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目的 :评估维持性血液透析(maintenance hemodialysis,MHD)患者注射对比剂后氧化应激水平的时序变化,同时观察患者外周血单个核细胞(peripheral blood mononuclear cell,PBMC)中核因子E2-相关因子2(nuclear factor E2-related factor 2,Nrf2)和血红素加氧酶-1(heme oxygenase-1,HO-1)的变化。方法 :选取30例未用对比剂进行CT检查的MHD患者(MHD-对照组)、30例应用对比剂行增强CT检查的MHD患者(MHD-CM组)和30例应用对比剂行增强CT检查的肾功能正常体检者(non HD-CM组),检测患者氧化应激指标:晚期蛋白质氧化物(advanced oxidation protein products,AOPP)、8-羟基脱氧鸟嘌呤核苷(8-hydroxydeoxyguanosine,8-OHd G)和丙二醛(malondialdehyde,MDA),同时应用Western blot检测患者PBMC中Nrf2核蛋白和HO-1总蛋白表达情况。结果:MHD-CM组AOPP、8-OHd G和MDA水平增高且持续时间长,AOPP和MDA水平在CT检查后28 d仍维持在高水平。non HD-CM组血清AOPP、8-OHd G和MDA水平在增强CT检查后1 d升高,7 d内恢复到CT检查前的水平。增强CT检查后1 d,MHD-CM组患者PBMC中Nrf2核蛋白和HO-1总蛋白的表达水平无明显变化(P>0.05),而non HDCM组显著增加(P均<0.01)。结论:MHD患者应用对比剂可引起较长时间的氧化应激,估计与MHD患者排泄对比剂能力下降和Nrf2活化障碍有关。
OBJECTIVE: To evaluate the temporal changes of oxidative stress in maintenance hemodialysis (MHD) patients after injection of contrast agent and to observe the changes of nuclear factor E2-related factor 2 (PBMC) in peripheral blood mononuclear cells (PBMC) nuclear factor E2-related factor 2, Nrf2) and heme oxygenase-1 (HO-1). Methods: Thirty cases of MHD patients (MHD-control group) without CT scan, 30 cases of MHD patients (MHD-CM group) with contrast-enhanced CT scan and 30 cases of contrast-enhanced CT (Non-HD-CM group) were enrolled in this study. Oxidative stress indicators were detected in patients with advanced oxidation protein products (AOPP), 8-hydroxydeoxyguanosine G) and malondialdehyde (MDA). Western blot was used to detect the expression of Nrf2 nuclear protein and HO-1 protein in PBMC. Results: The levels of AOPP, 8-OHd G and MDA in MHD-CM group increased and persisted for a long time. The level of AOPP and MDA remained high at 28 days after CT examination. Serum levels of AOPP, 8-OHd G and MDA in non HD-CM group increased on the 1st day after enhanced CT examination and returned to pre-CT level within 7 days. There was no significant change in the expression of Nrf2 nucleoprotein and HO-1 protein in PBMC of MHD-CM group (P> 0.05), but not in non-HDCM group (all P <0.01) at 1 d after enhanced CT examination. CONCLUSIONS: The use of contrast agents in MHD patients can cause a longer period of oxidative stress, which is estimated to be associated with decreased excretion of contrast agents and dysfunction of Nrf2 in MHD patients.