替米沙坦对代谢综合征肾损伤患者尿酸代谢及微炎症状态的影响

Effects of Telmisartan on Uric Acid Metabolism and Microinflammatory State in Patients with Renal Impairment of Metabolic Syndrome

目的评估替米沙坦对代谢综合征肾损伤患者尿酸代谢及微炎症状态的影响。方法采用回顾性队列研究,以2019年1月—2020年1月湖北省第三人民医院肾内科门诊和住院治疗187例代谢综合征肾损伤合并高尿酸血症患者为研究对象,分为替米沙坦40 mg(A组)、替米沙坦80 mg(B组)和对照组(C组),分析3组患者治疗前、治疗8周后血尿酸(UA)、肾小球滤过率(eGFR)、空腹血糖、血脂、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、转化生长因子β_(1)(TGF-β_(1))、单核细胞趋化蛋白-1(MCP-1)等指标,比较各组治疗前后血尿酸、eGFR、血糖、血脂、炎症反应指标的变化。采用Spearman相关性分析血尿酸的下降幅度与炎性反应指标的变化幅度以及eGFR变化幅度的相关性。结果治疗后,A组和B组血尿酸、空腹血糖、血脂、hs-CRP、IL-6、TGF-β_(1)、MCP-1水平较治疗前显著降低,eGFR显著升高,且B组优于A组,组间比较差异有统计学意义(P<0.05);而C组血尿酸、eGFR、空腹血糖、血脂、hs-CRP、IL-6、TGF-β_(1)、MCP-1水平与治疗前比无明显变化(P>0.05);分析替米沙坦组治疗前后各指标的差值的关系,ΔUA与ΔeGFR(r=0.814,P<0.01)具有较强的相关性,ΔUA与Δhs-CRP(r=0.563,P<0.01)、ΔIL-6(r=0.632,P<0.01)、ΔTGF-β_(1)(r=0.556,P<0.01)和ΔMCP-1(r=0.557,P<0.01)呈正相关;ΔeGFR与Δhs-CRP (r=0.596,P<0.01)、ΔIL-6(r=0.628,P<0.01)、ΔTGF-β_(1)(r=0.603,P<0.01)和ΔMCP-1(r=0.434,P<0.01)呈正相关。结论替米沙坦可以有效地降低尿酸并抑制代谢综合征肾损伤患者微炎症反应,保护肾功能,且呈剂量依赖,血尿酸下降幅度越大,炎症指标下降幅度也越明显,eGFR的变化幅度也越显著,血尿酸升高可能是促进代谢综合征肾损伤患者微炎症反应从而导致肾损伤进展的重要因素之一。

Objective To explore the effects of the treatment of temisartan on uric acid metabolism and microinflammatory state in patients with renal function in metabolic syndrome. Methods A total of 187 cases with metabolic syndrome in patients with high uric acid hematic disease were divided into 3 groups: telmisartan 40 mg(group A),telmisartan 80 mg(group B) and the control group(group C). Retrospective analysis of the three groups of patients before and after 8 weeks treatment was carried out for the blood uric acid, eGFR、fasting blood glucose, blood lipids, hs-CRP and IL-6 and TGF-β_(1),MCP-1 indicators. The blood uric acid, eGFR,blood glucose, blood lipids, inflammatory reaction index changes were compared between groups after treatment. Spearman correlation was used to analyze the correlation between changes in serum uric acid and changes in inflammatory response indicators and eGFR. Results After treatment, the levels of serum uric acid, blood glucose, blood lipid, hs-CRP,IL-6,TGF-β_(1) and MCP-1 in group A and group B were significantly lower than those before treatment, and eGFR was significantly higher in group B than group A.The difference between groups was statistically significant(P<0.05).The serum levels of uric acid, eGFR,blood glucose, blood lipid, hs-CRP,IL-6,TGF-β_(1) and MCP-1 in group C showed no significant in changes compared with those before treatment(P>0.05).In 8 weeks after treatment, the change of blood uric acid(ΔUA) and the hs-CRP,IL-6,TGF-β_(1),the change of MCP-1 index were positively correlated(r>0.5,P<0.05);The changes of serum creatinine(ΔCr) and the hs-CRP,IL-6,TGF-β_(1) and the change of MCP-1 was positively correlated(r>0.4,P<0.05). Conclusion Telemisartan can reduce uric acid and inhibit microinflammatory response in patients with renal damage of metabolic syndrome, which is dose-dependent.The increase of serum uric acid may be one of the important factors that promote the microinflammatory response in patients with renal damage of metabolic syndrome which further lead to the progress of renal function.