中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
8期
820-823
,共4页
杨焕荣%蔡淑芳%徐炳侠%常玲玲%张晓速%武文斌
楊煥榮%蔡淑芳%徐炳俠%常玲玲%張曉速%武文斌
양환영%채숙방%서병협%상령령%장효속%무문빈
血液透析%氟伐他汀%炎症%营养不良
血液透析%氟伐他汀%炎癥%營養不良
혈액투석%불벌타정%염증%영양불량
Hemodialysis%Fluvastatin%Inflammation%Malnutrition
目的 探讨微炎症状态对维持性血液透析(MHD)患者的影响及氟伐他汀的干预作用.方法 以2005年6月至2007年6月我院血液透析中心行MHD患者76例为研究对象.均在入组后第1天、6个月分别检测前白蛋白(PA)、ALB、BUN、Cr、TC、TG、HDL-C、LDL-C、脂蛋白a[Lp(a)]、转铁蛋白(SF)及超敏C-反应蛋白(hs-CRP)、IL-6、TNF-α.据CRP水平将患者分为炎症组(CRP≥8 mg/L)及非炎症组(CRP<8 mg/L).另设正常对照组30例,炎症组给予氟伐他汀治疗,非炎症组不给予氟伐他汀;观察时间为6个月.结果 与正常对照组比较MHD患者hs-CRP[(8.96±5.33)mg/L与(2.97±1.53)mg/L]、IL-6[(11.32±4.94)ng/L与(4.40±1.51)ng/L]、TNF-α[(15.89±6.20)ng/L与(9.62±3.45)ng/L]、TG[(2.98±1.36)mmol/L与(1.35±0.97)mmoL/L]、Lp(a)[(0.46±0.41)mg/L与(0.21±0.25)mg/L]、sF[(179.45±101.36)μg/L与(106.11±75.55)μg/L]水平明显升高(P<0.01或P<0.05);ALB[(35.02±4.83)g/L与(43.16±5.53)g/L]水平明显降低(P<0.01);炎症组心血管事件发生率明显高于非炎症组,且微炎症状态越明显,脂质代谢紊乱和营养不良越显著;炎症组较治疗前hs-CRP[(6.03±2.46)mg/L与(10.32±1.46)mg/L]、IL-6[(9.91±0.75)ng/L与(13.50±3.11)ng/L]、TG[(1.50±1.01)mmol/L与(3.05±1.55)mmol/L]、TC[(3.35±1.66)与(5.26±1.63)mmol/L]、LDL-C[(2.45±1.35)mmol/L与(3.46±1.36)mmol/L]、Lp(a)[(O.26±0.30)mmol/L与(0.50±0.31)mmol/L]水平明显降低(P<0.01或P<0.05),ALB[(38.16±4.63)g/L与(33.43±3.08)g/L]、HDL·C[(1.76±0.82)mmol/L与(0.96±0.58)mmol/L]明显升高(P均<0.05).结论 MHD患者普遍存在微炎症状态及血清脂质代谢紊乱和营养不良,微炎症反应状态对MHD患者心血管事件发生率及血清脂质代谢紊乱和营养不良起着重要的作用;氟伐他汀具有改善MHD患者微炎症反应状态的作用,其抗炎作用独立于调脂作用之外;早期发现及干预治疗微炎症反应状态对改善MHD患者的预后具有十分重要的意义.
目的 探討微炎癥狀態對維持性血液透析(MHD)患者的影響及氟伐他汀的榦預作用.方法 以2005年6月至2007年6月我院血液透析中心行MHD患者76例為研究對象.均在入組後第1天、6箇月分彆檢測前白蛋白(PA)、ALB、BUN、Cr、TC、TG、HDL-C、LDL-C、脂蛋白a[Lp(a)]、轉鐵蛋白(SF)及超敏C-反應蛋白(hs-CRP)、IL-6、TNF-α.據CRP水平將患者分為炎癥組(CRP≥8 mg/L)及非炎癥組(CRP<8 mg/L).另設正常對照組30例,炎癥組給予氟伐他汀治療,非炎癥組不給予氟伐他汀;觀察時間為6箇月.結果 與正常對照組比較MHD患者hs-CRP[(8.96±5.33)mg/L與(2.97±1.53)mg/L]、IL-6[(11.32±4.94)ng/L與(4.40±1.51)ng/L]、TNF-α[(15.89±6.20)ng/L與(9.62±3.45)ng/L]、TG[(2.98±1.36)mmol/L與(1.35±0.97)mmoL/L]、Lp(a)[(0.46±0.41)mg/L與(0.21±0.25)mg/L]、sF[(179.45±101.36)μg/L與(106.11±75.55)μg/L]水平明顯升高(P<0.01或P<0.05);ALB[(35.02±4.83)g/L與(43.16±5.53)g/L]水平明顯降低(P<0.01);炎癥組心血管事件髮生率明顯高于非炎癥組,且微炎癥狀態越明顯,脂質代謝紊亂和營養不良越顯著;炎癥組較治療前hs-CRP[(6.03±2.46)mg/L與(10.32±1.46)mg/L]、IL-6[(9.91±0.75)ng/L與(13.50±3.11)ng/L]、TG[(1.50±1.01)mmol/L與(3.05±1.55)mmol/L]、TC[(3.35±1.66)與(5.26±1.63)mmol/L]、LDL-C[(2.45±1.35)mmol/L與(3.46±1.36)mmol/L]、Lp(a)[(O.26±0.30)mmol/L與(0.50±0.31)mmol/L]水平明顯降低(P<0.01或P<0.05),ALB[(38.16±4.63)g/L與(33.43±3.08)g/L]、HDL·C[(1.76±0.82)mmol/L與(0.96±0.58)mmol/L]明顯升高(P均<0.05).結論 MHD患者普遍存在微炎癥狀態及血清脂質代謝紊亂和營養不良,微炎癥反應狀態對MHD患者心血管事件髮生率及血清脂質代謝紊亂和營養不良起著重要的作用;氟伐他汀具有改善MHD患者微炎癥反應狀態的作用,其抗炎作用獨立于調脂作用之外;早期髮現及榦預治療微炎癥反應狀態對改善MHD患者的預後具有十分重要的意義.
