心脉隆注射液对高龄2型心肾综合征患者肾动脉阻力指数及IL-18、TNF-α的影响
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摘要
目的观察心脉隆注射液对高龄2型心肾综合征患者肾动脉阻力指数及白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)的影响,评价心脉隆注射液的临床疗效。方法收集2型心肾综合征的高龄患者86例,根据随机数字表法分为两组。对照组43例给予常规内科治疗,心脉隆组43例在常规内科治疗的基础上加用心脉隆注射液5 mg/kg,2次/d,共治疗10 d。两组分别于治疗前后测定血清N端脑钠肽前体(NT-pro BNP)、血清胱抑素C(CysC)、肾小球滤过率(e GFR)、IL-18、TNF-α等指标;超声测定心功能及肾血流各项参数,计算肾动脉阻力指数(RRI);评价心脉隆注射液的临床疗效。结果治疗后两组心肾功能指标均有改善(P <0. 05),其中心脉隆组患者NT-pro BNP、CysC、IL-18、TNF-α较对照组下降明显(P <0. 05),24 h尿量、e GFR较对照组升高(P <0. 05);超声心功能指标及RRI心脉隆组改善较对照组明显(P <0. 05);心脉隆组临床疗效优于对照组(P <0. 05);治疗过程中两组均无明显不良反应发生。结论心脉隆注射液治疗高龄2型心肾综合征临床疗效及安全性良好,其机制可能与心脉隆注射液能扩张肾动脉,降低肾动脉阻力指数,改善肾脏灌注,降低患者血清中IL-18、TNF-α水平,抑制炎症反应有关。
Objective To observe the effect of Xinmailong injection on renal artery resistance index,IL-18 and TNF-α. Methods Eighty-six elderly patients with type 2 cardio-renal syndrome were randomly divided into control group( n = 43) and Xinmailong group( n = 43). Patients in control group received conventional medical therapy for 10 days,while those in Xinmailong group were treated with Xinmailong injection( 5 mg/kg,twice a day) on the basis of conventional medical treatment. Serum N-terminal pro-brain natriuretic peptide( NT-pro BNP),serum cystatin C( Cys C),glomerular filtration rate( e GFR),interleukin-18( IL-18),tumor necrosis factor-α( TNF-α) were measured in both groups before and after treatment. The cardiac function and renal blood flow parameters were measured by ultrasound. The renal artery resistance index( RRI) was calculated. The clinical efficacy of Xinmailong injection was evaluated. Results After treatment,the indexes of heart and kidney function were significantly improved in both groups( P <0. 05). NT-pro BNP,Cys C and IL-18 in Xinmailong group were significantly lower than those in control group( P <0. 05). The improvement of echocardiography and RRI of Xinmailong group were significantly better than those of control group( P < 0. 05). The clinical curative efficacy of Xinmailong group was significantly better than control group( P <0. 05). No adverse reactions occurred in both groups. Conclusion Xinmailong injection in the treatment of elderly patients with type 2 cardio-renal syndrome has good clinical efficacy and safety. The mechanism may be related to the expansion of renal artery,reduction of renal artery resistance,improvement of renal perfusion,and the reduction of serum IL-18 and TNF-α thus inhibiting the inflammatory response.
Objective To observe the effect of Xinmailong injection on renal artery resistance index,IL-18 and TNF-α. Methods Eighty-six elderly patients with type 2 cardio-renal syndrome were randomly divided into control group( n = 43) and Xinmailong group( n = 43). Patients in control group received conventional medical therapy for 10 days,while those in Xinmailong group were treated with Xinmailong injection( 5 mg/kg,twice a day) on the basis of conventional medical treatment. Serum N-terminal pro-brain natriuretic peptide( NT-pro BNP),serum cystatin C( Cys C),glomerular filtration rate( e GFR),interleukin-18( IL-18),tumor necrosis factor-α( TNF-α) were measured in both groups before and after treatment. The cardiac function and renal blood flow parameters were measured by ultrasound. The renal artery resistance index( RRI) was calculated. The clinical efficacy of Xinmailong injection was evaluated. Results After treatment,the indexes of heart and kidney function were significantly improved in both groups( P <0. 05). NT-pro BNP,Cys C and IL-18 in Xinmailong group were significantly lower than those in control group( P <0. 05). The improvement of echocardiography and RRI of Xinmailong group were significantly better than those of control group( P < 0. 05). The clinical curative efficacy of Xinmailong group was significantly better than control group( P <0. 05). No adverse reactions occurred in both groups. Conclusion Xinmailong injection in the treatment of elderly patients with type 2 cardio-renal syndrome has good clinical efficacy and safety. The mechanism may be related to the expansion of renal artery,reduction of renal artery resistance,improvement of renal perfusion,and the reduction of serum IL-18 and TNF-α thus inhibiting the inflammatory response.
