Research On The Intervention Of Irbesartan And The Effect Of Microinflammatory State On Nutritional Status Of Patients With Peritoneal Dialysis

Objective To observe the expression of the high sensitive C-reactive protein (hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) in patients with end stage renal disease(ESRD) by peritoneal dialysis and analyze the relationship between the aforesaid inflammatory factors and the markers of nutrition. Then to observe the effect on the the inflammatory factors and the markers of nutrition in the patients of peritoneal dialysis therapied by Irbesartan.Methods Forty-five patients with end stage renal disease (ESRD) by peritoneal dialysis and twenty healthy people,were included in this study.to detect the expression of hs-CRP,IL-6,TNF-αby enzyme-labeled immunosorbent assay(ELISA).Then to analyze the difference between the two groups. Forty-five peritoneal dialysis patients were divided into groups for hs-CRP≤3mg/l and hs-CRP>3mg/l,to evaluate the difference in nutrition makers of the two groups and evaluate the relationship between the aforesaid inflammatory factors and the markers of nutrition. Then to observe the effect on the aforesaid inflammatory factors and the markers of nutrition in the fifteen patients of peritoneal dialysis therapied by Irbesartan.Results 1. In comparison with the healthy people, the levels of the hs-CRP,IL-6 and TNF-αwere obviously elevated in the peritoneal dialysis patients(P<0.01). There was a positive correlation between the levels of the hs-CRP and IL-6,TNF-αin the peritoneal dialysis patients(P<0.01).2. There was a positive correlation between the levels of serum albumin(ALB),subjective global assessment (SGA) and the levels of serum prealbumin(PA),serum ransferrin(TF)(P<0.01);There was a positive correlation between the SGA and the levels of serum creatinine(SCR)(P<0.05), There was a positive correlation between the levels of serum albumin and the levels of blood urea nitrogen (BUN),serum creatinine (SCR) (P<0.05), There was no correlation between the levels of serum albumin,SGA and the levels of the triglyceride(TG),cholesterol(CHO),ferritin (Fer).In the peritoneal dialysis patients, The levels of the IL-6 and TNF-αwere markly elevated in the group of hs-CRP>3mg/L(P<0.01),the levels of serum albumin,serum prealbumin,serum ransferrin and SGA were degraded in the group of hs-CRP>3mg/L(P<0.01),no obviously difference in the levels of the blood urea nitrogen and serum creatinine (P>0.05).There was a negative correlation between the levels of the hs-CRP and serum albumin,serum prealbumin,serum ransferrin,serum creatinine and SGA(P<0.01),there was no correlation between the levels of the hs-CRP and the blood urea nitrogen (P>0.05); There was a negative correlation between the levels of the IL-6 and serum albumin,serum prealbumin,serum ransferrin,SGA(P<0.05),there was no correlation between the levels of the IL-6 and the blood urea nitrogen,serum creatinine(P>0.05); There was a negative correlation between the levels of the TNF-αand serum albumin,serum prealbumin,serum ransferrin,SGA(P<0.01),there was no correlation between the levels of the TNF-αand the blood urea nitrogen,serum creatinine (P>0.05).3. The levels of the hs-CRP,IL-6 and TNF-αin the patients treated by Irbesartan were lower than that before the treatment. There was a obviously difference in the levels of the hs-CRP and TNF-αbetween the patients before the treatment and after the treatment(P<0.05), no significant difference in IL-6(P>0.05); The levels of serum albumin,serum prealbumin,serum ransferrin and SGA in the patients treated by Irbesartan were highter than that before the treatment. There was a obviously difference in the levels of the serum albumin,serum ransferrin between the patients before the treatment and after the treatment(P<0.05). There was no difference in the levels of SGA.Conclusion The levels of the the inflammatory factors were obviously elevated in the peritoneal dialysis patients;There was a significant correlation between the microinflammation state and the malnutrition;The microinflammatory state and the malnutrition status was improved by Irbesartan.