辛伐他汀对维持性血液透析患者微炎性反应及贫血的影响

Influence of Simvastatin on Micro-Inflammation and Anemia in Patients with Maintenance Hemodialysis

目的探讨辛伐他汀对改善维持性血液透析(MHD)患者微炎性反应的作用。方法选择医院血液净化中心规律透析的患者124例,采用随机、单盲、对照法分成两组,试验组64例和对照组60例。对照组予以单纯重组人促红细胞生成素(rhEPO)治疗,试验组在对照组治疗基础上加用辛伐他汀,均治疗3个月。随访,检测每组患者治疗前后血红蛋白(Hb)、rh EPO的用量,以及超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,计算两组患者每周rhEPO的用量。结果治疗后,试验组患者hs-CRP(5.6±1.8)mg/L,IL-6(16.84±12.45)pg/mL,与治疗前和对照组治疗后相比下降明显(P<0.05);试验组患者TNF-α为(124.71±11.38)pg/m L,对照组为(129.64±11.95)pg/m L,均较治疗前下降,差异有显著性(P<0.05);平均每周rh EPO用量为(7 674.44±3 635.10)U,低于对照组的(8 566.67±4 808.66)U(P<0.05);对照组患者治疗后的hs-CRP为(8.2±2.8)mg/L,低于治疗前(P>0.05),IL-6(50.79±58.49)pg/mL,TNF-α(129.64±11.95)pg/mL,与治疗前比较明显升高(P<0.05)。结论辛伐他汀能明显降低MHD患者的炎症因子水平,改善微炎性反应,增加红细胞生成素的反应性,减少rhEPO的用量,改善贫血状态。

Objective To investigate the effects of Simvastatin in the improvement of micro- inflammation in patients with maintenance hemodialysis（MHD）. Methods Totally 124 MHD patients in the hospital were randomly divided into the experimental group（n=64） and the control group（ n =60）. The experimental group was given Simvastatin and rhEPO, and the control group was only given rhEPO, the two groups were treated for 3 months. The hs- CRP, IL- 6, TNF-α were detected before and after the treatment, and the amount of rhEPO per week was calculated for two groups. Results After treatment, the hs- CRP and the IL- 6 in the experimental group was （5.6±1.8）mg/L, （16.84± 12. 45） pg/mL, respectively, which were significantly decreased than those before treatment and the control group after treatment（P 〈 0.05）.The TNF-α in the experimental group and the control group were （124.71 ±11.38）pg/mL, （129.64±11.95）pg/mL, respectively, which were significantly decreased than those before treatment（P 〈 0.05）.The average weekly dosage of rhEPO of the experimental group was（7 674. 44±3 635.10） U, which was significandy lower than（8 566. 67 ±4 808.66） U of the control group（ P 〈 0. 05）. The hs-CRP in the control group was（8.2 ±2.8）mg/L, which was significantly lower than before treatment（ P 〉 0. 05）, the IL - 6 was（50.79 ± 58.49） pg/mL, TNF -α was （ 129.64 ± 11.95）pg/mL, which were significantly higher than before treatment（ P 〈 0. 05）. Conclusion Simvastatin can significantly reduce the level of inflammatory factors in patients with MHD, improve micro- inflammation, anemia and EPO responsiveness, and reduce the usage of rhEPO.