鱼油对维持性血液透析患者炎症和骨矿物质水平的影响
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摘要
目的了解鱼油对维持性血液透析(hemodialysis, HD)患者炎症和骨矿物质水平的影响。方法选取HD患者74例,随机分为对照组和观察组,每组37例。对照组患者接受规律HD治疗,观察组患者在对照组的基础上服用鱼油1 000 mg,3次/d,连续服用6个月。在治疗前和治疗6个月后检测两组患者的血红蛋白(Hb)、白细胞(WBC)、铁蛋白、尿酸、高敏C反应蛋白(hs-CRP)、钙、磷、甲状旁腺素(PTH)、碱性磷酸酶(ALP)和骨保护素(OPG)水平。结果两组患者治疗前Hb、WBC、铁蛋白、尿酸、hs-CRP、钙、磷、PTH、ALP和OPG水平差异无统计学意义(P>0.05)。治疗后对照组患者的铁蛋白水平显著高于治疗前(P<0.01);观察组患者的铁蛋白和钙水平亦高于治疗前,而hs-CRP水平则低于治疗前(P<0.01);且治疗后观察组患者的hs-CRP水平显著低于对照组,钙水平则高于对照组(P<0.05或0.01)。两组患者治疗后Hb、WBC、尿酸、磷、PTH、ALP、OPG水平以及不良反应发生情况差异无统计学意义(P>0.05)。结论鱼油可降低HD患者体内炎症因子水平,提高血钙浓度,值得临床应用。
Objective To explore the effect of fish oil on inflammatory and bone mineral level of maintenance hemodialysis(HD) patients. Methods A total of 74 HD patients were randomly divided into the Control Group and the Experimental Group, 37 cases in each group. Patients in the Control Group received regular HD treatment while those in the Experimental Group were orally administered with 1000 mg fish oil three times per day continuously for six months on the basis of regular HD treatment. The hemoglobin(Hb), white blood cells(WBC), serum ferritin, uric acid, high-sensitivity Creactive protein(hs-CRP), calcium, phosphorus, parathyroid hormone(PTH), alkaline phosphatase(ALP) and osteoprotegerin(OPG) level of both groups was detected before the treatment and 6 months after treatment. Results There was no significant difference in Hb, WBC, serum ferritin, uric acid, hs-CRP, calcium, phosphorus, PTH, ALP and OPG level between the two groups before treatment(P>0.05). After the treatment, the serum ferritin level of the Control Group was significantly higher than that before treatment(P<0.01). In the Experimental Group, the serum ferritin and calcium level was significantly higher than that before the treatment, but the hs-CRP level was significantly lower than that before treatment(P<0.01). Moreover, the Experimental Group had the hs-CRP level significantly lower and the calcium level significantly higher than the Control Group after the treatment(P<0.05 or 0.01). There was no significant difference in Hb, WBC, uric acid, phosphorus, PTH, ALP and OPG level as well as the incidence of adverse reactions between the two groups after the treatment(P>0.05). Conclusion Fish oil can decrease the inflammatory level and increase the calcium level in HD patients, which is worth clinical promotion.
Objective To explore the effect of fish oil on inflammatory and bone mineral level of maintenance hemodialysis(HD) patients. Methods A total of 74 HD patients were randomly divided into the Control Group and the Experimental Group, 37 cases in each group. Patients in the Control Group received regular HD treatment while those in the Experimental Group were orally administered with 1000 mg fish oil three times per day continuously for six months on the basis of regular HD treatment. The hemoglobin(Hb), white blood cells(WBC), serum ferritin, uric acid, high-sensitivity Creactive protein(hs-CRP), calcium, phosphorus, parathyroid hormone(PTH), alkaline phosphatase(ALP) and osteoprotegerin(OPG) level of both groups was detected before the treatment and 6 months after treatment. Results There was no significant difference in Hb, WBC, serum ferritin, uric acid, hs-CRP, calcium, phosphorus, PTH, ALP and OPG level between the two groups before treatment(P>0.05). After the treatment, the serum ferritin level of the Control Group was significantly higher than that before treatment(P<0.01). In the Experimental Group, the serum ferritin and calcium level was significantly higher than that before the treatment, but the hs-CRP level was significantly lower than that before treatment(P<0.01). Moreover, the Experimental Group had the hs-CRP level significantly lower and the calcium level significantly higher than the Control Group after the treatment(P<0.05 or 0.01). There was no significant difference in Hb, WBC, uric acid, phosphorus, PTH, ALP and OPG level as well as the incidence of adverse reactions between the two groups after the treatment(P>0.05). Conclusion Fish oil can decrease the inflammatory level and increase the calcium level in HD patients, which is worth clinical promotion.
