Effects Of Hemoperfusion On Lipid Profiles And Blood Pressure In Patients With Metabolic Syndrome And Its Mechanism

Background and objective:With the development of economy and lifestyle changes, cardiovascular and metabolic diseases, such as hypertension, dyslipidemia, diabetes and obesity, etc, have increased dramatically in the past twenty years. Epidemiological investigations show that there are more than 200 million patients with hypertension and dyslipidemia and that there are more than 100 million patients with diabetes and obesity in China. Those cardiovascular metabolic diseases usually exist together, and appear as metabolic syndrome(MS). The ratio of patients with hypertriglyceridemia or low high-density lipoprotein cholesterolemia was as high as 90% in MS patients. At present, the prevalence of MS is more than 15% and there are more than 200 million MS patients in China. The main consequences caused by MS include diabetes mellitus, myocardial infarction, peripheral atherosclerotic diseases, cardiac and renal dysfunction. Moreover, MS is also the main reason for disability and mortality in China. MS has become one of the major non-communicable diseases affecting the national health. Nowdays, the comprehensive control rate of three components of MS by multiple medicine intervention is less than 10%. Therefore, improving the control rate of MS is a crucial clinical problem for the prevention of cardio-cerebrovascular disease.Now the main strategy of MS treatment is the combination of therapeutic lifestyle changes and drug therapy. Lifestyle interventions mainly include dietary intervention, exercise and weight loss, which could improve insulin resistance and the long-term life quality. However, lifestyle intervention is difficult for most of the patients to insist on for a long time. Drug therapy is the main way of treating MS. The patients with MS needs to take a wide variety of drugs to reduce high plasma glucose, blood pressure and serum lipids. It is difficult for MS patients to take multiple medications for a long time. Nevertheless, even after taking drugs, residual risk of cardiovascular disease still existed, which means the blood triglyceride’s level was still significantly high and high-density lipoprotein cholesterol’s level was still low, despite the level of low-density lipoprotein cholesterol reached the target by statin treatment. Therefore, these patients were still prone to suffer from cardiovascular disease. Currently, there is no optimal treatment to control the residual risk of cardiovascular disease. For the Chinese MS patients, 53.5% of whom were suffered with both hypertension and dyslipidemia. Therefore, the key point to treat MS is further control of dyslipidemia and reducing the residual risk of cardiovascular disease. The strategy of treating MS is needed to be updated.Hemoperfusion(HP) was often used in the treatment of acute poisoning and renal failure and has been proven to be stable and effective to treat dyslipidemia in recent years. Some studies have showed that there was a significant decrease in blood lipid levels and a small decrease in blood pressure after HP. However, the mechanism of lowering blood pressure was still not elucidated. Therefore, MS patients with hypertension and dyslipidemia were enrolled in this study. All participants were performed with the HP and followed-up for 12 weeks. Blood lipid level, blood pressure, vasoactive substances and inflammation mediators were observed to explore the effects, and potential mechanisms of HP on lipid profiles and blood pressure. Subjects and methods:1. Subjects: MS was diagnosed according to the Diagnostic Criteria of MS issued by Chinese Diabetes Society(CDS)in 2004. A total of 52 outpatients with hypertension and dyslipidemia were screened in the Department of Hypertension and Endocrinology in the Third Affiliated Hospital of Third Military Medical University from October 24, 2012 to January 25, 2013. 31 patients who were diagnosed as MS were enrolled. Among them, 5 cases were lost of follow-up and 26 cases( including 17 male cases and 9 female cases) finished follow-up for 12 weeks.The baseline information of the enrolled patients with MS was listed as below:①Age: 37-68 years old, the average age was 54.65±10.28 years old;②Height: 147-179 cm, the average height was 159.69±9.08cm;③Weight: 46.0-126.7kg, the average weight was 73.50±15.73kg;④BMI: 21.29-39.54kg/m2, the average BMI was 28.08±3.49kg/m2;⑤Waist circumference: 70-122 cm, the average waist circumference was 93.26±9.84 cm.2. Methods: The general characteristics of MS patients, including present diseases, medical history, the usage of antihypertensive drugs, metabolic regulating drugs and other drugs, smoking history, drinking history and characteristics of physical activity, were collected when the patients were enrolled. Twelve-lead electrocardiogram was examined. One week after enrollment, HP was performed according to the guideline of blood purification if the informed consent has been signed by the patients who were eligible. The main laboratory indexes were detected including blood routine, urine routine, liver function, renal function, blood coagulation function, fasting plasma glucose, total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), angiotensin Ⅰ(AⅠ), angiotensin Ⅱ(AⅡ), aldosterone(Ald), high-sensitivity C-reactive protein(hs-CRP), monocyte chemotactic protein1(MCP-1) and serum resistin(Resistin), etc.Statistical analysis: SPSS19.0 software was adopted. The continuous variable was recorded as means ± standard deviation(SD). Difference between the data before- and after- HP was analyzed by the Student’s t test. The correlation between the two variables was analyzed by linear correlation analysis. Two-sided P value less than 0.05 was defined as statistical significant. Results:1. TC and TG were significantly declined at the 4th and 8th week after HP compared with baseline(TC: P=0.023, 0.024, respectively, vs baseline; TG: P=0.008, 0.008, respectively, vs baseline). Moreover, HDL-C was elevated at 4th week(P=0.029, vs. baseline).2. Serum resistin decreased obviously at the 4th, 8th and 12 th week after HP compared with that at baseline(P=0.044, P=0.012, P=0.010 respectively).3. SBP decreasedsignificantly at the 4th, 8th and 12 th week after HP compared with that at baseline(P=0.05, P=0.012, P=0.010), but there was no significant change in DBP after HP. Linear correlation analysis showed that there was a positive correlation between SBP and the reduction of serum resistin at the 4th and 12 th week follow-up(r=0.505, P=0.046; r=0.584, P=0.046).4. Cr decreased significantly at the 8th week after HP compared with that at baseline(P=0.008).5. There were no apparent chills, shivering, heart palpitations, sweating and other discomfort during and after HP, which showed that it was safe to treat MS with HP. Conclusion:1. Hemoperfusion was an effective and safe treatment for patients with metabolic syndrome.2. Systolic blood pressure was significantly decreased after hemoperfusion, the mechanisms for improving blood pressure may be due to improved dyslipidemia and declined resistin level in patients with metabolic syndrome.