厄贝沙坦联合左卡尼汀对维持性血液透析患者微炎症和营养状态的影响

Effects of irbesartan combined with levocarnitine on microinflammatory parameters and nutritional status in patients on maintenance hemodialysis

目的探讨联合应用厄贝沙坦与左卡尼汀对维持性血液透析(maintenace hemodialysis,MHD)患者微炎症和营养状态的影响。方法选择MHD 132例,随机分成4组:联合使用厄贝沙坦与左卡尼汀(厄加左组)34例;单纯应用厄贝沙坦治疗(厄组)32例;单纯应用左卡尼汀治疗(左组)33例;纯透析组33例。检测治疗前,治疗3、6个月后血清C反应蛋白(CRP),白细胞介素-8(IL-8),白细胞介素-10(IL-10),转化生长因子(TGF)水平及营养指标。结果治疗3个月后,厄加左组、厄组及左组CRP、IL-8、IL-10的水平与治疗前及纯透析组比较就有明显下降(P<0.05);治疗6个月后,厄加左组、厄组及左组IL-8水平较治疗前及纯透析组明显下降(P<0.05),厄加左组和厄组血清白蛋白(Alb)、前白蛋白(PA)水平较治疗前及纯透析组显著升高(P<0.05),厄加左组与厄组、左组比较,CRP、IL-8、IL-10、TGF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)。结论厄贝沙坦和左卡尼汀均能改善微炎症及营养状态,两者联合应用更明显降低炎性因子水平,同时改善营养状况。

Objective To investigate the effect of irbesartan combined with levocaruitine on microinflammatory and nutritional status in patients on maintenance hemodialysis （MHD）. Methods 132 patients on MHD were enrolled. They were randomly divided into four groups and followed up for six months. 34 of them were treated with irbesartan combined with levocarnitine （ group A ） , 32 treated with irbesartan （group B）, 33 treated with levocarnitine （group C）, and 33 not given ACEI, ARB or levocaruitine （group D）. The serum levels of c - reactive protein（ CRP）, interleukin（IL） - 8, IL - 10, transforming growth factor （TGF） and nutrition were measured at the beginning of treatment, three months, and six months later. Results At the outset of the investigation, the serum levels of CRP, IL - 8, and IL - 10 and TGF in the patients were significantly higher than those in the control group （P 〈0.01 ）. After the treatment of three months, the parameters of CRP, IL -8, and IL - 10 were significantly decreased in Group A, B and C, compared with Group D and before treatment （ P 〈 0. 05 ）. Six months later, the levels of IL - 8 in groups A, B and C were also significantly lower than those in Group D and baseline （P 〈0.05）. The serum levels of albumicn（Alb） and pre -albumin （PA） in Group A and C were increased significantly （P 〈 0.05 ）. The levels of serum CRP, IL- 8, IL- 10 and TGF in Group A were decreased greatly after treatment of six months （ P 〈 0.05 ） , while the levels of serum Alb and PA were increased significantly （ P 〈 0.05 ） , compared with those in Group B and C. Conclusions Irbesartan combined with levocarnitine significantly improves microinflammation and nutrition status in MHD patients, compared with using irbesartan or levocarnitine alone.