大黄对维持性血液透析患者血清SAA及hs-CRP的影响

Effects of rhubarb on the levels of serum SAA and hs-CRP in patients with hemodialysis

目的探讨大黄对尿毒症维持性血液透析(MHD)患者血清淀粉样蛋白A(SAA)及超敏C反应蛋白(hs-CRP)的影响。方法选择2010年1月～2012年1月在该院肾内科门诊及住院的MHD患者60例,按不同的治疗方法分为治疗组和对照组,每组30例。对照组患者常规给予降压药、红细胞生成素及对症治疗;治疗组在对照组治疗的基础上加用生大黄10 g开水泡服,1次/d。2组疗程均为2周。选择同期在该院门诊体检科体检的健康者(正常对照组)30例。治疗组和对照组在治疗前后分别检测血肌酐(Scr)、SAA和hs-CRP的水平,同时计算内生肌酐清除率(Ccr)。并与正常对照组进行对比。结果两组患者治疗后血清Scr、Ccr水平与治疗前比较差异均无显著性(均P>0.05),两组患者治疗前血清SAA和hs-CRP水平均较正常对照组显著升高(均P<0.05),对照组患者治疗前血清SAA和hs-CRP水平与治疗后比较差异均无显著性(均P>0.05),而治疗组患者治疗后血清SAA和hs-CRP水平均较治疗前、对照组显著下降(均P<0.05)。相关性分析结果显示,治疗前MHD患者hs-CRP与SAA呈正相关(r=0.962,P<0.05)。结论尿毒症MHD患者血清SAA及hs-CRP水平升高,存在微炎症状态。大黄能降低MHD患者SAA及hs-CRP水平,改善患者微炎症状态。

[ Objective ] To study the effects of rhubarb on the levels of serum amyloid A （SAA） and high sensi- tivity C-reative protein（hs-CRP） in patients with uremic maintenance hemodialysis （MHD patients）. [Methods ] Six- ty outpatients and inpatients with MHD from department of Nephrology of the Second Affiliated Hospital of Nan- chang University In January 2010 to January 2012 were randomly divided into treatment group and control group ac- cording to the different treatment, thirty cases each. Control group were routinely offered antihypertensive drugs, ery- thropoietin and heteropathy; the treatment group were supplied with additional infused decotion of rhubarb（ten grams per day）. The period of therapy was two weeks for two groups. Thirty healthy subjects （normal control group） in the outpatients department of physical examination of our hospital were recruitted. The levels of serum creatinine（Scr）, SAA, hs-CRP were detected respectively before and after treatment in treatment group and control group, and crea- tinine clearance rate（Ccr） were calculated compared with normal control group. [ Results ] The levels of Scr and Ccr in both control and treatment group showed no obvious difference before and after therapy （P 〉0.05）. The levels of SAA and hs-CRP increased a lot in control and treatment group compared with normal control group before treatment （P 〈0.05）, and displayed no significant change in control group before and after therapy （P 〉0.05）, but was ob- viously lower after therapy in treatment group than before taking rhubarb and also control group （P 〈0.05）. Levels of SAA showed a positive relationship with hs-CRP by correlation analysis on sixty MI-ID patients before therapy （r = 0.962, P 〈0.05）. [Conclusion] The levels of serum SAA and hs-CRP on uremia MHD patients are elevated. MHD patients exist microinflammation state. Rhubarb can reduce the levels of serum SAA and hs-CRP, and improve mi- croinflammatory state in MHD patients.