中国血液净化

›› 2003, Vol. 2 ›› Issue (9): 485-489.

• 论著 • 上一篇    下一篇

一氧化氮及血液净化治疗对糖尿病肾病患者血浆晚期糖基化终产物水平的影响

左 楠 严海东 任 青   

  1. 110001 沈阳，中国医科大学附属第一医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-09-19 发布日期:2003-09-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-09-19 Published:2003-09-19

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摘要：

目的 观察不同血液净化治疗方法及血浆一氧化氮（NO）对终末期糖尿病肾病（DN）患者血浆 晚期糖基化终产物（AGEs）的影响。方法 终末期DN患者应用不同血液净化方式治疗2个月，应用荧光分光光度法检测血浆AGEs水平；应用α－萘胺显色分光光度计比色法测定血浆中NO浓度。结果 随着肾功能的恶化, DN患者的血浆AGEs水平逐渐升高，二者呈明显正相关(r=0.781)。血液透析(HD)治疗后AGEs水平变化不明显。单次血液透析滤过(HDF)使血浆AGEs水平明显降低（P<0.01），治疗两个月后 AGEs水平无明显变化。血浆AGEs的水平与NO水平成正相关(r=0.597)。结论 终末期DN患者血浆AGEs水平受血糖和肾功能双方面的影响，其中肾功能对其影响较大。HDF可以有效清除AGEs，但不能有效控制AGEs的透析前水平。未见NO对AGEs在体内有明确的抑制作用。

关键词: 晚期糖基化终产物, 糖尿病肾病, 血液透析滤过, 血液透析, 一氧化氮

Abstract: Objective To investigate the cleaning effect of different blood purification treatments on the level of advanced glycation end products(AGEs) and the relationship between serum nitric oxide and plasma levels of AGEs in vivo in end-stage diabetic nephropathy patients. Method Thirty patients suffering from end-stage diabetic nephropathy were divided into HDF group, HD group and non-dialysis group.Non-DN dialysis patients, DM patients with normal renal function and healthy persons were considered as control groups and each group consisted of 10 patients.The age and sex of six groups were matching. HDF and HD groups were treated separately with hemodiafiltration and hemodialysis for two months. Immunofluorescence spectrophotometry was used to determine the serum level of AGEs and α－naphthyl amine spectrophotometer colorimetry was used to determine the level of plasma nitric oxide.The level of serum creatine was measured by ELISA. Results The levels of AGEs in DN and non-DN dialysis patients were higher than that in the normal（P<0.01）. The plasma levels of AGEs in DN patients increased gradually with depravation of renal function. There was positive correlation between the level of AGEs and serum creatine(r=0.781). The level of AGEs had no change after single HD treatment and decreased apparently after single HDF treatment, but was undiversified after two-month treatment. The plasma level of AGEs increased with the increase of plasma NO. There is positive correlation between them(r=0.597). Conclusion The plasma level of AGEs was related with the level of blood sugar and renal function, and renal function played a more important role. HDF can clean AGEs efficiently, but it couldn't control the level of AGEs in pre-dialysis efficiently. In vivo, inhibition effect of NO on AGEs had not been observed.

Key words: DiHemodialysis, Nitric oxide abetic nephropathy, Hemodiafiltration