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目的:探讨替米沙坦联合活性维生素D_3对维持性血液透析患者微炎性反应及营养状态的临床疗效。方法:2013年5月~2015年4月我院血液透析中心的62例患者,均符合慢性肾衰竭维持性血液透析诊断标准[血清状旁腺激素(iPTH)>300 pg/mL],随机分为对照组和治疗组。两组均以活性维生素D_3冲击治疗;治疗组加用替米沙坦,80 mg/d口服,连续观察治疗12周。比较治疗前后血红蛋白(Hb)、白蛋白(Alb)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、iPTH、Ca~(2+)及P~(3+)的变化。结果:治疗12周后,两组hs-CRP、IL-6、TNF-α明显降低,Hb、ALB明显升高,与治疗前比较差异均有统计学意义(P<0.05),以治疗组疗效更优(P<0.05);iPTH与治疗前比较差异有统计学意义(P<0.01),组间比较差异无计学意义(P>0.05)。结论:替米沙坦联用活性维生素D_3通过下调维持性血液透析患者hsCRP、IL-6、TNF-α的表达,升高Hb及Alb的水平,从而改善微炎性反应与营养状态,提高维持性血透患者的生活质量。
Objective: To investigate the clinical efficacy of telmisartan combined with active vitamin D_3 in maintenance hemodialysis patients with micro-inflammatory response and nutritional status. Methods: From May 2013 to April 2015, 62 patients with hemodialysis center in our hospital were all eligible for the diagnostic criteria of maintenance hemodialysis of chronic renal failure [serum parathyroid hormone (iPTH)> 300 pg / mL] For the control group and treatment group. Both groups were treated with active vitamin D_3 impact; treatment group plus telmisartan, 80 mg / d orally, continuous observation and treatment for 12 weeks. The levels of serum Hb, Alb, hs-CRP, IL-6, TNF-α, iPTH and Ca ~ 2+) and P ~ (3+). Results: The levels of hs-CRP, IL-6 and TNF-α in the two groups were significantly decreased, while the levels of Hb and ALB in the two groups were significantly increased after 12 weeks of treatment, with statistical significance (P <0.05) (P <0.05). The difference between iPTH and before treatment was statistically significant (P <0.01). There was no significant difference between the two groups (P> 0.05). Conclusion: Telmisartan combined with active vitamin D 3 can decrease the levels of Hb and Alb in maintenance hemodialysis patients by decreasing the expression of hsCRP, IL-6 and TNF-α, thereby improving the microinflammatory response and nutritional status, Quality of life of patients with hemodialysis.