维持性血液透析患者顽固性中重度心力衰竭心脏结构及功能的改善与微炎症状态关系的研究

Study of the relationship between micro - inflammation and the improvement of heart structure and function in maintenance hemodialysis patients with refractory medium - severe heart failure

目的探讨维持性血液透析（MHD）患者顽固性中重度心力衰竭心脏结构与功能的改善与微炎症状态的关系。方法选取30例MHD伴顽固性中重度心力衰竭患者，在常规综合治疗基础上＋血必净纠正微炎症状态，观察其心胸比率（CTR）、瓣膜返流及左室射血分数（LVEF）改善情况，并建立预测改善量的多元线性回归模型，观察血必净总剂量与微炎症状态指标C-反应蛋白改善量（△CRP）的关系。结果治疗后CTR值小于治疗前（t=3．450．P=0．001）。治疗后主动脉瓣及三尖瓣返流程度轻于治疗前（Z=2．278，P=0．023；Z=2．047，P=0．041）；治疗前后二尖瓣返流程度比较差异无统计学意义（Z=1．940，P=0．052）。治疗后LVEF值高于治疗前（t=5．935，P=0．000）。预测CTR及LVEF改善量的因素主要有血红蛋白改善量、治疗后血红蛋白水平、年龄、ACRP、血必净总剂量、碳酸氢根改善量及血清肌酐改善量等，不同指标间各因素的种类及权重略有差别。血必净总剂量与△CRP呈明显正相关（r=0．561。P=0．001）。结论微炎症状态的纠正有助于MHD患者心脏大小结构、瓣膜返流及心功能的改善。血必净是有效选择，其剂量与疗效呈正相关。治疗中还需注意贫血的改善、酸中毒的纠正及透析的充分性。

Objective To investigate the relationship between micro- inflammation and the improvement of heart structure and function in maintenance hemodialysis （MHD） patients with refractory medium- severe heart failure. Methods The clinical data of 30 MHD patients with refractory medium - severe heart failure who received routine combined modality therapy and Xuebijing injection for the rectification of micro - inflammation, whose cardiothoracic ratio （ CTR）, back streaming of valve and left ventricular ejection fraction （LVEF） were compared before and after therapy. Multiple linear regression models were established to predict the improvements of CTR and LVEF. Relationship between the accumulated dose of Xuebijing injection and improvement of C - reactive protein （ A CRP） was observed. Results The value of CTR after therapy was less than that before therapy （t = 3. 450, P = 0. 001 ）. The back streaming degrees of aortic valve and tricuspid valve after therapy were lighter than those before therapy （ Z = 2.278, P = 0.023 ; Z = 2. 047, P = 0.041 ）, and the back streaming degrees of mitral valve had no difference after and before therapy （ Z = 1. 940, P = 0. 052）. The value of LVEF after therapy was higher than that before therapy （ t = 5. 935, P = 0. 000）. In the multivariate linear regression models of A CTR and A LVEF, the independent variables that affect dependent variables included aHb, the level of Hb after therapy, age, ACRP, accumulated dose of Xuebijing injection, a HCO3- and a Scr, the factors and weights of which had slight variation in accordance with different dependent variables. There was significant positive correlation between accumulated dose of Xuebijing injection and a CRP（r = 0. 561, P = 0. 001 ）. Conclusion Rectification of micro - inflammation in MHD patients can improve their heart size, structure, back streaming of valve and function. Xuebijing is a good choice, whose accumulated dose and therapeutic effect show positive correlation. Also, the improvement of heart structure and function has something to do with the correction of anemia, acidosis and dialysis sufficiency.