氯沙坦及辛伐他汀对慢性肾衰竭患者C－反应蛋白的影响

The effect of Losartan and Simvastatin on C-reactive protein in CRF patients

目的观察慢性。肾衰竭（CRF）患者血清C－反应蛋白（CRP）及生化指标的变化；探讨CRP在CRF病程进展及其并发症发生中的作用以及氯沙坦、辛伐他汀对CRF患者的影响。方法将120例CRF患者随机分为4组：A组（常规治疗组）；B组（常规治疗加氯沙坦100mg／d）；C组（常规治疗加辛伐他汀20mg／d）；D组（常规治疗加氯沙坦100mg／d，加辛伐他汀20mg／d），同时设E组（健康对照组）20例。测定各组治疗前和治疗4周后各指标的水平。结果CRF患者治疗前的CRP几何均数显著高于E组。A、B、C、D组治疗后CRP、尿素氮（BUN）、血肌酐（SCr）水平有所下降，A、B组治疗前后总胆固醇（TC）、低密度脂蛋白（LDL）水平无明显改变，但C、D组治疗前后组内比较有统计学意义。B、C、D组分别与A组相比，CRP、BUN、SCr治疗前后差值比较，差异有统计学意义。B组TC、LDL下降值与A组比较无明显差异，但C、D组与A组相比，差异有统计学意义。CRP与BUN、TC、LDL具有正相关性，与血红蛋白（Hb）、白蛋白（Alb）具有显著负相关性，与SCr之间无相关性。结论①CRF患者CRP普遍升高；②CRP水平升高可能是CRF患者慢性贫血、营养不良、动脉粥样硬化等合并症的原因之一；③在某种程度上氯沙坦、辛伐他汀具有独立于降血压、降血脂以外的降低CRP、延缓。肾衰竭进展的作用。

Objective To observe the changes of serum CRP, Hb,Alb,TC,LDL,BUN and SCr in patients with chronic renal failure（CRF）, to explore the effect of CRP in the progression and complications of CRF and explore the effect of Losartan and Simvastatin on CRP in patients with CRF. Method 120 patients of CRF were randomizedly divided into A group （routine therapy）; B group （routine therapy plus Losartan 100mg/d）; C group （routine therapy plus Simvastatin 20mg/d）; D group （routine therapy plus Losartan 100mg/d and Simvastatin 20rag/d）. Besides, a healthy control group consisted of 20 subjects was set up as control group（E）. The changes of aboved parameters of all groups before and 4 weeks after treatment were recorded. Results The serum CRP level increased in CRF patients before treatment, which were significantly higher as compared to E group. After treatment, the levels of CRP,BUN and SCr of A-D groups decreased. The levels of TC,LDL had no statistical changes in A and B groups, but with significant differences in C and D groups before and after treatment. As compared to A group, the differences of CRP,BUN and SCr level after treatment in B,C,D groups were statistically significant respectively. The difference of TC and LDL levels between B and A groups showed no statistical significance, but between C and A groups, between D and A groups, the differences were significant. Serum CRP level was significant positively correlated to BUN,TC and LDL, and was negatively correlated to Hb and Alb. There was no correlation between CRP and SCr. Conclusions ① The level of CRP was increased in CRF patients. ②CRP may be one of the causes of chronic anemia,malnutrition and atherosclerosis. ③In some way, Losartan and Simvastatin could decrease the level of CRP and delay the progression of CRF, independently on the effect of decreasing hypertension and hyperlipemia.