Oxidative stress is increased in critically ill patients with acute renal failure
Oxidative stress is increased in critically ill patients with acute renal failure
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DOI：
10.1097/01.asn.0000138232.68452.3b
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发表时间：
2004-09-01
影响因子：
13.6
通讯作者：
Ikizler, TA
中科院分区：
文献类型：
--
作者：
Himmelfarb, J;McMonagle, E;Ikizler, TA
急性肾功能衰竭(ARF)患者的死亡率很高。炎症调节失调和代谢改变可能会增加ARF患者的氧化应激。38名符合改善急性肾脏疾病护理计划(PICARD)研究纳入标准的患者接受了血浆蛋白氧化和血浆细胞因子测定。为了进行比较，21名无ARF的危重患者、28名ESRD患者和49名健康受试者也进行了类似的测量。用分光光度法检测血浆蛋白硫醇的氧化程度。用双抗体夹心酶联免疫吸附试验测定血浆蛋白羰基含量和细胞因子浓度。急性肾衰患者血浆蛋白硫醇氧化和羰基含量与健康人、终末期肾病患者和危重病患者相比有显著差异(均P<；0.001)。与健康人相比，终末期肾病患者和危重病患者的血浆蛋白氧化水平有显著差异，但差异不显著。透析改善了急性肾衰患者血浆硫醇氧化(P<；0.001)；然而，在透析间期(P<；0.001)有显著的血浆氧化剂再积聚，而不是由于室隔化溶质的反弹平衡。ARF患者和危重病患者血浆促炎细胞因子水平显著高于健康人(P<；0.05)。ARF患者的血浆蛋白氧化水平显著高于健康人、终末期肾病患者和危重患者。氧化应激增加可能是ARF患者营养和药物治疗的重要靶点。
Patients with acute renal failure (ARF) experience a high mortality rate. Dysregulated inflammation and altered metabolism may increase oxidative stress in ARF patients. Thirty-eight patients who met the Program to Improve Care in Acute Renal Disease (PICARD) Study inclusion criteria underwent plasma protein oxidation and plasma cytokine measurements. For comparison, similar measurements were also performed in 21 critically ill patients without ARF, 28 patients with ESRD, and 49 healthy subjects. Plasma protein thiol oxidation was measured by spectrophotometry. Plasma protein carbonyl content and cytokine concentrations were measured by ELISA. Plasma protein thiol oxidation and carbonyl content were markedly different in ARF patients compared with healthy subjects, ESRD patients, and critically ill patients (P < 0.001 in all cases). There were significant but less marked differences in plasma protein oxidation between ESRD patients and critically ill patients compared with healthy subjects. Plasma protein thiol oxidation in ARF patients improved with dialysis (P < 0.001); however, there was significant plasma oxidant reaccumulation during the interdialytic period (P < 0.001) not due to rebound equilibration of compartmentalized solutes. Plasma proinflammatory cytokine levels were significantly higher (P < 0.05) in ARF patients and critically ill patients than in healthy subjects. Plasma protein oxidation is markedly increased in ARF patients compared with healthy subjects, ESRD patients, and critically ill patients. Increased oxidative stress may be an important target for nutritional and pharmacologic therapy in ARF patients.