Research Of Microinflammation In Maintenance Hemodialysis Patients And The Intervention Effect Of The ACEI Drugs

Objective：To discuss the existence of microinflammation in patientswith Maintenance Hemodialysis （Maintenance Hemodialysis, MHD）, therelated factors and the intervention effect of the ACEI drugs, and to providenew treatment idea to improve the life quality of uremic patients and to reducethe incidence of complication and mortality。Methods：We selected57uremic patients as group M undergoingmaintenance hemodialysis（MHD）during May2011to August2012in theBlood Purification Center,Department of Nephroiogy,the Affiliated Hospitalof Chinese People’S Armed Police Forces Medical College.They were27males and30females aged from19to81years old, with an average of48.3±17.1years old, who underwent hemodialysis for0.5-9.5months with anaverage duration of5.87±1.57months,The patients of group M were randomlydivided into2groups: the Captopril treatment group（group C） and the controlgroup（group P）.There were37cases in group C, among which18cases weremale and19cases female, who underwent the treatment of maintenancehemodialysis therapy+Captopril and20cases in group P, among which9cases were male and11cases female, who underwent the treatment ofhemodialysis only.27healthy people as the normal control group wereselected also, including15male and12female, with an average age of39.56±10.97years old.Dialysis Method: The dialyzer was the polysulfonemembrane dialyzer made by German’s Fresenius（F7-HPS）, with the effectivemembrane surface area of1.5m2,and the dialyzer was Fresenius （4008S）. Thehydrocarbonate dialysis solution(Na⁺140mmol/L, K⁺2mmol/L, Cl-109.5mmol/L, Ca²⁺1.75mmol/L, Mg2+0.5mmol/L, HCO3-32mmol/L) wasadopted for all the patients. The dialysis solution flow was500ml/min,Theblood flow was200-250ml/min and the temperature is36-37℃. The hemodialysis was conducted3times per week, once4hours.Low molecularweight sodium heparin （brigitte Lin, J20090005, approved by glaxosmithklinetianjin co., LTD.） was adopted for anticoagulation. Internal arteriovenousfistula was adopted as the vascular access in all cases.Drug taken method:group C: maintenance hemodialysis treatment plus captopril25mg/tid takenbefore meals, group P: maintenance hemodialysis treatment. The treatmentduration was6months.2ml blood samples were collected before the start ofthe treatment in the MHD group （group C and group P） and the normal controlgroup, and2ml blood samples were collected again6months after thetreatment in the MHD group. All the blood samples were drawn from thecubital vein in the morning after10hours of fasting and the serum, aftercentrifugation, was sent for cryostorage at-80℃for detection.（1） theconcentration of microinflammation indicators in group N and M: tumornecrosis factor alpha（TNF-α）, serum C-reactive protein （CRP） andinterleukin-6（IL-6）.（2） The value of erythropoietin（EPO）, serum albumin（ALB）, serum creatinine （Scr）, urea nitrogen （BUN） in group M.（3） theconcentration of microinflammation indicators in group N and M after6months treatment: tumor necrosis factor alpha（TNF-α）, serum C-reactiveprotein （CRP） and interleukin-6（IL-6）.Compare the concentration ofTNF-α, CRP and IL–6in group N with group M,analyze the Correlation ofserum CRP, TNF-α and IL-6, with EPO, ALB, Scr, BUN of maintenancehemodialysis patients,and observe the difference of CRP, TNF-α and IL-6between group C and group P.All data using measurement data to plus orminus s, said the differences in test USES independent samples t test, pairedsample t-test, Pearson correlation analysis. Using SPSS16.0statisticalsoftware processing, P <0.05for the difference was statistically significant.Results：1MHD patients comparing with N set healthy physical examination werenormal, the patients with maintenance hemodialysis group, il-6, TNF alpha,CRP levels were significantly elevated, was statistically significant（respectively （2.62+/-0.65mg/L） vs （1.64+/-0.37mg/L）, P <0.05; pg/ml （52.81+17.31） vs （16.39+/-5.62pg/ml）, P <0.05; pg/ml （15.65+4.56） vs（4.89+/-1.36pg/ml）, P <0.05）2Correlation analysis showed that patients with MHD group of CRP andil-6, TNF alpha, BUN, Scr, dialysis age was significantly positive correlation(r=0.786, respectively （P <0.001and r=0.001, P <0.001and r=0.001, P <0.05and r=0.309, P <0.05and r=711, P <0.001）, and nutrition state indexpropagated has significant negative correlation （r=0.371, P <0.05） anderythropoietin （EPO） has significant negative correlation （r=0.477, P <0.001）, no obvious correlation with patient’s age （r=0.15, P=0.911>0.05）3In MHD patients, ACEI drugs in the treatment group compared withnot ACEI drugs control group, blood CRP, il-6, TNF alpha are significantlyreduced, statistically differences [respectively （1.67+/-0.46mg/L） vs （2.56+/-0.64mg/L）, P <0.05; pg/ml （17.48+6.89） vs （49.98+/-14.59pg/ml）,P <0.05; pg/ml （6.76+2.37） vs （14.57+/-3.75pg/ml）, P <0.05Conclusion：1The concentrations of CRP, IL-6and TNF-α in blood of MHD patientswere higher than normal,indicating the existence of microinflammatory.2Microinflammation in MHD patients was related with malnutrition inpatients certainly and Low EPO was associated with the existence ofmicroinflammation status.3ACEI drugs could reduce the concentration of CRP, IL-6and TNF-α inblood of MHD patients, improving the inflammation state in patients withMHD.