Exercise Program for Chronic Kidney Disease Improves Pathophysiological Condition with a Shift of Oxidative Stress
Exercise Program for Chronic Kidney Disease Improves Pathophysiological Condition with a Shift of Oxidative Stress
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慢性肾脏病的运动计划可通过氧化应激的转变改善病理生理状况
DOI：
10.1016/j.freeradbiomed.2017.10.200
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发表时间：
2017
影响因子：
7.4
通讯作者：
Oowada Shigeru
中科院分区：
文献类型：
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作者：
Hirayama Aki;Miura Misa;Yasuda Go;Nagano Yumiko;Matsui Hirofumi;Hirayama Yoh;Ueda Atsushi;Aoyagi Kazumasa;Kohzuki Masahiro;Oowada Shigeru
目前，慢性肾脏病患者的运动计划被认为是改善患者病情多因素的有效方法，但仍存在包括心血管事件在内的全身风险。我们使用基于电子自旋共振的多重自由基清除（MULTIS）方法检查了透析中运动计划带来的氧化应激风险。对多个透析中心的39名稳定的血液透析（HD）患者进行了检查。肾功能康复计划为每周2次，在血液透析过程中使用下肢测力计进行有氧训练，博格量表评分为11 ~ 13分，运动时间为15 ~ 60 min，其中11例患者连续进行9 mo。采用MULTIS法测定血清对5种活性氧的清除活性，评价氧化应激。肾功能康复组患者的日常活动能力、运动耐量、肌力均明显增加，收缩压、LDL、HDL均明显下降，血液透析效率（Kt/V）明显提高。运动3个月和9个月后，血清烷基过氧自由基（ROO·）和羟自由基（·OH）清除活性显著升高，分别与此相反，超氧阴离子（O2·OH）和烷氧基自由基（RO·）清除活性降低。在运动计划的患者中检测到TNF-α的增加。这些结果表明，肾功能恢复的效果大多被认为是有利的，但O2·OH和RO·清除活性的下降伴随TNF-α的升高应引起关注。HD患者的氧化应激相关反应与健康受试者不同。
Exercise program for patients with chronic kidney disease currently recognized as a useful method to improve multiple factors of patients’ condition, however there still remains systemic risks including cardiovascular events. We examined the risk of oxidative stress brought by the intra-dialysis exercise program using electron spin resonance-based multiple radical scavenging (MULTIS) method.Thirty-nine stable hemodialysis (HD) patients of multiple dialysis centers were examined. The renal rehabilitation program was aerobic training using the lower limb ergo-meter twice a week during HD, with Borg scale 11 to 13 and the work time was 15 to 60 min. Eleven patients of them continued the program up to 9 mo. Oxidative stress was evaluated by MULTIS method measuring serum scavenging activities against five reactive oxygen species. Inflammatory cytokines were also measured.The patients received the renal rehabilitation showed significant increase of daily activity, exercise tolerance and muscular strength, accompanied with decreases of systolic blood pressure, LDL and HDL, and an improvement of HD efficiency (Kt/V). The serum alkylperoxyl radical (ROO•) and hydroxyl radical (•OH) scavenging activities were significantly increased by the exercise program within the 3 and 9 mo., respectively. To the contrary, superoxide (O2•‒) and alkoxyl radical (RO•) scavenging activities was decreased. An increase of TNF-a was detected in the patients with the exercise program. No severe unfavorable effects were confirmed during the program.These results indicate that the effects of renal rehabilitation are mostly recognized as favorable, while decreases of O2•‒and RO•scavenging activities accompanied with an increase of TNF-a should be concerned. The oxidative stress related responses of HD patients are different from healthy subjects.