海洋性貧血患者氧化性傷害之研究

目的：因為溶血及輸血所以會導致海洋性貧血患者體內的鐵離子過多，而過多的鐵離子會引發一連串的氧化性傷害，所以本研究探討海洋性貧血患者其鐵離子對其體內氧化性傷害之研究。材料與方法：本實驗以高雄醫學大學附設中和紀念醫院血液腫瘤科的海洋性貧血患者59 人為實驗對象，其中23 人為甲型海洋性貧血，其餘36 人為乙型海洋性貧血，同時徵求非海洋性貧血患者73 人作為對照組，我們收集這些受試者之血液檢體進行生化分析。結果：甲型海洋性貧血與對照組比較：血清鐵(serum iron, Fe)與丙二醛(malondialdehyde, MDA)濃度，超氧自由基歧化酵素(superoxide dismutase, SOD)、穀胱甘肽還原酶(glutathione peroxidase, GPx)和穀胱甘肽氧化酶(glutathione reductase, GRx)的活性及超氧陰離子( superoxide anion, O2 •-)的含量均呈現統計學上顯著性的增加(p<0.05)；而運鐵蛋白(transferrine, TRF)、總鐵結合能力(Total iron binding capacity, TIBC)、維他命C(vitamin C, Vit C)、穀胱甘肽 (glutathione, GSH)和Total GSH 的濃度則呈現有意義的減少 (p<0.05)；至於乙型海洋性貧血與對照組相比，其Fe、MDA、Total Nitric Oxide (Total NO)和亞硝酸鹽(nitrite, NO2-)的濃度、SOD 活性及O2•-的含量呈現顯著性的增加(p<0.05)；反之TRF、TIBC 及Vit C 的濃度則呈現顯著性的減少(p<0.05)；另外，此兩型病人比較，乙型海洋性貧血患者的TRF 與TIBC 濃度及SOD、GPx、GRx 活性較甲型者為低(p<0.05)，反之， Fe、Total NO、NO2 -的濃度及O2•-的含量則叫甲型者為高(p<0.05)。結論：海洋性貧血患者體內過量的鐵確實會使其體內的氧化還原狀態發生改變。

關鍵字

甲型海洋性貧血；乙型海洋性貧血；鐵；氧化性傷害

並列摘要

Objective: Hyper-ferrous state is the result of multiple transfusions, whereby the iron excess in such conditions may be toxic to the organism through increased oxidative stress. Therefore, we investigated the changes of oxidative stress-related biomarkers in thalassemia patients with excessive iron. Materials and Methods: A total of 23 a-thalassemia and 36 b-thalassemia patients from Kaohsiung Medical University Chung-Ho Memorial Hospital and 73 healthy subjects as the controls were enrolled in this study. The biochemical tests (serum iron [Fe], transferring [TRF], ferritin, total iron binding capacity [TIBC]), and the biomarkers of oxidative stress-related tests (superoxide dismutase [SOD], glutathione peroxidase [GPx], and glutathione reductase [GRx]; reduced glutathione [GSH], oxidized glutathione [GSSG), vitamin C [Vit C], total Nitric Oxide [Total NO], superoxide anion [O2•-], and malondialdehyde [MDA]) were measured. Results: Activities of antioxidant enzymes (SOD, GPx and GRx); levels of Fe, MDA, and the generation of O2•- in the patients with a-thalassemia were significantly higher than those in the controls (p<0.05). Conversely, the levels of TRF, TIBC, GSH, Total GSH, and Vit C in the patients with a-thalassemia were significantly decreased compared to those in the controls (p<0.05). Activities of SOD and levels of Fe, O2•-, Total NO, NO2-, and MDA in b-thalassemia patients were significantly higher than those in the controls (p<0.05); however, concentrations of TRF, TIBC and Vit C in the patients were significantly lower than those in the controls (p<0.05). In addition, there were significantly higher levels of Fe, Total NO, NO2 -, and the generation of O2•- in the b-thalassemia than in the a-thalassemia. Conversely, there were significantly lower levels of TRF and TIBC, and activities of SOD, GPx, and GRx in the b-thalassemia than in the a-thalassemia. Conclusion: Oxidative stress is increased, especially in the patients b-thalassemia with iron ovweload.