微炎症状态与维持性血液透析患者顽固性中重度心功能衰竭关系的研究

Study of the relationship between microinflammation and refractory medium and fantasy heart failure in maintenance hemodialysis patients

关键词:  肾透析  炎症  心血管疾病  血必净注射液

Key words:  renal dialysis  inflammation  cardiovascular diseases  Xuebijing injection

摘要:

[目的] 探讨微炎症状态与维持性血液透析(MHD)患者顽固性中重度心功能衰竭的关系及治疗方法。[方法] 伴顽固性中重度心功能衰竭MHD患者40例, 随机分为观察组(26例)及对照组(14例),观察组使用血必净注射液改善微炎症状态+常规治疗, 对照组仅予常规治疗, 观察两组间治疗后C-反应蛋白(CRP)及左心功能[射血分数(EF)、短缩分数(FS)、每搏量(SV)]情况;观察组血必净总剂量与CRP变化量(△CRP)的关系;两组间治疗后3月时CRP及左心功能情况;观察组治疗后与治疗后3月时CRP及左心功能情况;观察组治疗后3月间△CRP与EF变化量(△EF)的关系。[结果] 观察组治疗后CRP及左心功能优于对照组;观察组血必净总剂量与△CRP呈负相关, 接近统计学意义(r=-0.382,P=0.054);治疗后3个月时观察组与对照组CRP无统计学差异, 左心功能优于对照组;观察组治疗后与治疗后3个月时相比CRP无统计学差异, 左心功能中SV治疗后优于治疗后3个月时, EF及FS相比无统计学差异;观察组治疗后3个月间△CRP与△EF无相关关系。[结论] 通过改善微炎症状态可有效纠正MHD患者顽固性中重度心功能衰竭;血必净总剂量与微炎症状态的改善量呈剂量疗效依赖关系;由于MHD患者病情的特殊性, 微炎症状态改善后会再次加重, 但纠正的心功能短期内可相对维持稳定。

Abstract:

[Objective] To investigate the relationship and treatment between microinflammation and refractory medium and fantasy heart failure in maintenance hemodialysis (MHD) patients. [Methods] The clinical data consisted of 40 MHD patients with refractory medium and fantasy heart failure who were randomly divided into two groups, group I received routine combined modality therapy and Xuebijing injection, and group II received routine combined modality therapy only. The C-reactive protein (CRP) and systolic functions of left ventricle [ejection fraction (EF), fractional shortening (FS), and stroke volume (SV)] after therapy between the two groups were compared. Relationship between the accumulated dose of Xuebijing injection and improvement of CRP (△CRP) in group I was studied. The CRP and systolic functions of left ventricle 3 months after therapy between the two groups were contrasted. The CRP and systolic functions of left ventricle in group I between after and 3 months after therapy were compared. Relationship of △CRP and descent of EF (△EF) between after and 3 months after therapy in group I was studied too. [Results] The CRP and systolic functions of left ventricle of group I after therapy were better than those of group II. There was negative correlation between accumulated dose of Xuebijing injection and △CRP in group I, which was near to statistical criterion (r=-0.382, P=0.054). The CRP had no statistical difference 3 months after therapy between group I and II, but the systolic function of left ventricle was better in group I. The CRP of group I had no statistical difference between after and 3 months after therapy, while SV after therapy was better than that 3 months after therapy, and there were no statistical differences concerning EF and FS. There was no correlation between △CRP and △EF in group I within 3 months after therapy. [Conclusion] Improvement of microinflammation in MHD patients can elevate their heart function. There is positive correlation between accumulated dose of Xuebijing injection and therapeutic effect. The microinflammation will aggravate again in MHD patients for their specificness, but the improvement of heart function will stabilize in short period.