黄芪注射液联合高通量血液透析对尿毒症患者肾功能和血清微RNA-155、白细胞介素-17、超敏C反应蛋白水平的影响

Effect of astragalus injection combined with high-flux hemodialysis on renal function and serum microRNA-155,interleukin-17 and hypersensitive C-reactive protein levels of patients with uremia

目的探讨黄芪注射液联合高通量血液透析(HFHD)对尿毒症患者肾功能及血清微RNA-155(miR-155)、白细胞介素-17(IL-17)、超敏C反应蛋白(hs-CRP)水平的影响。方法选择2016年12月至2019年12月长安医院收治的156例尿毒症患者为研究对象,根据治疗方法将患者分为观察组(n=86)和对照组(n=70)。2组患者均给予积极治疗原发疾病、纠正贫血及进食低盐、富含优质蛋白质类食物等常规治疗措施;在常规治疗基础上,对照组患者给予HFHD治疗,观察组患者给予黄芪注射液和HFHD联合治疗。治疗前及治疗3、6个月,测量患者舒张压(DBP)和收缩压(SBP),检测患者血尿素氮(BUN)、血肌酐(SCr)、前白蛋白(PA)、白蛋白(Alb)、血红蛋白(Hb)、IL-17和hs-CRP及miR-155水平,并测量患者24 h尿量和24 h尿蛋白。治疗6个月后评估2组患者临床疗效。结果治疗前2组患者DBP、SBP、SCr、BUN水平及24 h尿蛋白、24 h尿量比较差异无统计学意义(P>0.05),2组患者治疗3、6个月后DBP、SBP、SCr、BUN水平及24 h尿蛋白、24 h尿量显著低于治疗前(P<0.05),2组患者治疗6个月后DBP、SBP、SCr、BUN水平及24 h尿蛋白、24 h尿量显著低于治疗3个月(P<0.05);治疗3、6个月后,观察组患者DBP、SBP、SCr、BUN水平及24 h尿蛋白显著低于对照组,24 h尿量显著高于对照组(P<0.05)。治疗前2组患者PA、Alb、Hb水平比较差异无统计学意义(P>0.05)。观察组患者治疗3、6个月后PA、Alb、Hb水平显著高于治疗前(P<0.05);对照组患者治疗3、6个月后Hb水平显著高于治疗前(P<0.05);对照组患者治疗3、6个月后PA、Alb水平与治疗前比较差异无统计学意义(P>0.05);2组患者治疗6个月后Hb水平显著高于治疗3个月(P<0.05);2组患者治疗6个月后PA、Alb水平与治疗3个月比较差异无统计学意义(P>0.05)。治疗3、6个月后,观察组患者PA、Alb、Hb水平显著高于对照组(P<0.05)。治疗前2组患者血清IL-17、hs-CRP水平及miR-155相对表达量比较差异无统计学意义(P>0.05)。2组患者治疗3、6个月后血清IL-17、hs-CRP水平及miR-155相对表达量显著低于治疗前(P<0.05);2组患者治疗6个月后血清IL-17、hs-CRP水平及miR-155相对表达量显著低于治疗3个月(P<0.05)。治疗3、6个月后,观察组患者IL-17、hs-CRP水平及miR-155相对表达量显著低于对照组(P<0.05)。观察组和对照组患者治疗总有效率分别为93.02%(80/86)、74.29%(52/70),观察组患者治疗总有效率显著高于对照组(χ^(2)=10.408,P<0.05)。结论黄芪注射液和HFHD联合治疗可有效控制尿毒症患者的血压,抑制炎症反应,延缓肾功能损伤,改善营养状况。

Objective To investigate the effect of astragalus injection combined with high-flux hemodialysis(HFHD)on renal function and serum microRNA-155(miR-155),interleukin-17(IL-17)and hypersensitive C-reactive protein(hs-CRP)levels of patients with uremic.Methods A total of 156 uremic patients admitted to Chang′an Hospital from December 2016 to December 2019 were selected as the study subjects,and the patients were divided into the observation group(n=86)and control group(n=70)according to the treatment methods.The patients in the both groups were given routine treatment measures such as actively treating the primary disease,correcting anemia,eating low salt and high quality protein foods.On the basis of routine treatment,the patients in the control group were treated with HFHD,and the patients in the observation group were treated with astragalus injection and HFHD.Before treatment and after 3 and 6 months of treatment,the levels of diastolic blood pressure(DBP),systolic blood pressure(SBP),blood urea nitrogen(BUN),serum creatinine(SCr),prealbumin(PA),albumin(Alb),hemoglobin(Hb),IL-17,hs-CRP,miR-155,24-hour urine volume and 24-hour urine protein were measured.The clinical efficacy of patients in the two groups was evaluated after 6 months of treatment.Results There was no significant difference in the levels of DBP,SBP,SCr,BUN,24-hour urine protein and 24-hour urine volume between the two groups before treatment(P>0.05).The levels of DBP,SBP,SCr,BUN,24-hour urine protein and 24-hour urine volume of patients in the both groups after 3 and 6 months of treatment were significantly lower than those before treatment(P<0.05).The levels of DBP,SBP,SCr,BUN,24-hour urine protein and 24-hour urine volume of patients in the both groups after 6 months of treatment were significantly lower than those after 3 months of treatment(P<0.05).Compared with the control group,the levels of DBP,SBP,SCr,BUN and 24-hour urine protein of patients in the observation group decreased significantly,and 24-hour urine volume increased significantly after 3 and 6 months of treatment(P<0.05).There was no significant difference in the levels of PA,Alb and Hb between the two groups before treatment(P>0.05).The levels of PA,Alb and Hb of patients after 3 and 6 months of treatment were significantly higher than those before treatment in the observation group(P<0.05).The level of Hb of patients after 3 and 6 months of treatment was significantly higher than that before treatment in the control group(P<0.05).There was no significant difference in the levels of PA and Alb after 3,6 months of treatment and before treatment in the control group(P>0.05).The Hb level of patients in the two groups after 6 months of treatment was significantly higher than that after 3 months of treatment(P<0.05).There was no significant difference in the levels of PA and Alb after 6 months of treatment and 3 months of treatment in the two groups(P>0.05).After 3 and 6 months of treatment,the levels of PA,Alb and Hb in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in serum IL-17,hs-CRP levels and the relative expression of miR-155 between the two groups before treatment(P>0.05).The levels of serum IL-17,hs-CRP levels and the relative expression of miR-155 after 3 and 6 months of treatment were significantly lower than those before treatment in the both groups(P<0.05).The serum IL-17,hs-CRP levels and the relative expression of miR-155 after 6 months of treatment were significantly lower than those after 3 months of treatment in the both groups(P<0.05).After 3 and 6 months of treatment,the levels of serum IL-17,hs-CRP and the relative expression of miR-155 in the observation group were significantly lower than those in the control group(P<0.05).The total effective rate of patients in the observation group and the control group was 93.02%(80/86)and 74.29%(52/70),respectively.The total effective rate of patients in the observation group was significantly higher than that in the control group(χ^(2)=10.408,P<0.05).Conclusion The combination of astragalus injection and HFHD can effectively control the blood pressure,inhibit inflammatory reaction,delay renal function damage,and improve nutritional status in patients with uremic.