Research On The Influencing Factors Of Oxidative Stress State In Maintenance Hemodialysis Patients And Their Relationship With TCM Syndromes

ObjectiveTo Observe the correlation and differences between oxidative stress indicators and basic information,nutritional status,adequacy of dialysis,inflammation,anemia,etc.in maintenance hemodialysis(MHD)patients in Dongfang Hospital of Beijing University of Chinese Medicine;at the same time,using the information of the four Chinese medicine diagnoses of the patients conducts the syndrome differentiation of traditional Chinese medicine(TCM)and exploring the differences of oxidative stress among the syndromes of TCM in patients with MHD provides a basis for antioxidative treatment of Chinese medicine.Methods1.A total of 76 patients who received maintenance hemodialysis from the Blood Purification Center of Dongfang Hospital of Beijing University of Chinese Medicine and met the inclusion criteria were collected2.Taking venous whole blood before dialysis,the superoxide dismutase(SOD)activity,malondialdehyde(MDA)content,advanced oxidation protein product(AOPP)content,urea nitrogen(BUN),hemoglobin(HGB),hematocrit(HCT),human blood albumin(ALB),C-reactive protein(CRP),B-type natriuretic peptide(BNP),and Parathyroid hormone(PTH)were measured,and urea nitrogen was checked after dialysis to calculate the standardized proteolysis rate(nPCR)and urea clearance index(Kt/V)together with Calcium-phosphorus product3.Body composition analyzer(BCM)was used to measure body composition indexes of patients with MHD before and after dialysis,including lean tissue index(LTI),fat tissue index(FTI),total body water(TBW),extracellular water(ECW),intracellular water(ICW),and ratio of extracellular water to intracellular water,etc.The general information of the patients during dialysis on the same day was recorded and tested,including dry weight,post-dialysis weight,ultrafiltration volume,blood pressure before and after dialysis,patient's age,gender,dialysis age,and dialysis frequency.4.T The correlations and differences between oxidative stress indicators and basic data,albumin(ALB),C-reactive protein(CRP),hemoglobin(HGB),hematocrit(HCT),standardized proteolysis rate,urea clearance index(Kt/V),B-type natriuretic peptide(BNP),BCM indicators,Calcium-phosphorus product,Parathyroid hormone(PTH).etc in MHD patients were analyzed.5.By means of observation,smelling,asking,and pulse diagnosis of Chinese Medicine,patients' clinical syndromes were collected.The Ministry of Health's 2002 edition of the "Chinese medicine clinical research guidelines,"was used to conduct TCM differentiation and classification of MHD patients in our hospital.At the same time,the relationship between oxidative stress and TCM syndromes was analyzed.Results1.Of the 76 patients with MHD,43of them were male(57%)and 33 were female(43%)The average age was 63.71 ± 12.635 years.The longest dialysis age was 221 months,the shortest was 4 months.The top three of the primary diseases were diabetic nephropathy(34%),chronic glomerulonephritis(20%)and hypertensive renal damage(17%)(22%).2.The differences in oxidative stress indexes superoxide dismutase(SOD)and malondialdehyde(MDA)were statistically significant within 60 months,60-120 months,and more than 120 months(P<0.05).However,There were no significant differences in the oxidative stress indicators in different gender,different age groups,and different primary diseases(P>0.05)3.Correlation analysis of dialysis age,superoxide dismutase(SOD)and dialysis age were negatively correlated.Malondialdehyde(MDA),advanced oxidation protein product(AOPP)and dialysis age were positively correlated(P<0.05)4.Correlation analysis of biochemical indicators,where B-type natriuretic peptide(BNP)was significantly negatively correlated with superoxide dismutase(SOD),and was signi ficantly positively correlated with malondialdehyde(MDA)and advanced oxidation protein product(AOPP)(P<0.05),The correlation between C-reactive protein(CRP)and superoxide dismutase(SOD)was significantly negative,with malondialdehyde(MDA),advanced oxidation protein product(AOPP)positive(P<0.05)).There was a positive correlation between normalized protein catabolic rate(nPCR)and superoxide dismutase(SOD)and a negative correlation between this and advanced oxidation protein product(AOPP)(P<0.05).Urea clearance index(KT/V)was positively correlated with superoxide dismutase(SOD)and negatively correlated with malondialdehyde(MDA)(P<0.05).Parathyroid hormone(PTH)was negatively correlated with superoxide dismutase(SOD),positively correlated with malondialdehyde(MDA)?advanced oxidation protein product(AOPP).There was a negative correlation between Calcium-phosphorus product with superoxide dismutase(SOD),and a positive correlation with malondialdehyde(MDA).There had no significant difference in albumin(ALB),hemoglobin(HGB),hematocrit(HCT)and oxidative stress(P>0.05).5.Correlation analysis of body composition index,lean tissue index(LTI)was positively correlated with superoxide dismutase(SOD),negatively correlated with malondialdehyde(MDA)and advanced oxidation protein product(AOPP);Fat tissue index(FTI)had a positively correlation with superoxide dismutase(SOD)and negative correlation with malondialdehyde(MDA)and advanced oxidation protein product(AOPP)(P<0.05)6.Multiple linear regression results indicate that dialysis age,B-type natriuretic peptide(BNP),C-reactive protein(CRP),lean tissue index(LTI),calcium and phosphorus product may be independent influencing factors of oxidative stress indicators.7.The syndrome differentiation of TCM in MHD patients.The deficiency syndromes are mainly made up of spleen-kidney-yang deficiency syndromes,spleen-kidney-qi deficiency syndromes,followed by Qi-yin deficiency syndromes,liver-kidney-yin deficiency syndromes,and yin-yang deficiency syndromes.Excess syndrome were mainly included syndrome of dampness-heat,syndrome of damp-turbidity,and syndrome.of blood stasis.The difference in oxidative stress between the syndromes of this deficiency syndrome was not statistically significant(P>0.05)and the difference of standardized proteolysis rate(nPCR)in the syndromes of spleen and kidney yang deficiency and yin and yang deficiency is statistically significant.The level of oxidative stress in patients with excess syndromes group is higher than the group without those syndromes.The calcium-phosphorus product,C-reactive protein(CRP),and normalized protein catabolic rate(nPCR)are statistically significant in the two groups.Conclusions?Oxidative stress indicators in MHD patients have differences and correlations between different dialysis age periods.The longer the dialysis age,the more severe the oxidative stress status.? Correlations between oxidative stress with B-type natriuretic peptide(BNP),C-reactive protein(CRP),normalized protein catabolic rate(nPCR),urea clearance index(KT/V),lean tissue index(LTI),Parathyroid hormone(PTH),Calcium-phosphorus product and fat tissue index(FTI)were positive.The results of multiple regression analysis indicated that dialysis age,B-type natriuretic peptide(BNP),C-reactive protein(CRP),lean tissue index(LTI),calcium and phosphorus products may be independent influencing factors of oxidative stress indicators.Inflammation status,volume load,mineral metabolism,nutritional status,etc.in hemodialysis patients may have certain effects on oxidative stress status in MHD patients.?In the MHD patients,the deficiency syndrome mainly was made up of spleen and kidney yang deficiency and spleen and kidney qi deficiency syndrome;the excess syndrome mainly consist of syndromes of damp-heat,damp-turbidity and blood-stasis.?The difference in oxidative stress between the syndromes of this deficiency syndrome was not statistically significant(P>0.05);The level of oxidative stress in patients with excess syndromes is higher than that without those with syndromes.