| 摘要: | 依照美國腎臟病資料登錄系統（The United States Renal Data System, USRDS）的資料顯示台灣透析人口的發生率為全球第一，盛行率為全球第二。血液透析仍是目前末期腎臟疾病（ESRD）病患最主要的治療方式，由於人工腎臟及透析用水不斷的改良，但心臟血管疾病及感染仍為血液透析病患主要的死因，其中自由基的過度生成和血液透析病患的動脈粥狀硬化、貧血、透析相關之類澱粉沉積症有關，且血液透析治療過程也會造成部分微量元素的改變。因此，本研究之目的在瞭解血液透析患者血液中氧化壓力及微量元素之濃度。選取60位透析超過三個月的病人，依其使用不同的人工透析膜分成三組，再進行問卷調查及抽血檢驗。問卷內容包含基本資料、生活型態、透析相關病歷資料及臨床生化檢驗值。血液檢驗包含氧化壓力指標malondialdehyde（丙二醛,MDA）、glutathione peroxidase（榖胱甘肽過氧化酶,GPX）和八種微量元素包括銅（Cu）、硒（Se）、鋅（Zn）、鉛（Pb）、汞（Hg）、鎘（Cd）、砷（As）、鎳（Ni）。
研究結果顯示血液透析患者透析後紅血球中MDA濃度顯著高於透析前（p=0.009）；全血中Cu、Se濃度和Cu/Zn、Cu/Se比值在透析後也顯著性高於透析前（p<0.01），而全血中As濃度則顯著低於透析前（p<0.001）。分析使用三種不同人工透析膜患者透析濃度的差異與三組間MDA、GPX、微量元素濃度均無統計上之差異。經調整MDA、GPX、微量元素濃度之前測、性別、年齡後，三種透析膜間亦無統計上差異。透析前血清中Albumin值和全血中Pb濃度、Cu/Se比值呈負相關，和全血中Se濃度呈正相關；而CRP值和Ni、Pb濃度、Cu/Se比呈正相關，和Se濃度呈負相關。經調整人工透析膜、年齡後，Albumin值、CRP值和Ni、Pb、Se濃度、Cu/Se比仍有統計上顯著差異。因此，建議血液透析患者除使用生物相容性較佳的人工透析膜外，應額外補充抗氧化劑維他命，以預防或減少自由基過度生成造成之氧化性傷害，進而降低罹患心臟血管疾病及其他併發症的危險性。
According to the United States Renal Data System (USRDS), the incidence rate and prevalence rate of dialysis in Taiwan population are higher than other nations. Recently, hemodialysis is the major treatment to are for ESRD patients using high-performance dialyzer and reverse-osmose water in order to prevent cardiovascular diseases (CVDs) and infection. However, long-term hemodialysis may increase levels of free radical in ESRD patients. Overproduction of reactive oxygen species in ESRD patients are significantly associated with complications, such as atherosclerosis, anemia and amyloidosis, and change of trace element during hemodialysis. The purpose of this study is to investigate the correlation between blood oxidative stress and concentrations of trace elements among patients receiving hemodialysis. Sixty ESRD patients receiving dialysis for 3 months or longer were enrolled to this study and classified into three groups based on three types of dialyzer（PMMA, PS, Helixone）. All participants were interviewed using a questionnaire and blood samples were collected for laboratory test. Contents of Questionnaire were demographic characteristics, lifestyle, and experience of dialysis and biochemical laboratory values in the past time. Laboratory tests included oxidative stress markers malondialdehyde, glutathione peroxidase and trace elements such as Cu, Se, Zn, Pb, Hg, Cd, As and Ni.
Our results showed that mean levels of MDA, Cu, Se, Cu/Zn ratio, Cu/Se in the red blood cell were significantly higher in post-dialysis than in pre-dialysis (p=0.009). However, the mean blood level of As in the post-dialysis was lower than that in the pre-dialysis (p<0.001). The pre-and post-dialysis differences in MDA, GPX and trace elements between among the three types of dialyzers were not significant after controlling for sex, age and hemodialysis duration using multiple regression models. The level of albumin in the pre-dialysis was positively correlated with the Pb and Cu/Se levels in blood, but negatively correlated with the Se level. Furthermore, CRP was positively correlated with Ni and Pb in these blood samples. However, it was negatively correlated with Se level in blood. After adjusting for the type of remained dialyzing membrane and age in multivariate analysis, these association significant. We recommend the use of better biocompatibility dialyzer and intake of anti-oxidants (Vitamin) in order to reduce the production of radical agent to reduce the risk of developing CVDs among dialysis patients. |