引文
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[17]FONOLLA-JOYA J,REYES-GARCIA R,GARCIA-MARTIN A,et al.Daily intake of milk enriched with n-3fatty acids,oleic acid,and calcium improves metabolic and bone biomarkers in postmenopausal women[J].J Am Coll Nutr,2016,35(6):529-536.
[18]KOLAHI S,GHORBANIHAGHJO A,ALIZADEH S,et al.Fish oil supplementation decreases serum soluble receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio in female patients with rheumatoid arthritis[J].Clin Biochem, 2010, 43(6):576-580.
[19]MARTIN-BAUTISTA E,MUNOZ-TORRES M,FONOLLA J,et al.Improvement of bone formation biomarkers after 1-year consumption with milk fortified with eicosapentaenoic acid,docosahexaenoic acid,oleic acid,and selected vitamins[J].Nutr Res,2010,30(5):320-326.
[20]LEE S M,SON Y K,KIM S E,et al.The effects of omega-3fatty acid on vitamin D activation in hemodialysis patients:a pilot study[J].Mar Drugs,2015,13(2):741-755.
[21]HAAG M,MAGADA O N,CLAASSEN N,et al.Omega-3fatty acids modulate ATPases involved in duodenal Ca absorption[J].Prostaglandins Leukot Essent Fatty Acids,2003, 68(6):423-429.
[22]HAAG M,KRUGER M C.Upregulation of duodenal calcium absorption by poly-unsaturated fatty acids:events at the basolateral membrane[J].Med Hypotheses,2001,56(5):637-640.
[23]LEE S M,SON Y K,KIM S E,et al.The effects of omega-3fatty acid on vitamin D activation in hemodialysis patients:a pilot study[J].Mar Drugs,2015,13(2):741-755.
[24]GHAREKHANI A,KHATAMI M R,DASHTI-KHAVIDAKI S,et al.Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients[J].Daru,2014,22(1):11.
[2]杨雨润,王闯,陈瀛,等.老年骨质疏松合并终末期肾病髋部骨折患者的临床特点及管理[J].中国骨质疏松杂志,2018,24(8):1040-1043.
[3]唐芳,张波,沈俊.维持性血液透析对患者血清降钙素原、白细胞介素-6及超敏C反应蛋白的影响[J].贵州医科大学学报,2018,43(4):478-481.
[4]薛徽,孙瑶.影响骨折愈合的生物因素研究新进展[J].口腔医学,2018,38(11):1043-1047.
[5]GHAREKHANI A,KHATAMI M R,DASHTI-KHAVIDAKI S,et al.The effect of omega-3 fatty acids on depressive symptoms and inflammatory markers in maintenance hemodialysis patients:a randomized,placebocontrolled clinical trial[J].Eur J Clin Pharmacol,2014,70(6):655-665.
[6]SAIFULLAH A,WATKINS B A,SAHA C,et al.Oral fish oil supplementation raises blood omega-3 levels and lowers C-reactive protein in haemodialysis patients-a pilot study[J].Nephrol Dial Transplant,2007,22(12):3561-3567.
[7]RASIC-MILUTINOVIC Z,PERUNICIC G,PLJESA S,et al.Effects of N-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients[J].Ren Fail,2007,29(3):321-329.
[8]BOWDEN R G,WILSON R L,DEIKE E,et al.Fish oil supplementation lowers C-reactive protein levels independent of triglyceride reduction in patients with end-stage renal disease[J].Nutr Clin Pract,2009,24(4):508-512.
