江洪

摘 要 目的：探讨辛伐他汀对维持性血液透析患者的血清细胞高敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）和脂联素（ADPN）水平的影响。方法：回顾性分析2013年5月—2015年5月我院肾内科收治的维持性血液透析患者80例，按其是否用药分为辛伐他汀组和对照组，辛伐他汀组给予辛伐他汀+血液透析治疗，剂量为20 mg/d，对照组单纯给予血液透析治疗。比较两组患者治疗前、治疗6个月后血清hs-CRP、IL-6和ADPN水平，同时测定治疗前、后患者的血脂TG、TC、LDL、HDL的水平，观察并记录患者治疗期到治疗结束1年内发生的心血管事件。结果：与对照组比较，辛伐他汀组治疗后血清hs-CRP、IL-6的水平均有所下降 ，ADPN水平升高，血脂TG、TC、LDL水平下降，HDL水平升高。辛伐他汀组发生的心血管事件有6例，发生率为15%，显著低于对照组发生的心血管事件13例，发生率为32.5%，组间差异有统计学意义（P<0.05）。结论 ：辛伐他汀能降低维持性血液透析患者的血清hs-CRP、IL-6水平，并使ADPN水平升高，具有良好的抗炎、降血脂作用，能有效改善维持性血液透析患者动脉粥样硬化症状，降低心血管事件的发生率。

关键词 辛伐他汀 维持性血液透析 脂联素 微炎症 心血管事件

中图分类号：R692.5； R972.6 文献标识码：B 文章编号：1006-1533（2016）15-0022-04

Effect of simvastatin on the maintenance of the levels of serum hs-CRP， IL-6 and ADPN in the treatment of hemodialysis patients*

JIANG Hong**

（Department of Nephrology， The Peoples Hospital of Yingtan City， Yingtan 335000， China）

ABSTRACT Objective： To discuss the effect of simvastatin on the maintenance of the levels of serum high-sensitivity C-reactive protein （hs-CRP）， interleukin 6 （IL-6） and adiponectin （ADPN） in the treatment of hemodialysis patients. Methods： The data from 80 patients with maintenance hemodialysis were retrospectively analyzed and the patients were divided into a simvastatin group and a control group according to whether or not they were taking simvastatin. The simvastatin group received 20 mg of simvastatin daily plus hemodialysis treatment while the control group only hemodialysis. The serum hs-CRP， IL-6 and ADPN levels and the levels of serum TG， TC， LDL and HDL in all patients were simultaneously determined before treatment and 6 months after and then analyzed. The cardiovascular events occurred within 1 year from the end of the treatment were also observed. Results： The levels of serum hs-CRP， IL-6， TG， TC and LDL were reduced while the levels of ADPN and HDL were increased in the simvastatin group after treatment compared with those in the control group. There were 6 cases of cardiovascular events in the simvastatin group and 13 cases in the control group （15% vs 32.5%， P<0.05）. Conclusion： Simvastatin can reduce the serum hs-CRP and IL-6 levels and increase ADPN level with a good anti-inflammatory and lipid-lowering function and can effectively improve the symptoms of atherosclerosis and reduce the incidence of cardiovascular events for patients with maintenance hemodialysis.

KEY WORDS simvastatin； maintenance hemodialysis； adiponectin； microinflammation； cardiovascular event

近年来，我国慢性肾病患者越来越多，不同类型的肾病发展到晚期都会形成终末期肾病（end stage of renal disease，ESRD）[1]。大多数ESRD患者采取维持性血液透析（MHD）治疗来延长生命，但长时间的血液透析会带来微炎症、心血管疾病等并发症。而微炎症状态与维持性血液透析患者的多种并发症如动脉粥样硬化、心肌梗死密切相关[2]。辛伐他汀为降脂药物，且具有非常明显的抗炎作用[3]。对此，本研究通过给予MHD患者加服辛伐他汀治疗，探讨他汀类药物对MHD患者微炎症、心血管事件等的改善作用，现报道如下。……