【肾脏病变.2019】肾脏替代治疗患者的抗氧化剂补充：有证据吗？

文献DOI：10.1155/2019/9109473

文献PMID：30774749

文献原文链接：http://doi.org.sci-hub.tw/10.1155/2019/9109473

Antioxidant Supplementation in Renal Replacement Therapy Patients: Is There Evidence?

肾脏替代治疗患者的抗氧化剂补充：有证据吗？

【Abstract】

The disruption of balance between production of reactive oxygen species and antioxidant systems in favor of the oxidants is termed oxidative stress (OS). To counteract the damaging effects of prooxidant free radicals, all aerobic organisms have antioxidant defense mechanisms that are aimed at neutralizing the circulating oxidants and repair the resulting injuries. Antioxidants are either endogenous (the natural defense mechanisms produced by the human body) or exogenous, found in supplements and foods. OS is present at the early stages of chronic kidney disease, augments progressively with renal function deterioration, and is further exacerbated by renal replacement therapy. End-stage renal disease patients, on hemodialysis (HD) or peritoneal dialysis (PD), suffer from accelerated OS, which has been associated with increased risk for mortality and cardiovascular disease. During HD sessions, the bioincompatibility of dialyzers and dialysate trigger activation of white blood cells and formation of free radicals, while a significant loss of antioxidants is also present. In PD, the bioincompatibility of solutions, including high osmolality, elevated lactate levels, low pH, and accumulation of advanced glycation end-products trigger formation of prooxidants, while there is significant loss of vitamins in the ultrafiltrate. A number of exogenous antioxidants have been suggested to ameliorate OS in dialysis patients. Vitamins B, C, D, and E, coenzyme Q10, L-carnitine, a-lipoic acid, curcumin, green tea, flavonoids, polyphenols, omega-3 polyunsaturated fatty acids, statins, trace elements, and N-acetylcysteine have been studied as exogenous antioxidant supplements in both PD and HD patients.

摘要翻译：

活性氧物质的生产与有利于氧化剂的抗氧化剂体系之间的平衡的破坏被称为氧化应激（OS）。为了抵消促氧化剂自由基的破坏作用，所有需氧生物都具有抗氧化防御机制，旨在中和循环氧化剂并修复由此产生的伤害。抗氧化剂是内源性的（由人体产生的天然防御机制）或外源性的，在补充剂和食物中发现。 OS存在于慢性肾病的早期阶段，随着肾功能恶化逐渐增加，并且随着肾替代疗法进一步恶化。血液透析（HD）或腹膜透析（PD）的终末期肾病患者患有OS加速，这与死亡和心血管疾病的风险增加有关。在HD期间，透析器和透析液的生物不相容性引发白细胞的活化和自由基的形成，同时还存在显著的抗氧化剂损失。在PD中，溶液的生物不相容性，包括高渗透压、升高的乳酸水平、低pH和晚期糖基化终产物的积累引发促氧化剂的形成，而超滤液中存在显著的维生素损失。已经提出许多外源性抗氧化剂来改善透析患者的OS。维生素B、C、D和E，辅酶Q10，左旋肉碱，α-硫辛酸，姜黄素，绿茶，黄酮类化合物，多酚，ω-3多不饱和脂肪酸，他汀类，微量元素和N-乙酰半胱氨酸已被研究作为PD和HD患者的外源性抗氧化剂补充剂。