【摘要】 目的   探讨还原型谷胱甘肽(GSH)对早期糖尿病慢性肾脏疾病(CKD)患者氧化应激(OS)、血管新生及免疫功能指标的影响。 方法    随机盲法将90例CKD患者分为对照组和治疗组，另选40名健康对照组。检测各组晚期蛋白氧化产物(AOPP)、超氧化物歧化酶(SOD)、丙二醛(MDA)、血管内皮生长因子(VEGF)、内皮抑素(ES)及免疫细胞因子。 结果    治疗组治疗后BUN、UAER、TG及
FPG与其他组比较，差异有统计学意义(P<0.05或P<0.01)；AOPP，MDA，VEGF，ES及免疫功能指标中CD3⁺T细胞、CD3⁺CD8⁺T细胞、CIN⁺/CD8⁺细胞、CD3-CDl9⁺B细胞与对照组比较，差异有统计学意义(P<0.05或P<0.01)。Pearson相关分析显示，AOPP与SOD、CD3⁺T细胞、CD3⁺CD4⁺T细胞、CD3⁺CD8⁺T细胞、CD3-CDl6⁺CD56⁺NK细胞、CD3-CDl6⁺CD56⁺NK T细胞呈负相关(P<0.01)，与MDA、VEGF、ES及CD3^一CDl9+B细胞呈正相关(P<0.05或P<0.01)；SOD与ⅧA、VEGF、ES负相关(P<0.01)，与CD3⁺T细胞、CD3⁺CD4⁺T细胞、CD3 CDl6⁺CD56⁺NK细胞、CD3 CDl6⁺CD56⁺NK T细胞呈正相关(P<0.01)；MDA与VEGF、ES、CD3⁺T细胞、CD3⁺CD4⁺T细胞、CD3⁺CD8⁺T细胞、CD3 CDl6⁺CD56+NK细胞、CD3 CDl6⁺CD56+NK T细胞呈正相关(P<0.05或P<0.01)，与CD3-CDl6⁺CD56⁺NK细胞、CD3-CDl6⁺CD56+NK T细胞呈负相关(P<0.01)；CKD与AOPP、MDA、VEGF呈正相关，与SOD、CD3⁺T细胞、CD3+CD8+T细胞、CD3一CDl6+CD56+NK细胞、CD3-CDl6⁺CD56+NK T细胞呈负相关(P<0.05或P<0.01)。 结论    GSH能降低CKD患者AOPP、MDA、VEGF的水平，同时能升高ES、SOD及T淋巴细胞、NK细胞因子水平；OS与CKD异常血管新生、细胞免疫应答失衡有关。
      【关键词】   还原型谷胱甘肽；糖尿病慢性肾脏疾病；氧化应激；血管新生；免疫功能

      【Abstract】  Objective   To investigate the effect of glutatbione on oxidative stress，angiogenesis and immune function in pa-tients with early chronic kidney disease (CKD) in diabetes． Methods   A total of130 participants were divided into three groups：control group(Con，n=45)，treatment group (n=45 )andhealthy group (NC，n=40)．AOPP，SOD，MDA，VEGF，ES and irnmune cytokines were detected in all the three groups． Results    After treatment，BUN，UAER，TG and FPG were statistically significant
between the treatment group and the other groups(P<0.05 or P<0.01)；AOPP，MDA，VEGF，ES and immune function including CD3⁺T cells，CD3⁺CD8⁺T ceils，CD4⁺／CD8⁺and CD3^一CD19⁺B cells were statistically significant between treatment group and Con group (P<0.05 or P<0.01)；Pearson correlation analysis showed that A()PP was negatively correlated with SOD，CD3⁺T ceils，CD3⁺CD4⁺T cells，CD3+CD8+T cells，CD3 CDl6+CD56+NK ceils and CD3 CDl6⁺CD56⁺NK T cells(P<0.01)，and positively correlated with～Ⅱ)A，VEGF，ES and CD3 CDl9+B cells (P<0.05 or P<0.01)；SOD wasnegatively correlated with MDA，VEGF and ES (P<0.01) and positively correlated with CD3+T cells，CD3⁺CD4⁺T cells，CD3 CDl6⁺CD56⁺NK cells and CD3^一CDl6⁺CD56⁺NK T cells (P<0.01)；MDA was positively correlated with VEGF，ES，CD3⁺T cells，CD3⁺CD4⁺T cells，CD3⁺CD8⁺T cells，CD3^一CDl6⁺CD56⁺NK cells and CD3 CDl6⁺CD56⁺NK T cells (P<0.05 or P<0.01)and negativelycorrelated with CD3^一CDl6⁺CD56⁺NK cells and CD3⁺CDl6⁺CD56⁺NK T cells(P<0.01)；CKD was positively correlated with AOPP。MDA，VEGF and negatively correlated with SOD，CD3⁺T cells，CD3⁺ CD8⁺T cells，CD3 CDl6⁺CD56⁺NK cells and CD3～CDl6⁺CD56⁺NK T cells (P<0.05 or P<0.01)．
Conclusion     GSH is likely to suppress the expression of AOPP，MDA，VEGF and promote the expression of ES。SOD，T 1ymphocytes and NK cells factor in CKD patients．OS is associated with abnormal angiogenesis and imbalanced cellular immune response in CKD patients．
       【Key words】 Glutathione Chronic kidney disease(CKD)in diabetes；0xidative stress(OS)；Angiogenesis；Immune function