中文摘要：

目的：基于高效液相色谱-四极杆飞行时间串联质谱仪（HPLC．MS／MSQ—TOF）分析糖尿病肾病（DN）维持性血透患者单次使用含糖透析液（含葡萄糖5．5mmol／L）的代谢特征。方法：对10例DN维持性血透患者采用自身对照研究，先后单次使用无糖及含糖透析液作为无糖透析组（G一组）和含糖透析组（G＋组），应用HPLC—MS／MSQ—TOF检测G-组和G＋组血液透析前、血液透析后血清样本d用主成分分析法（PCA）、正交信号校正一偏最小二乘判别分析法（OSC．PLS—DA）分析数据，鉴别代谢物的差异。结果：（1）血液透析前及血液透析后PCA模型均无法区分G-组和G＋组样本。OSC—PLS．DA模型能有效区分血液透析后G-组和G＋组样本。（2）对OSC—PLS—DA模型中变量投影重要性（VIP）〉3的变量进行配对样本t检验，P〈0．05的物质为主要差异代谢物，鉴定出G＋组升血糖、增加糖异生水平的物质氢化可的松和石胆酸含量较G-组低，可以参与糖异生、也是一种兴奋性神经递质的物质天冬氨酸含量亦较低，而反映氧化应激水平的指标Ⅳ-甲基烟酰胺和二羟基前列腺素F水平较G-组高。结论：通过代谢组学方法证实，单次使用含糖透析液较无糖透析液DN维持性血透患者内代谢状态稳定，减少糖异生，可能在改善患者营养状态具有优势，同时可能对脑细胞有潜在保护作用，但从目前实验结果来看可能有加重患者氧化应激状态的风险。

英文摘要：

AIM： To investigate the metabolic features of maintenance hemodialysis patients with diabetic ne- phropathy treated with glucose-added dialysate （containing glucose at concentration of 5.5 mmol/L for one time） by high- performance liquid chromatography/quadrupole time-of-flight mass spectrometry （HPLC-MS/MS Q-TOF）. METHODS： Self-control study was conducted in 10 maintenance hemodialysis patients with diabetic nephropathy, who were dialyzed with glucose-free dialysate for one time （as glucose-free dialysate group, G- group） and then changed to glucose-added di- alysate for another time （as glucose-added dialysate group, G ＋ group）. The serum samples from the patients in G- group and G ~ group before and after hemodialysis were analyzed and tested by the method of HPLC-MS/MS Q-TOF. In order to identify the differential metabolites, the metabonomic data was processed by principal component analysis （PCA） and or- thogonal signal correction-partial least square discriminate analysis （OSC-PLS-DA）. RESULTS ： Regardless of before or after hemodialysis, the PCA model could not distinguish the serum samples from G ~ group and G- group, but the samples could be effectively distinguish by OSC-PLS-DA model. The substances lined with variable importance in projection （VIP） value 〉 3 in the OSC-PLS-DA model and P 〈 0.05 in the paired sample t-test as differential metabolites of the 2 groups and included metabolites such as hydrocortisone, lithocholic acid, aspartic acid, N-methyl niacinamide and dihydroxypros-taglandin F. The concentrations of hydrocortisone and lithochlic acid, which was able to raise the levels of blood glucose and gluconeogenesis, were lower in G ~ group than those in G- group. The concentration of aspartic acid, which was in- volved in gluconeogenesis and also a kind of excitatory neurotransmitter, was lower in G ~ group than that in G- group. The concentrations of N-methyl niacinamide and dihydroxyprostaglandin F, which reflected the level of oxidative stress, were h