维持性血液透析患者不同初始剂量静脉铁剂治疗前后炎症、氧化应激的变化及对主要不良心血管事件的影响OACSTPCD

Objective To explore the changes in inflammation and oxidative stress before and after treatment with different initial doses of intravenous iron agents in maintenance hemodialysis(MHD)patients and their predictive value for major adverse cardiovascular events(MACE).Methods Clinical data of 158 patients who underwent MHD treatment in the hemodialysis room of the First Hospital of Qinhuangdao from August 2017 to August 2019 were retrospectively analyzed.According to the initial dosage of intravenous iron agents,patients were divided into a high-dose group(400 mg iron sucrose per month,78 cases)and a low-dose group(200 mg iron sucrose per month,80 cases).After 2.5 months of medication in both groups,all patients received intravenous infusion with 100 mg iron sucrose once every 2 weeks,maintaining this regimen for more than 24 months.The levels of hemoglobin(Hb),serum ferritin(SF),transferrin saturation(TSAT),inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and oxidative stress factors[superoxide dismutase(SOD),malondialdehyde(MDA),myeloperoxidase(MPO)]before treatment,after 12 months and 24 months of treatment were compared between the two groups.The occurrence of MACE in both groups within 3 years was observed,and the predictive value of relevant indicators for the occurrence of MACE was analyzed through receiver operating characteristic(ROC)curve.Results After 12 and 24 months of treatment,the levels of Hb,SF,TSAT,serum CRP,IL-6,TNF-α,MDA and MPO in both groups were increased compared with before treatment,the differences were statistically significant(P<0.05),while the levels of serum SOD were decreased compared with before treatment(P<0.05).After 24 months of treatment,the levels of Hb,SF,TSAT,serum CRP,IL-6,TNF-α,MDA and MPO in two groups were increased compared with 12 months of treatment,and the level of serum SOD was decreased compared with 12 months of treatment,with statistically significant differences(P<0.05).There was no significant difference in the incidence of MACE between the high-dose group and the low-dose group(χ2=0.396,P>0.05).The levels of serum IL-6 and MDA in the MACE group were higher than those in the non-MACE group,with statistically significant differences(t=5.352,8.584;P<0.05).The level of serum SOD in the MACE group was lower than that in the non-MACE group,and the difference was statistically significant(t=2.467,P<0.05).The areas under ROC curves of serum IL-6,SOD,and MDA levels for predicting the occurrence of MACE in MHD patients were 0.741,0.691,and 0.887,with sensitivity of 57.80%,64.40%and 84.40%,and specificity of 81.40%,69.00%and 79.60%,respectively.Conclusion Intravenous iron agents at doses of 200 mg/month and 400 mg/month can effectively correct iron deficiency in MHD patients,while exacerbating inflammation and oxidative stress in patients.Serum IL-6,SOD and MDA levels can predict the occurrence of MACE in MHD patients effectively.