The Effect Of Ascorbic Acid On Ameliorating Oxidative Stress In Maintenance Hemodialysis Atherosclerosis Patients

Background and Purpose Atherosclerotic cardiovascular disease is a common complication for the chronic maintenance hemodialysis(MHD) patients and is also a common death reason for the MHD patients.Recent study demonstrated that oxidative stress play an important role in the atherosclerosis pathophysiologic process which caused vascular endothelial dysfunction and vascular smooth muscle proliferation.The enhancement level of oxidative stress(OS) and serious injury of oxygen free radical scavenging system of hemodialysis patients can cause ROS raising up and oxidation as well as antioxidant imbalance eventually.Increased level of OS,may be an important reason for the high incidence of arteriosclerotic cardiovascular disease in MHD patients. Ascorbic acid,an inhibitor for the lipid peroxidation chain reaction,can prevent or slow down the lipid peroxidation to achieved antioxidant role by reducing the length of lipid peroxidation chain.This study further confirmed that there is correlation between oxidative stress and atherosclerosis in hemodialysis patients,and that ascorbic acid can reduce oxidative stress.Our study might provide a reasonable economic interventional therapy for the MHD patients with atherosclerotic cardiovascular disease.Method The study collected 60 cases of MHD patients with adequacy dialysis from blood purification center of Hefei No.1 People's Hospital.30 cases were received ascorbic acid continuous intravenous infusion from begin to the end in each dialysis during 3 months treatment while other 30 cases did not have ascorbic acid continuous infusion.60 cases of MHD patients were divided into AS and non-AS group under the criteria of carotid IMT thickness and atherosclerosis.We selected the level of peripheral blood plasma malondialdehyde(MDA) and the activity of superoxide dismutase(SOD) as the oxidative stress indicators,and selected the high sensitivity C-reactive protein (HS-CRP),monocyte chemoattactant protein-1(MCP-1) and soluble intercellular adhesion molecule-1(sICAM-1) as the indicators of the state of micro-inflammation.At the same time,the level of ascorbic acid were detected.Result1.The level of plasma MDA,MCP-1,sICAM-1,and serum HsCRP in MHD group were significantly higher than those in the control group(P＜0.05,P＜0.01).SOD and Ascorbic acid were significantly lower than those in the control group(P＜0.01).2.The sex ratio,body mass index,dialysis adequacy,systolic blood pressure,diastolic blood pressure,blood glucose of MHD patients in non-AS group were no significant difference(P＞0.05) with those in AS group.Age,dialysis time,serum LDL,MDA, HSCRP,HCY in AS group were significantly higher than those of non-AS group(P＜0.05,P＜0.01).SOD and level of ascorbic acid in AS group were lower than those in non-AS group(P＜0.01).In the correlation analysis,MDA has the positive correlationship with dialysis time,Hcy and sICAM-1 and has the negative correlationship with SOD.3.The level of blood plasma MDA,MCP-1,sICAM-1 and blood serum HsCRP of after dialysis was higher(P＜0.05,P＜0.01) than that of pre-dialysis,and level of plasma SOD and ascorbic acid of after-dialysis was lower than that of pre-dialysis(P＜0.01).4.The level of MDA in plasma,MCP-1,sICAM-1 and HsCRP of the MHD patients with ascorbic acid therapy in the MHD group was lower(P＜0.05,P＜0.01) than that of pre-treatment,The level of SOD and ascorbic acid was higher than that of pre-treatment (P＜0.01).5.The level of plasma MDA,MCP-1,sICAM-1 and serum HsCRP was decreased(P＜0.05,P＜0.01),but still higher than that of control group.The level of SOD and ascorbic acid was markedly increased(P＜0.01).Ascorbic acid has the positive correlationship with SOD,but has negative correlationship with MDA,HsCRP,MCP-1 and sICAM-1.6.The level of plasma MDA,MCP-1,sICAM-1 and serum HsCRP was decreased,but still higher than that of control group.The level of SOD and ascorbic acid was significantly lower that of non-ascorbic acid treatment group(P＜0.05,P＜0.01).The level of ascorbic acid in ascorbic acid treatment group was higher that in non-ascorbic acid treatment group(P＜0.01).Conclusion1 OS existed in MHD patients2 There is correlation between AS and OS in MHD patients3 Antioxidants ascorbic acid can effectively ameliorate the state of OS in MHD patients4 Antioxidants ascorbic acid can effectively ameliorate the state of OS in AS patients.5 Ascorbic acid may have the interventional function to control the development of AS in MHD patients.