。研究了红细胞中谷胱甘肽过氧化物酶、超氧化物歧化酶和过氧化氢酶的酶活性；通过测量红细胞和血浆样本中丙二醛的含量研究脂质过氧化。与对照组相比，在所有测量的剪切速率下，PD患者在自然血细胞比容时的血液粘度显著降低，但在校正（45%）血细胞比容时，PD患者的血液粘度较高。两组之间的红细胞变形性没有差异。与对照组相比，PD患者的渗透变形性显著降低。血浆中PD患者的聚集指数值显著升高。与对照组相比，PD患者红细胞中的过氧化氢酶和谷胱甘肽过氧化物酶活性降低，而超氧化物歧化酶活性升高。PD患者的红细胞和血浆样本中丙二醛显著增加，这也与聚集参数相关。得出的结论是，PD患者的红细胞更容易聚集，这种倾向可能受患者血浆中脂质过氧化活性的影响。这些结果表明，尿毒症状态、血浆蛋白丢失以及由于抗氧化酶水平降低导致的氧化应激风险增加，会影响腹膜透析期间的红细胞流变学。这种变形程度可能具有关键影响，损害血流动力学并导致微循环灌注不足。
