目的 探讨缬沙坦对维持性血液透析患者微炎症和肺功能的影响.方法 将66例慢性肾衰竭患者(行维持性血液透析≥3个月)按不同的治疗方法分为2组:对照组和试验组,每组33例.2组患者均给予常规治疗.在此基础上,对照组不使用血管紧张素Ⅱ受体拮抗剂(ARB)、血管紧张素转化酶抑制剂(ACEI)类药物；试验组采用缬沙坦胶囊80 mg口服,1次·d-1,连用3个月.分别测定2组患者治疗前、治疗3个月后微炎症指标(CRP、TNF-α、IL-1、IL-6)水平及肺功能参数(FVC、FEV1、MVV)的变化.结果 对照组治疗3个月后血清CRP、IL-1、IL-6水平均较治疗前明显升高(均P＜0.05),而血清TNFα水平较治疗前有所升高,但差异无统计学意义(P＞0.05)；对照组治疗3个月后FEV1、MVV水平均较治疗前降低(均P＜0.05),而FVC水平较治疗前降低,但差异无统计学意义(P＞0.05).试验组治疗3个月后血清CRP、IL-1、IL-6、TNF-α水平均较对照组明显降低(均P＜0.05),FVC、FEV1、MVV水平均较对照组明显升高(均P＜ 0.05).相关性分析结果显示,微炎症状态与肺通气功能呈负相关.结论 缬沙坦可降低维持性血液透析患者微炎症水平,微炎症状态改善后可减轻对肺通气功能损害.%Objective To investigate the effects of valsartan on microinflammatory state and pulmonary function in maintenance hemodialysis patients. Methods Sixty-six patients with chronic renal failure who received maintenance hemodialysis for more than or equal to 3 months were divided into control group and test group, with 33 patients in each group. All patients received conventional treatment. On this basis,the test group were given oral administration of 80 mg valsartan capsule once per day for 3 months. The control group were treated without angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors. The levels of microinflammatory markers (CRP, TNF-a, IL-1 and IL-6) and pulmonary function parameters (FVC,FEV1 and MVV) were measured before and after treatment for 3 months. Results In control group,serum levels of CRP,IL-1 and IL-6 significantly increased and levels of FEV1 and MVV significantly decreased after treatment for 3 months (all P<0. 05) ,but the increase in TNF-α levels and the decrease in FVC levels were not obvious (F>0. 05). Compared with control group, serum levels of rnCRP,IL-l,IL-6 and TNF-a significantly decreased and levels of FVCFEV1 and MVV significantly increased in test group after treatment for 3 months (all P<0. 05). The correlation analysis showed that microinflammatory state was negatively correlated with pulmonary ventilation function. Conclusion The treatment with valsartan can decrease microinflammatory state in maintenance hemodialysis patients. The improvement in microinflammatory state can reduce the impairment of pulmonary ventilation function.
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