氟伐他汀联合缬沙坦对腹膜透析患者微炎症状态的影响

Effect of Fluvastatin Combined with Valsartan on the Microinflammatory State of Patients with Peritoneal Dialysis

目的研究氟伐他汀联合缬沙坦对腹膜透析患者微炎症反应的影响。方法将150例腹膜透析患者随机分为3组,每组50例。对照组进行常规腹膜透析;缬沙坦组在常规腹膜透析治疗基础上,口服缬沙坦片80mg/d;氟伐他汀联合缬沙坦组在常规腹膜透析治疗基础上,口服缬沙坦片80mg/d,氟伐他汀胶囊20mg,1次/晚,共24周。检测治疗前后3组患者的炎症反应指标、血脂指标以及营养状态指标。结果缬沙坦组、氟伐他汀联合缬沙坦组患者治疗后与治疗前血清中C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、血清淀粉样蛋白A (serum amyloid A,SAA)、妊娠相关血浆蛋白-A (pregnancy associated plasma protein-A,PAPP-A)、胆碱酯酶(cholinesterase,CHE)水平比较显著降低,且氟伐他汀联合缬沙坦组治疗后血清中CRP、IL-6、IL-8、TNF-α、SAA、PAPP-A、CHE水平与缬沙坦组比较均显著降低;缬沙坦组、氟伐他汀联合缬沙坦组患者治疗后相比治疗前甘油三脂(triglyceride,,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白(low lensity lipoprotein,LDL)水平均显著下降,高密度脂蛋白(high density lipoprotein,HDL)水平显著升高。氟伐他汀联合缬沙坦组患者的TG、TC、LDL水平较对照组、缬沙坦组均显著降低,HDL水平也更显著升高;氟伐他汀联合缬沙坦组治疗前后血清白蛋白(albumin,Alb)、前白蛋白(prealbumin,PA)、组织因子(tissue factor,TF)的水平无明显变化,对照组与缬沙坦组治疗后血清中Alb、PA、Tf的水平较治疗前显著降低。结论氟伐他汀联合缬沙坦对腹膜透析患者微炎症的治疗具有较好的疗效,有一定的临床推广应用价值。

Objective To study the effect of fluvastatin combined with valsartan on the microinflammatory state of patients with peritoneal dialysis. Methods 150 patients with peritoneal dialysis were randomly divided into three groups,with 50 patients in each group. The control group was given conventional peritoneal dialysis. The valsartan group was treated with oral 80 mg/d valsartan tablets on the basis of conventional peritoneal dialysis treatment. On the basis of routine peritoneal dialysis treatment, the fluvastatin combined with valsartan group was given oral 80 mg valsartan and 20 mg fluvastatin once daily for 24 weeks. To detect the inflammatory response indicators,blood lipids and nutritional status indicators were analysed before and after treatment of the three groups. Results C-reactive protein( CRP), interleukin-6(IL-6), interleukin-8( IL-8), tumor necrosis factor-α(TNF-α), serum amyloid A(SAA),pregnancy associated plasma protein-A(PAPP-A) and cholinesterase( CHE) levels in the valsartan group and fluvastatin combined with valsartan group after treatment were significantly lower than those before treatment. Serum levels of CRP、IL-6、IL-8、TNF-a、SAA、PAPP-A and CHE in the fluvastatin combined with valsartan group after treatment were significantly lower than those in valsartan group; The triglyceride( TG), total cholesterol( TC), and low-density lipoprotein(LDL) levels in the valsartan group and fluvastatin combined with valsartan group after treatment were significantly lower than those before treatment,and the level of high density lipoprotein(HDL) increased significantly. The TG、TC and LDL levels in the fluvastatin combined with valsartan group was significantly lower than those in the control group and valsartan group,and the HDL levels were significantly higher. After treatment, serum albumin(Alb), prealbumin( PA),and tissue factor(TF) levels in the fluvastatin combined with valsartan group were not significantly different from those before treatment,while serum Alb,PA and Tf levels in control group and valsartan group after treatment were significantly lower than those before treatment. Conclusion Fluvastatin combined with valsartan has good effect on the treatment of microinflammation in peritoneal dialysis patients,and has a certain clinical application value.