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  

The effect of minimal inflammation on patients with maintenance hemodialysis and the intervention effect of fluvastatin.

作　　者：杨焕荣[1] 蔡淑芳[1] 徐炳侠[1] 常玲玲[1] 张晓速[1] 武文斌[1] 

机构地区：[1]潍坊医学院附属青州医院肾内科,262500

出　　处：《中国综合临床》2009年第8期820-823,共4页Clinical Medicine of China

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a[Lp（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≥8mg／L）及非炎症组（CRP〈8mg／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[（11．324-4．94）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）μg／L与（13．50±3．11）ng／h]、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）[（0．26±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�Objective To invest the effect of minimal inflammation on patients with maintenance hemodialysis（MHD） and the intervention effect of fluvastatin. 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 CRPlevels. 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 obvi- ously（ 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.

关 键 词：血液透析 氟伐他汀 炎症 营养不良 

分 类 号：R459.5[医药卫生—治疗学] R589.2[医药卫生—临床医学]