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微炎症状态对维持性血液透析患者的影响及氟伐他汀的干预作用
引用本文:杨焕荣,蔡淑芳,徐炳侠,常玲玲,张晓速,武文斌.微炎症状态对维持性血液透析患者的影响及氟伐他汀的干预作用[J].中国综合临床,2009,25(8).
作者姓名:杨焕荣  蔡淑芳  徐炳侠  常玲玲  张晓速  武文斌
作者单位:潍坊医学院附属青州医院肾内科,262500
摘    要:目的 探讨微炎症状态对维持性血液透析(MHD)患者的影响及氟伐他汀的干预作用.方法 以2005年6月至2007年6月我院血液透析中心行MHD患者76例为研究对象.均在入组后第1天、6个月分别检测前白蛋白(PA)、ALB、BUN、Cr、TC、TG、HDL-C、LDL-C、脂蛋白aLp(a)]、转铁蛋白(SF)及超敏C-反应蛋白(hs-CRP)、IL-6、TNF-α.据CRP水平将患者分为炎症组(CRP≥8 mg/L)及非炎症组(CRP<8 mg/L).另设正常对照组30例,炎症组给予氟伐他汀治疗,非炎症组不给予氟伐他汀;观察时间为6个月.结果 与正常对照组比较MHD患者hs-CRP(8.96±5.33)mg/L与(2.97±1.53)mg/L]、IL-6(11.32±4.94)ng/L与(4.40±1.51)ng/L]、TNF-α(15.89±6.20)ng/L与(9.62±3.45)ng/L]、TG(2.98±1.36)mmol/L与(1.35±0.97)mmoL/L]、Lp(a)(0.46±0.41)mg/L与(0.21±0.25)mg/L]、sF(179.45±101.36)μg/L与(106.11±75.55)μg/L]水平明显升高(P<0.01或P<0.05);ALB(35.02±4.83)g/L与(43.16±5.53)g/L]水平明显降低(P<0.01);炎症组心血管事件发生率明显高于非炎症组,且微炎症状态越明显,脂质代谢紊乱和营养不良越显著;炎症组较治疗前hs-CRP(6.03±2.46)mg/L与(10.32±1.46)mg/L]、IL-6(9.91±0.75)ng/L与(13.50±3.11)ng/L]、TG(1.50±1.01)mmol/L与(3.05±1.55)mmol/L]、TC(3.35±1.66)与(5.26±1.63)mmol/L]、LDL-C(2.45±1.35)mmol/L与(3.46±1.36)mmol/L]、Lp(a)(O.26±0.30)mmol/L与(0.50±0.31)mmol/L]水平明显降低(P<0.01或P<0.05),ALB(38.16±4.63)g/L与(33.43±3.08)g/L]、HDL·C(1.76±0.82)mmol/L与(0.96±0.58)mmol/L]明显升高(P均<0.05).结论 MHD患者普遍存在微炎症状态及血清脂质代谢紊乱和营养不良,微炎症反应状态对MHD患者心血管事件发生率及血清脂质代谢紊乱和营养不良起着重要的作用;氟伐他汀具有改善MHD患者微炎症反应状态的作用,其抗炎作用独立于调脂作用之外;早期发现及干预治疗微炎症反应状态对改善MHD患者的预后具有十分重要的意义.

关 键 词:血液透析  氟伐他汀  炎症  营养不良

The effect of minimal inflammation on patients with maintenance hemodialysis and the intervention effect of fluvastatin
YANG Huan-rong,CAI Shu-fang,XU Bing-xia,CHANG Ling-ling,ZHANG Xiao-su,WU Wen-bin.The effect of minimal inflammation on patients with maintenance hemodialysis and the intervention effect of fluvastatin[J].Clinical Medicine of China,2009,25(8).
Authors:YANG Huan-rong  CAI Shu-fang  XU Bing-xia  CHANG Ling-ling  ZHANG Xiao-su  WU Wen-bin
Abstract:Objective To invest the effect of minimal inflammation on patients with maintenance hemodialysis(MHD) and the intervention effect of ftuvastatin.Methods Blood indicators such as PA,ALB and BUN,Cr,TC,TG,HDL-C,LDL-C,Lp(a),SF,hs-CRP,IL-6 and TNF-α were detected at the first day of the study and six months later in all patients.Patients were divided into inflammation group(CRP≥8 mg/L) and non-inflammation group(CRP<8 mg/L) according to CRP levels.Only inflammation group used fluvastatin.Two groups were observed for six months.Results The level of hs-CRP,IL-6,TNF-α,TG,Lp(a),SF in MHD patients was obviously higher than the normal control group.The level of ALB was obviously lower than the normal control group.The angiocardiopathy incidence of inflammation group was obviously higher than that of the non-inflammation.The more obvious of minimal inflammation,the more significant of lipid metabolism disturbance and malnutrition.Hs-CRP,IL-6,TG,TC,LDL-C and Lp(a) of inflammation group decreased obviously(P<0.01 or P<0.05).ALB、HDL-C increased obviously(P<0.05).Indicators of the non-inflammation had no statistical difference after therapy.Conclusions Patients with MHD generally have minimal inflammation and malnutrition.Minimal inflammation has important effect on the angiocardiopathyincidence,lipid metabolism disturbance and malnutrition.Fluvastatin not only could regulate lipid metabolism but also improve the minimal inflammation of patients with MHD.Early detection and therapy of minimal inflammation has important significance on improving prognosis of patients with MHD.
Keywords:Hemodialysis  Fluvastatin  Inflammation  Malnutrition
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