引文
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[15]张耀,王振花,徐峥嵘.肾动脉阻力指数诊断早期肾脏损害的研究进展[J].医学综述,2017,23(21):4281-4286.
[16]张莉,赵一俏,靳文,等.白细胞介素-18与Ⅱ型心肾综合征的相关性[J].广东医学,2015,36(4):548-550.
[17]Chiang CK,Hsu SP,Pai MF,et al.Interleukin-18 is a strong predictor of hospitalization in haemodialysis patients[J].Nephrol Dial Transplant,2004,19(11):2810-2815.
[2]Hebert K,Dias A,Delgado MC,et al.Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population[J].Eur J Heart Fail,2010,12(8):861-865.
[3]Cruz DN,Bagshaw SM.Heart-Kidney Interaction:Epidemiology of Cardiorenal Syndromes[J].Int J Nephrol,2010,2011:351291.
[4]Smith GL,Shlipak MG,Havranek EP,et al.Race and renal impairment in heart failure:mortality in blacks versus whites[J].Circulation,2005,111(10):1270-1277.
[5]Ronco C,Mccullough PA,Anker SD,et al.Cardiorenal syndromes:an executive summary from the consensus conference of the Acute Dialysis Quality Initiative(ADQI)[J].Contrib Nephrol,2010,165:54-67.
[6]Di Lullo L,Bellasi A,Barbera V,et al.Pathophysiology of the cardio-renal syndromes types 1-5:An uptodate[J].Indian Heart J,2017,69(2):255-265.
[7]Colucci WS,Elkayam U,Horyon DP,et al.Intravenous nesiritide,a natriuretic peptide,in the treatment of decompensated congestive heart failure[J].N Engl J Med,2000,343(4):246-253.
[8]Ronco C,Haapio M,House AA,et al.Cardiorenal syndrome[J].J Am Coll Cardiol,2008,52(19):1527-1539.
[9]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[10]林喆,李全学,徐静,等.美洲大蠊化学成分和生物活性研究进展[J].中草药,2017,48(17):3645-3649.
[11]张文静,王琳琳,宋树英.心脉隆注射液对动脉硬化大鼠血管内皮细胞的保护作用[J].河北北方学院学报:自然科学版,2012,38(2):79-81.
[12]苏丽军,王建中,房志华.心脉隆注射液治疗慢性心力衰竭疗效观察[J].中西医结合心脑血管病杂志,2014,12(7):884-885.
[13]陈剑峰,薛书峰,段卡丹,等.心脉隆注射液治疗急性心力衰竭的对照研究[J].中西医结合心脑血管病杂志,2017,15(9):1039-1040.
[14]Bahser N,Godehardt E,Hess AP,et al.Examination of intrarenal resistance indices indicate the involvement of renal pathology as a significant diagnostic classifier of preeclampsia[J].Am J Hypertens,2014,27(5):742-749.
[15]张耀,王振花,徐峥嵘.肾动脉阻力指数诊断早期肾脏损害的研究进展[J].医学综述,2017,23(21):4281-4286.
[16]张莉,赵一俏,靳文,等.白细胞介素-18与Ⅱ型心肾综合征的相关性[J].广东医学,2015,36(4):548-550.
[17]Chiang CK,Hsu SP,Pai MF,et al.Interleukin-18 is a strong predictor of hospitalization in haemodialysis patients[J].Nephrol Dial Transplant,2004,19(11):2810-2815.