厄贝沙坦联合左卡尼汀对维持性血液透析患者微炎症反应和营养状况的影响

目的:探讨厄贝沙坦和左卡尼汀对维持性血液透析(MHD)患者炎症因子和营养指标的改善作用。方法:选择2013年1月至2014年6月在我院血液透析中心接受MHD的终末期肾脏病患者120例为研究对象,依据随机数字表分成单纯透析组、厄贝沙坦组、左卡尼汀组和联合用药组,各30例,分别接受单纯透析治疗,口服厄贝沙坦0.15-0.3g/d,静脉推注左卡尼汀1g/次,厄贝沙坦和左卡尼汀联合治疗。检测治疗前,治疗3、6个月后血清中C反应蛋白(CRP)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)转化生长因子(TGF)水平及营养状况指标的变化。结果:治疗3个月后,厄贝沙坦组、左卡尼汀组及联合用药组CRP、IL-8和TGF的水平与治疗前及单纯透析组比较均有明显下降(P0.05),治疗6个月后,厄贝沙坦组、左卡尼汀组及联合用药组CRP、IL-8、IL-10和TGF水平较治疗前及纯透析组均明显下降(P0.05),且联合用药组下降程度显著高于厄贝沙坦组和左卡尼汀组(P0.05)。治疗6个月后,左卡尼汀组及联合用药组血清红蛋白(Hb)、血清白蛋白(Alb)、前白蛋白(PA)水平较治疗前及单纯透析组显著升高(P0.05),联合用药组血清Hb、Alb和PA水平上升更明显,差异均有统计学意义(P0.05)。结论:厄贝沙坦联合左卡尼汀既能缓解MHD患者的微炎症反应,又能改善其营养状况。

Effects of Irbesartan Combined with Levocarnitine on Micro-inflammatory Reaction and Nutritional Status in Patients Undergoing Maintenance Hemodialysis

Objective:To investigate the effect of irbesartan combined with levocarnitine on micro-inflammatory reaction and nutritional status in patients undergoing maintenance hemodialysis (MHD).Methods:A total of 120 patients with end stage renal disease, who underwent MHD in the hemodialysis center of Yibin Second People''s Hospital from January 2013 to June 2014, were chosen as the research subjects and randomly divided into control group(n=30),irbesartan group(n=30), levocamitine group(n=30) and combined group (n=30). which were treated with pure hemodialysis, oral irbesartan 0.15-0.3 g/d, intravenous injection of levocamitine 1g/times, and irbesartan combined with levocarnitine on the basis of hemodialysis respectively. Detected The the serum levels of C-reactive protein(CRP), interleukin(IL)-8, IL-10, transforming growth factor(TGF) and nutrition indexes before treatment, 3 months and 6 months after treatment.Results:The serum levels of CRP, IL-8, and TGF significantly decreased in irbesartan group, levocamitine group and combined group 3 months after treatment, compared with control group and before treatment(P<0.05); the serumlevels of CRP, IL-8, IL-10 and TGF significantly decreased in irbesartan group, levocamitine group and combined group 6 months after treatment, compared with control group and before treatment (P<0.05), but the indexes of the combined group were lower than those of the other two groups (P<0.05). The hemoglobin(Hb) albumien(Alb) and pre-albumin(PA) in levocamitine group and combined group significantly increased 6 months after treatment, comparedwith control groupandbefore treatment (P<0.05), but the indexes of combined groupwere higher (P<0.05).Conclusion:Irbesartan combined with levocamitine not only can significantly relieve the micro-inflammatory reaction, but also improve the nutrition status of patients undergoing MHD.