厄贝沙坦联合血液透析对肾性蛋白尿患者肾血流动力学变化的影响

Effect of irbesartan combined with hemodialysis on renal hemodynamics in patients with renal pro­teinuria

目的探讨厄贝沙坦联合血液透析对肾性蛋白尿患者肾功能、炎症因子、肾血流动力学的影响。方法选取2016年5月至2018年5月海军军医大学附属长征医院收治的106例接受血液透析治疗的肾性蛋白尿患者为研究对象,采用随机数字表法将其分为观察组和对照组各53例。两组患者均予以血液透析治疗,观察组患者在此基础上加用厄贝沙坦。观察两组患者治疗前后肾脏相关检查指标[24 h尿蛋白定量、24 h尿量、血肌酐(Scr)、尿素氮(BUN)]、炎症因子[C反应蛋白(CRP)、白介素-8(IL-8)、细胞间黏附分子-1(ICAM-1)、单核细胞趋化蛋白-1(MCP-1)]、双肾叶间动脉阻力指数(RI)、血液流变学(全血黏度、低切黏度、高切黏度、红细胞聚集指数)等指标变化情况。结果治疗3个月后,两组患者尿蛋白定量、血清Scr、BUN、CRP、IL-8、ICAM-1、MCP-1水平均较治疗前降低,且观察组低于对照组(P <0. 05),24h尿量较治疗前升高,且观察组高于对照组(P <0. 05);两组患者双肾RI均较治疗前降低,且观察组低于对照组(P <0. 05);两组患者全血黏度、低切黏度、高切黏度、红细胞聚集指数均较治疗前降低,且观察组低于对照组(P <0. 05)。结论行血液透析治疗的肾性蛋白尿患者联合厄贝沙坦治疗可有效改善肾功能,降低炎症水平和血液黏度,改善肾血流动力,促进疾病转归。

Objective To explore the effects of irbesartan combined with hemodialysis on renal function,inflammatory factors and renal hemodynamics in patients with renal proteinuria.Methods A total of 106 patients with renal proteinuria who underwent hemodialysis in Changzheng Hospital Affiliated to Naval Medical University from May 2016 to May 2018 were selected for the study and were divided into observation group and control group according to the random number table method.The two groups were given hemodialysis,and observation group was given irbesartan on this basis.Kidney-related examination indexes[24 h urine protein quantitation,24 h urine volume,serum creatinine(Scr),urea nitrogen(BUN)],inflammatory factors[C-reactive protein(CRP),interleukin-8(IL-8),intercellular adhesion molecule-1(ICAM-1),monocyte chemoattractant protein-1(MCP-1)],bilateral renal interlobar artery resistance index(RI),he-morheology(whole blood viscosity,low-shear viscosity,high-shear viscosity,enthrocyte aggregation index)were observed in the two groups before and after treatment.Results After 3 months of treatment,the levels of urine protein quantitation,serum Scr,BUN,CRP,IL-8,ICAM-1 and MCP-1 in the two groups were lower than those before treatment,and the levels in observation group were lower than lhose in control group(P<0.05);the 24h urine volume was more than that before treatment,and the level in observation group was more than that in control group(P<0.05).The RI values of bilateral kidney in the two groups were lower than those before treatment,and the value in observation group was lower than that in control group(P<0.05).The whole blood viscosity,low-shear viscosity,high-shear viscosity and erythrocyte aggregation index in the two groups were lower than those before treatment,and the indexes in observation group were lower than those in control group(P<0.05).Conclusions Addition of irbesartan in patients with renal proteinuria treated by hemodialysis can effectively improve renal function,reduce inflammation and blood viscosity,and improve renal hemodynamics,and promote the disease outcomes.