[9]KOOSHKI A,TALEBAN F A,TABIBI H,et al.Effects of marine omega-3 fatty acids on serum systemic and vascular inflammation markers and oxidative stress in hemodialysis patients[J].Ann Nutr Metab,2011,58(3):197-202.
[10]POULIA K A,PANAGIOTAKOS D B,TOURLEDE E,et al.Omega-3 fatty acids supplementation does not affect serum lipids in chronic hemodialysis patients[J].J Ren Nutr,2011,21(6):479-484.
[11]GHAREKHANI A,KHATAMI M R,DASHTI-KHAVIDAKI S,et al.Effects of oral supplementation with omega-3 fatty acids on nutritional state and inflammatory markers in maintenance hemodialysis patients[J].J Ren Nutr,2014,24(3):177-185.
[12]PERUNICIC-PEKOVIC G B,RASIC Z R,PLJESA S I,et al.Effect of n-3 fatty acids on nutritional status and inflammatory markers in haemodialysis patients[J].Nephrology(Carlton),2007,12(4):331-336.
[13]BOUZIDI N,MEKKI K,BOUKADDOUM A,et al.Effects of omega-3 polyunsaturated fatty-acid supplementation on redox status in chronic renal failure patients with dyslipidemia[J].J Ren Nutr,2010,20(5):321-328.
[14]COETZEE M,HAAG M,KRUGER M C.Effects of arachidonic acid,docosahexaenoic acid,prostaglandin E(2)and parathyroid hormone on osteoprotegerin and RANKL secretion by MC3T3-E1 osteoblast-like cells[J].J Nutr Biochem,2007,18(1):54-63.
[15]POULSEN R C,WOLBER F M,MOUGHAN P J,et al.Long chain polyunsaturated fatty acids alter membranebound RANK-L expression and osteoprotegerin secretion by MC3T3-E1 osteoblast-like cells[J].Prostaglandins Other Lipid Mediat,2008,85(1-2):42-48.
[16]LAPPE J,KUNZ I,BENDIK I,et al.Effect of a combination of genistein,polyunsaturated fatty acids and vitamins D3 and K1 on bone mineral density in postmenopausal women:a randomized,placebo-controlled,double-blind pilot study[J].Eur J Nutr,2013,52(1):203-215.
[17]FONOLLA-JOYA J,REYES-GARCIA R,GARCIA-MARTIN A,et al.Daily intake of milk enriched with n-3fatty acids,oleic acid,and calcium improves metabolic and bone biomarkers in postmenopausal women[J].J Am Coll Nutr,2016,35(6):529-536.
[18]KOLAHI S,GHORBANIHAGHJO A,ALIZADEH S,et al.Fish oil supplementation decreases serum soluble receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio in female patients with rheumatoid arthritis[J].Clin Biochem, 2010, 43(6):576-580.
[19]MARTIN-BAUTISTA E,MUNOZ-TORRES M,FONOLLA J,et al.Improvement of bone formation biomarkers after 1-year consumption with milk fortified with eicosapentaenoic acid,docosahexaenoic acid,oleic acid,and selected vitamins[J].Nutr Res,2010,30(5):320-326.
[20]LEE S M,SON Y K,KIM S E,et al.The effects of omega-3fatty acid on vitamin D activation in hemodialysis patients:a pilot study[J].Mar Drugs,2015,13(2):741-755.
[21]HAAG M,MAGADA O N,CLAASSEN N,et al.Omega-3fatty acids modulate ATPases involved in duodenal Ca absorption[J].Prostaglandins Leukot Essent Fatty Acids,2003, 68(6):423-429.
[22]HAAG M,KRUGER M C.Upregulation of duodenal calcium absorption by poly-unsaturated fatty acids:events at the basolateral membrane[J].Med Hypotheses,2001,56(5):637-640.
[23]LEE S M,SON Y K,KIM S E,et al.The effects of omega-3fatty acid on vitamin D activation in hemodialysis patients:a pilot study[J].Mar Drugs,2015,13(2):741-755.
[24]GHAREKHANI A,KHATAMI M R,DASHTI-KHAVIDAKI S,et al.Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients[J].Daru,2014,22(1):11.