辛伐他汀对维持性血液透析患者血CRP和D-二聚体的影响

金惠敏; 朱士建; 沈国勇

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中国血液净化 ›› 2005, Vol. 4 ›› Issue (8) : 437-439.

论著

辛伐他汀对维持性血液透析患者血CRP和D-二聚体的影响

金惠敏　朱士建　沈国勇

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摘要

目的微炎症在维持性血液透析（HD）中很常见，本文主要探讨辛伐他汀对HD患者血C-反应蛋白(CRP)和D-二聚体的影响。方法上海第二医科大学附属宝钢医院2000年2月～2004年11月51例血胆固醇＞6.0mmol/L的HD患者纳入研究对象，辛伐他汀剂量20mg/d口服.观察12周。观察指标包括血总胆固醇、甘油三酯、LDL-胆固醇、高密度脂蛋白（HDL）、脂蛋白a[Lp(a)]；血CRP和D-二聚体分别反映炎症和凝血情况。结果在治疗组 (n=30)，使用辛伐他汀12周后血总胆固醇、甘油三酯、LDL-胆固醇均明显下降,而HDL上升。CRP从治疗前(10.0±0.3)mg/L降至(1.8±0.9)mg/L（P<0.01）, D-二聚体亦有所下降，从治疗前(1.03±0.80)mg/ml降至(0.8±0.2)mg/ml。血白蛋白经辛伐他汀12周治疗后上升，从治疗前(30.0±1.0)g/L上升至(34.0±1.0)g/L，(P＜0.05)，白蛋白上升与血CRP下降呈负相关（r=-0.85, P<0.01）。结论我们的结果说明辛伐他汀对HD患者除降脂外，还具有抗炎和抗凝血作用，能明显降低血CRP水平和D-二聚体水平。

Abstract

Objective Microinflammation is common in hemodialysis patients. The purpose of our study is to investigate the effects of simvastatin on the levels of C-reactive protein (CRP) and D-dimer in hemodialysis patients. Methods In a single-blind randomized trial,We evaluated 51 HD patients with total plasma cholesterol over 6.0mmol/L and administered simvastatin 20mg/d for 12 weeks. Cholesterol, triglyceride, LDL-cholesterol, high-density lipoprotein (HDL), lipoprotein(a) and the inflammatory marker CRP, and D-dimer (a marker of intravascular coagulation) were measured at baseline and again at 12 weeks. Results In the treatment group (n=30), simvastatin administration for 12 weeks significantly reduced total cholesterol, triglyceride, LDL-cholesterol, and increased HDL. The levels of CRP decreased obviously from (10±1.3)mg/L at baseline to (4.8±0.9)mg/L at 12 weeks (P＜0.001) and D-dimer from (1.03±0.8)μg/ml at baseline to (0.8±0.2)μg/ml after 12 weeks treatment. Whereas simvastatin increased serum albumin levels from (30±10)g/L to (34±11)g/L (P＜0.05). The negative relationship between serum albumin levels and serum CRP levels was significant (r=-0.85, P＜0.01). Conclusions These results show that simvastatin exhibits comparable favourable effects on lipid profiles in patients with HD. Moreover, the reduction of serum CRP and D-dimer levels as shown in our investigation may indicate that simvastatin exhibits favourable effects on microinflammation and coagulation in HD patients.