阿托伐他汀对血液透析患者血清铁调素水平的影响

The influence of atorvastatin on serum hepcidin level in patients with maintenance hemodialysis

目的前瞻性观察阿托伐他汀对维持性血液透析(MHD)患者血清铁调素水平的影响。方法选择32例维持性血液透析患者,随机分为阿伐他汀组(16例)和常规治疗组(16例)。阿伐他汀组每晚给予阿托伐他汀20 mg共12周,常规治疗组不使用阿托伐他汀及其他调脂药。观察两组实验前后血清铁调素、超敏CRP(hs-CRP)、白介素6(IL-6)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血红蛋白(Hb)、血细胞比容(Hct)、铁蛋白(SF)、转铁蛋白饱和度(TSAT)等指标的变化。同时选取健康对照者15例,测定血清铁调素、hsCRP及IL-6水平,与MHD患者做比较。结果与健康对照组相比,32例MHD患者血清铁调素、hsCRP、IL-6水平均显著性升高(P<0.01)。12周后,阿伐他汀组较前相比,铁调素下降20.5%(P<0.05)、IL-6下降32.2%(P<0.05)、hsCRP下降31.7%(P<0.05);较常规治疗组治疗后相比,铁调素下降13.4%(P>0.05)、IL-6下降34.2%(P<0.05),hsCRP下降29.9%(P<0.05)。同时12周后阿伐他汀组TG、TC、LDL-C均较治疗前明显降低(P<0.05),HDL-C、Hb、Hct较治疗前明显升高(P<0.05)。而常规治疗组各项及治疗组TSAT、SF值组内及组间比较均无统计学差异。结论口服常规剂量阿托伐他汀可降低MHD患者血清铁调素水平。

Objective To prospectively study the influence of atorvastatin on serum hepcidin level in maintenance hemodialysis （MHD） patients. Methods We assigned 32 MHD patients equally into experiment group and control group. Patients in the experiment group took 20 mg atorvastatin orally per night for 12 weeks, and those in the control group without atorvastatin and other lipid modulating drugs. Before and after ex- periment, the level of serum hepcidin, high - sensitivity C - reactive protein （ hsCRP）, interleukin 6 （ IL - 6 ）, triglyceride （ TG）, cholesterol （ TC ）, low density lipoprotein （ LDL - C ）, high density lipoprotein （ HDL - C ）, hemoglobin （ Hb）, hematokrit （ Hct）, ferritin （ SF ）, transfer- fin saturation （TSAT） were determined. Meanwhile, 15 healthy subjects were enrolled as healthy control group, and their serum hepcidin, hsCRP and IL -6 were determined. Results Compared with healthy control group, the level of serum hepcidin, hsCRP and IL -6 in 32 MHD patients were significantly elevated （ P 〈0. O1 ）. In the experiment group, after atorvastatin treatment for 12 weeks, serum hepcidin decreased by 20.5% （ P 〈0.05）, IL-6 decreased by 32.2% （ P 〈0.05） and hsCRP decreased by31.7% （ P 〈0.05）. When compared with the control group after 12 weeks, the level of serum hepcidin decreased by 13.4% （ P 〉 0.05 ）, the level of IL - 6 decreased by 34.2% （ P 〈 0.05 ） and the lev- el of hsCRP decreased by 29.9% （ P 〈 0.05 ）. The level of TG, TC and LDL - C were significantly reduced （ P 〈 0.05 ）, and the level of HDL - C, Hb and Hct significantly increased （ P 〈 0.05 ） after atorvastatin treatment in experiment group. While all indicators had no significant changes （ P 〉0. 05 ） in the control group, and the level of TSAT and SF had no statistical difference （ P 〉 0.05 ） in the experiment group. Conclusion Conventional - dose atorvastatin may decrease the level of serum hepcidin in patients with MHD.