목적 탐토미염증상태대유지성혈액투석(MHD)환자적영향급불벌타정적간예작용.방법 이2005년6월지2007년6월아원혈액투석중심행MHD환자76례위연구대상.균재입조후제1천、6개월분별검측전백단백(PA)、ALB、BUN、Cr、TC、TG、HDL-C、LDL-C、지단백a[Lp(a)]、전철단백(SF)급초민C-반응단백(hs-CRP)、IL-6、TNF-α.거CRP수평장환자분위염증조(CRP≥8 mg/L)급비염증조(CRP<8 mg/L).령설정상대조조30례,염증조급여불벌타정치료,비염증조불급여불벌타정;관찰시간위6개월.결과 여정상대조조비교MHD환자hs-CRP[(8.96±5.33)mg/L여(2.97±1.53)mg/L]、IL-6[(11.32±4.94)ng/L여(4.40±1.51)ng/L]、TNF-α[(15.89±6.20)ng/L여(9.62±3.45)ng/L]、TG[(2.98±1.36)mmol/L여(1.35±0.97)mmoL/L]、Lp(a)[(0.46±0.41)mg/L여(0.21±0.25)mg/L]、sF[(179.45±101.36)μg/L여(106.11±75.55)μg/L]수평명현승고(P<0.01혹P<0.05);ALB[(35.02±4.83)g/L여(43.16±5.53)g/L]수평명현강저(P<0.01);염증조심혈관사건발생솔명현고우비염증조,차미염증상태월명현,지질대사문란화영양불량월현저;염증조교치료전hs-CRP[(6.03±2.46)mg/L여(10.32±1.46)mg/L]、IL-6[(9.91±0.75)ng/L여(13.50±3.11)ng/L]、TG[(1.50±1.01)mmol/L여(3.05±1.55)mmol/L]、TC[(3.35±1.66)여(5.26±1.63)mmol/L]、LDL-C[(2.45±1.35)mmol/L여(3.46±1.36)mmol/L]、Lp(a)[(O.26±0.30)mmol/L여(0.50±0.31)mmol/L]수평명현강저(P<0.01혹P<0.05),ALB[(38.16±4.63)g/L여(33.43±3.08)g/L]、HDL·C[(1.76±0.82)mmol/L여(0.96±0.58)mmol/L]명현승고(P균<0.05).결론 MHD환자보편존재미염증상태급혈청지질대사문란화영양불량,미염증반응상태대MHD환자심혈관사건발생솔급혈청지질대사문란화영양불량기착중요적작용;불벌타정구유개선MHD환자미염증반응상태적작용,기항염작용독립우조지작용지외;조기발현급간예치료미염증반응상태대개선MHD환자적예후구유십분중요적의의.
Objective To invest the effect of minimal inflammation on patients with maintenance hemodialysis(MHD) and the intervention effect of ftuvastatin.Methods Blood indicators such as PA,ALB and BUN,Cr,TC,TG,HDL-C,LDL-C,Lp(a),SF,hs-CRP,IL-6 and TNF-α were detected at the first day of the study and six months later in all patients.Patients were divided into inflammation group(CRP≥8 mg/L) and non-inflammation group(CRP<8 mg/L) according to CRP levels.Only inflammation group used fluvastatin.Two groups were observed for six months.Results The level of hs-CRP,IL-6,TNF-α,TG,Lp(a),SF in MHD patients was obviously higher than the normal control group.The level of ALB was obviously lower than the normal control group.The angiocardiopathy incidence of inflammation group was obviously higher than that of the non-inflammation.The more obvious of minimal inflammation,the more significant of lipid metabolism disturbance and malnutrition.Hs-CRP,IL-6,TG,TC,LDL-C and Lp(a) of inflammation group decreased obviously(P<0.01 or P<0.05).ALB、HDL-C increased obviously(P<0.05).Indicators of the non-inflammation had no statistical difference after therapy.Conclusions Patients with MHD generally have minimal inflammation and malnutrition.Minimal inflammation has important effect on the angiocardiopathyincidence,lipid metabolism disturbance and malnutrition.Fluvastatin not only could regulate lipid metabolism but also improve the minimal inflammation of patients with MHD.Early detection and therapy of minimal inflammation has important significance on improving prognosis of patients with MHD.
