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IgA肾病患儿血浆氧化应激水平及早期联用ACEI的影响[J]. 中山大学学报(医学科学版), 2014,35(4).
Plasma Oxidative Stress Level of IgA Nephropathy in Children and Effect of Early Combination with ACEI[J]. Journal of Sun Yat-sen University (Medical Sciences), 2014, 35(4).
【目的】 研究IgA肾病(IgAN)患儿血浆氧化应激水平的变化及其与临床病理的关系,探讨血管紧张素转换酶抑制剂(ACEI)对IgAN患儿血浆氧化应激水平的影响。【方法】38例IgAN患儿根据按临床表现分为3组:血尿蛋白尿(HP)组(14例),急性肾炎(AGN)组(7例),肾病综合征(NS)组(17例);按病理分级分为3组:病理Ⅲ级组(22例),病理Ⅳ级组(10例),病理Ⅴ级组(6例);按初次就诊时是否曾接受激素和(或)免疫抑制剂治疗分为2组:初发组(28例),非初发组(10例);其中,初发组IgAN患儿根据是否早期联用ACEI治疗随机分为2组:ACEI组(10例)和非ACEI组(18例)。选取同期在我院体检的20例健康儿童为对照组。分别采用Witko-Sarsat法、硫代巴比妥酸分光光度法和黄嘌呤氧化酶法检测病例组和对照组血浆晚期蛋白氧化产物(AOPP)、丙二醛(MDA)和超氧化物歧化酶(SOD)水平,并分析其与临床表现及病理改变的相关性。【结果】 ①与对照组相比,IgAN组血浆氧化应激水平明显升高,表现为AOPP和MDA水平明显升高[AOPP:(99 ± 27) vs (53 ± 21)μmol/mL,MDA:(5.3 ± 2.1) vs (2.5 ± 1.4) nmol/mL,均P < 0.01],SOD水平明显下降[(67 ± 21) vs (95 ± 20)U/mL,P< 0.01]。②血浆氧化应激水平在肾病综合征组和病理V级组最高,且与IgAN患儿的肾脏Katafuchi评分密切相关。③与非ACEI组相比,ACEI组治疗后血浆氧化应激水平明显降低(P< 0.05)。【结论】 IgAN患儿存在血浆氧化应激水平的升高,表现为血浆AOPP和MDA水平升高,且血浆SOD水平下降,氧化应激与IgAN患儿的进展及预后有关,早期联用ACEI治疗可以改善IgAN患儿血浆氧化应激水平。
【Objective】 To investigate the change of plasma oxidative stress level in childrenwith IgA nephropathy, analyze its relativity to the clinical and pathological classificationof IgAN. To discuss the effect of combine with ACEI (angiotensin converting enzymeinhibitors) early on the plasma oxidative stress level in IgAN children. 【Methods】Thirty-eight children with IgAN were divided into 3 groupsaccording to their clinical features: hematuria and proteinuria (HP) group (contained14 patients), acute glomerular nephritis (AGN) group (contained 7 patients) andnephrotic syndrome (NS) group (contained 17 patients); divided into 3 groups accordingto pathologic grades: grade Ⅲ group (contained 22 patients), grade Ⅳ group (contained10 patients) and grade Ⅴ group (contained 6 patients); divided into 2 groups accordingto whether received corticosterone and/or immunosuppressor treatment at the firstvisit in our center: treated group (contained 10 patients) and untreated group (contained28 patients). The untreated IgAN children (contained 28 patients) were randomizeddivided into 2 groups according to whether received ACEI therapy at the beginningof their treatment: ACEI group (contained 10 patients) and Non-ACEIgroup (contained 18 patients). 20 healthy children were included in control group.The plasma level of advanced oxidation protein products (AOPP), malonaldehyde (MDA),and superoxide dismutase (SOD) were detected by Witko-Sarsatmethod, thiobarbituric acid-reactive substances method andxanthine oxidoreductase method respectively in both patient group and control group,analyze its relativity to the clinical and pathological classification of IgAN.【Results】 ①Compared with the control group, the plasma level of oxidative stresswas significantly increased in IgAN group, included a higher plasma level of AOPPand MDA [AOPP: (99 ± 27) μmol/mL vs (53 ± 21) μmol/mL, P < 0.01; MDA: (5.3 ± 2.1)nmol/mL vs (2.5 ± 1.4) nmol/mL, P < 0.01], and a lower plasma level of SOD [(67 ± 21) U/mL vs (95 ± 20) U/mL, P < 0.01]. ②The highest plasma level of oxidativestress was in NS group and grade Ⅴ group, and this plasma oxidative stress levelwas closely accociated with Katafuchi score in IgAN children. ③After treatment,the plasma level of oxidative stress was significantly decreased in ACEI group comparedto the non-ACEI group (P < 0.05). 【Conclusions】 The childrenwith IgAN had an increase plasma level of oxidative stress, expressed as the increasedplasma level of AOPP and MDA, and the decreased plasma level of SOD. Oxidative stresswas associated with the progression of IgAN children. Combined with the ACEI therapyearly in the treatment can significantly reduce the plasma level of oxidative stressin IgAN children.
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