阿托伐他汀联合厄贝沙坦对血透微炎症状态的影响

Effects of atorvastatin combined with irbesartan on microinflammatory state in patients with maintenance hemodialysis

目的探讨阿托伐他汀联合厄贝沙坦对维持性血液透析患者微炎症状态的影响。方法采用免疫比浊法及ELISA法检测80例维持性血液透析(MHD)治疗的终末期肾脏病(ESRD)患者及正常对照组血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)表达水平;并将MHD患者随机分为4组,A组常规治疗基础上予阿托伐他汀+厄贝沙坦治疗,B组予阿托伐他汀,C组予厄贝沙坦。D组患者不予应用他汀类及ACEI/ARB类药物,比较各组治疗前后血清hs-CRP、TNF-α和IL-6水平的变化。结果 MHD组患者血清hsCRP、TNF-α及IL-6水平分别为(12.03±3.15)mg/L、(42.56±12.65)pg/ml、(21.78±7.78)pg/ml,对照组上述指标水平分别为(2.64±1.26)mg/L、(14.42±6.1)pg/ml、(12.46±4.72)pg/ml,MHD组较对照组均明显升高,差异有统计学意义(P<0.05);治疗后A、B、C三组患者血清hs-CRP、TNF-α及IL-6水平均明显下降,差异有统计学意义(P<0.05);且治疗后A组上述指标明显低于B组、C组,差异有统计学意义(P<0.05);D组患者治疗前后上述指标无明显变化(P>0.05)。结论阿托伐他汀及厄贝沙坦均可以降低MHD患者血清炎症因子水平,并且联合应用阿托伐他汀及厄贝沙坦具有更强的改善MHD患者微炎症状态的作用。

Objective To investigate the effect of atorvastatin combined with irbesartan on microinflammatory state in pa- tients with maintenance hemodialysis （MHD）. Methods The levels of serum high-sensitivity C-reactive protein （ hs- CRP）, tumor necrosis factor-α（TNF-α） and interleukin-6 （IL-6） were detected by using turbidimetric immunoassay and ELISA in 80 cases of end-stage renal disease（ESRD） with MHD and normal subjects in the control group;MHD patients were randomly divided into group A（atorvastatin ＋ irbesartan）,group B（atorvastatin） ,group C（irbesartan） and group D （without statin and ACEI/ARB） , the serum hs-CRP, TNF-α and IL-6 levels in each group were compared before and af- ter the treatment. Results The levels of serum hs-CRP, TNF-α and IL-6 in MHD patients were （ 12.03 ± 3.15 ） rag/L, （42.56 ± 12.65 ） pg/ml and （21.78 ± 7.78 ） pg/ml, and in normal subjects were （ 2.64 ± 1.26 ） mg/L, （ 14.42 ± 6.1 ） pg/ml and （ 12.46 ± 4.72） pg/ml, the difference was of statistically significant （ P 〈 0.05 ） ; after the treatment, the hs- CRP, TNF-ot and IL-6 levels in the 4 groups of MHD patients were significantly decreased（P 〈 0.05）, and the above in- dex in group A was lower than that in group B and C, the difference was statistically significant （ P 〈 0.05 ）, but there were no significant difference in the group D （ P 〉0. 05 ）. Conclusion Atorvastatin and irbesartan can reduce the serum levels of inflammatory cytokines in patients with MHD, and the combination of them can effectively improve the microinflamma- tion state.