替米沙坦联合活性维生素D_3对维持性血液透析患者微炎性反应和营养状态的影响

Effect of Telmisartan and active vitamin D_3 on microinflammation and nutritional status in patients with maintained hemodialysis

目的:探讨替米沙坦联合活性维生素D_3对维持性血液透析患者微炎性反应及营养状态的临床疗效。方法:2013年5月~2015年4月我院血液透析中心的62例患者,均符合慢性肾衰竭维持性血液透析诊断标准[血清状旁腺激素(iPTH)>300 pg/mL],随机分为对照组和治疗组。两组均以活性维生素D_3冲击治疗;治疗组加用替米沙坦,80 mg/d口服,连续观察治疗12周。比较治疗前后血红蛋白(Hb)、白蛋白(Alb)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、iPTH、Ca^(2+)及P^(3+)的变化。结果:治疗12周后,两组hs-CRP、IL-6、TNF-α明显降低,Hb、ALB明显升高,与治疗前比较差异均有统计学意义(P<0.05),以治疗组疗效更优(P<0.05);iPTH与治疗前比较差异有统计学意义(P<0.01),组间比较差异无计学意义(P>0.05)。结论:替米沙坦联用活性维生素D_3通过下调维持性血液透析患者hsCRP、IL-6、TNF-α的表达,升高Hb及Alb的水平,从而改善微炎性反应与营养状态,提高维持性血透患者的生活质量。

Objective：To investigate the clinical effect of Telmisartan and active vitamin D,on microinflammation and nutritional status in patients with maintained hemodialysis.Methods：Sixty-two patients,who underwent hemodialysis in the hemodialysis center of our hospital between May 2013 and April 2015,were randomly divided into the control group and the treatment group.All patients met the diagnostic criteria of chronic renal failure for hemodialysis[intact parathyroid hormone（iPTH） 〉300 pg/mL].The control group and the treatment group received shock therapy with active vitamin D_3,and the treatment group was added with Telmisartan,80 mg/d orally,with continuous observation for 12 weeks.The changes of hemoglobin（Hb）,albumin（Alb）,high-sensitivity C-reactive protein（hs-CRP）,interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）,iPTH,Ca^（2＋） and P^（3＋） were compared before and after the treatment.Results：After 12-week treatment,significantly decreased hs-CRP,IL-6 and TNF-α,and increased Hb and ALB were found in the two groups,and there were statistically significant differences compared with those before the treatment（P〈0.05）.The effect in the treatment group was better than that in the control group（P〈0.05）.There was statistically significant difference in iPTH after the treatment compared with that before the treatment,whereas no statistical significance was found between the two groups（P〉0.05）.Conclusion：Telmisartan and active vitamin D3 can down-regulate hs-CRP,IL-6 and TNF-α expression,and increase Hb and Alb levels in patients with maintained hemodialysis,thereby improving the micro-inflammation,nutritional status,and quality of life.