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目的探讨影响慢性肾脏病(chronic kidney disease,CKD)进展的因素,为综合干预治疗提供依据。方法 CKD患者279例,分为CKD-1、CKD-2、CKD-3a、CKD-3b、CKD-4期组以及CKD-5期非透析组、CKD-5期腹膜透析(peritoneal dialysis,PD)组和CKD-5期血液透析(hemodialysis,HD)组,同期体检健康者23例为对照组,测定不同CKD分期患者血清同型半胱氨酸(homocysteine,Hcy)、游离脂肪酸(free fatty acid,FAA)、超氧化物歧化酶(superoxide dismutase,SOD)变化,并与对照组进行比较。结果 (1)CKD-2、CKD-3a、CKD-3b、CKD-4期以及CKD-5期非透析组、CKD-5期PD组和CKD-5期HD组Hcy[12.70(10.40,15.40)、15.80(14.10,19.00)、20.05(18.08,24.85)、22.10(17.40,30.30)、27.70(19.30,42.30)、23.00(16.98,28.78)、29.45(18.38,53.13)μmol/L]均高于对照组[(10.60(9.30,11.70)μmol/L)](P<0.01);(2)CKD各期FFA与对照组比较差异无统计学意义(P>0.05);CKD-1、CKD-3a、CKD-4以及CKD-5期非透析组FFA阳性率(25.00%、20.59%、20.00%、23.53%)高于对照组(0)(P<0.05);(3)CKD-1、CKD-2、CKD-3a、CKD-3b和CKD-4期组,CKD-5期非透析组,CKD-5期PD组和CKD-5期HD组SOD值分别为138.05(102.58,153.33)、122.40(96.80,141.60)、134.00(109.05,144.20)、113.35(97.45,127.18)、98.00(84.30,108.50)、85.90(71.55,95.20)、87.95(75.50,107.70)、103.55(85.23,124.00)u/mL,CKD各期SOD均低于对照组[144.20(141.70,151.60)u/mL],差异有统计学意义(P<0.01);CKD-1、CKD-2、CKD-3a、CKD-3b期SOD值比较差异无统计学意义(P>0.05);与CKD-3b期比较,CKD-4及CKD-5期非透析组和PD组SOD均降低(P<0.01);CKD-5期HD组SOD值高于CKD-5期非透析组和PD组,差异有统计学意义(P<0.01)。结论随着CKD的进展,患者Hcy升高、SOD降低,且同时存在FFA阳性率升高,建议自CKD-3期应注重抗氧化应激治疗。
Objective To explore the factors affecting the progression of chronic kidney disease (CKD) and provide the basis for comprehensive intervention treatment. Methods CKD-1, CKD-2, CKD-3a, CKD-3b and CKD-4 groups and CKD-5 non-dialysis group were divided into two groups. CKD-5 peritoneal dialysis (PD) 23 patients with CKD-5 hemodialysis (HD) and healthy subjects at the same period were selected as the control group. Serum levels of homocysteine (Hcy), free fatty acid (FAA) ), Superoxide dismutase (SOD), and compared with the control group. Results (1) Hcy [12.70 (10.40,15.40)) in CKD-2, CKD-3a, CKD-3b, CKD-4 and CKD-5 non-dialysis groups, CKD-5 PD group and CKD- , 15.80 (14.10,19.00), 20.05 (18.08,24.85), 22.10 (17.40,30.30), 27.70 (19.30,42.30), 23.00 (16.98,28.78), 29.45 (18.38,53.13) μmol / L] (P <0.01); (2) There was no significant difference between the control group and the FFA group in CKD (P> 0.05); CKD-1, CKD-3a, The positive rate of FFA in CKD-4 and CKD-5 non-dialysis group was significantly higher than that in control group (25.00%, 20.59%, 20.00%, 23.53%) (P <0.05); (3) CKD-1 and CKD-2 , CKD-3a, CKD-3b and CKD-4 group, CKD-5 non-dialysis group, CKD-5 PD group and CKD-5 HD group were 138.05 (102.58,153.33), 122.40 , 141.60), 134.00 (109.05,144.20), 113.35 (97.45,127.18), 98.00 (84.30,108.50), 85.90 (71.55,95.20), 87.95 (75.50,107.70), 103.55 (85.23,124.00) u / mL, CKD The levels of SOD in each stage were lower than those in the control group [144.20 (141.70, 151.60) u / mL] (P <0.01). The SOD levels in CKD-1, CKD-2, CKD-3a and CKD-3b The difference was not statistically significant (P> 0.05); Compared with CKD-3b stage, CKD-4 and CKD- The SOD in the 5 non-dialysis group and the PD group decreased (P <0.01). The SOD level in the CKD-5 HD group was higher than that in the CKD-5 non-dialysis group and the PD group (P <0.01). Conclusion With the progress of CKD, patients with Hcy increased, SOD decreased, and at the same time the positive rate of FFA increased, it is recommended since CKD-3 should pay attention to anti-oxidative stress therapy.