福辛普利与辛伐他汀联合治疗维持性血液透析患者微炎症、营养状态的作用

Effects of fosinopril combined with simvastatin on inflammatory parameters and nutritional status in maintenance hemodialysis patients

目的观察联合应用福辛普利及辛伐他汀治疗对维持性血液透析患者(MHD)相关炎症因子及营养状况的影响,探讨其对MHD患者微炎症的治疗作用。方法选择MHD患者127例,随机分成4组,A组32例,联合使用福辛普利和辛伐他汀治疗;B组32例,予福辛普利治疗;C组31例,予辛伐他汀治疗;D组32例患者为对照组[不服用血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体1拮抗剂(ARB)、他汀类药物]。4组病例随访6个月,分别检测治疗前、治疗3月后、治疗6月后血清C反应蛋白(CRP)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平及营养指标。另设健康对照组26例,健康对照组无治疗。结果治疗前,4组MHD患者血清CRP、IL-1β、IL-6及TNF-α水平均较对照组显著升高(P<0.01);治疗3月后,A组、B组及C组患者的血清CRP、TNF-α、IL-6的水平与治疗前及D组比较就有明显下降,有统计学意义(P<0.05);治疗6月后,A组、B组及C组IL-1β水平较治疗前及D组显著下降(P<0.05);治疗6月后,A组与B组患者的血清白蛋白(Alb)、前白蛋白(PA)水平较治疗前及D组也显著升高(P<0.05)。A组和B组的血CRP、IL-1β、IL-6、TNF-α、和血清Alb、PA水平随着治疗时间的延长差异越明显(P<0.05),治疗6月后,A组与B组、C组比较,A组的血清CRP、IL-1β、IL-6及TNF-α水平下降更明显,血清Alb和PA水平上升更明显,均有统计学意义(P<0.05)。结论MHD患者普遍存在微炎症状态,福辛普利治疗能改善微炎症及营养状态,福辛普利联合辛伐他汀治疗能更明显降低炎症因子水平,同时改善营养状况,这一作用随治疗时间的延长更明显。

Objective To investigate the effects of fosinopril combined with simvastatin on inflammatory parameters and nutritional status in maintenance hemodialysis （MHD） patients. Methods 127 MHD patients were enrolled. All MHD patients were randomly divided into four groups and followed up for six months. 32 patients of them were treated with fosinopril combined with simvastain （group A）, 32 patients of them were treated with fosinopril （group B）, 31 patients of them were treated with simvastain （group C）, and 32 patients were not given ACE1, ARB and statins （group D）. The serum levels of c-reactive protein （CRP）, interleukin （IL）-1β, IL-6, tumor necrosis factor-α （TNF-α） and nutrition were measured at the experiment onset, three months and six months later.Twenty-six normal medical examination adults who took no medicines were selected as healthy control group. Results At the initiation of the investigation, the serum levels of CRP, IL-1β, IL-6 and TNF-α in MHD patients were obviously higher than those in the control group （P〈0.01）. After treatment for three months, the scores of CRP, IL-6, TNF-α were obviously decreased in group A ,B and C, compared with group D and before treatment （P〈0.05）. Six months later, the levels of IL-1β in group A, B and C were also significantly lower than those in group D and baseline （P〈0.05）. The serum levels of albumin （Alb） and pre-albumin （PA） in group A and B were increased remarkably （P〈0.05）. Except for group C, the longer the duration of the experiment, the more significantly changes of the levels of inflammatory parameters, Alb and PA （P〈0.05）. The degree of serum CRP, IL-1β, IL-6 and TNF-ct in group A were decreased greatly after treatment for six months （P〈0.05）, while the degree of serum Alb and PA were increased remarkably （P〈0.05）, compared with those in group B and C. Conclusion Using fosinopril combined with simvastain may significantly improved microinflammation parameters and nutrition states in MHD patients than that of using fosinopril or simvastain only.