阿托伐他汀对高血压肾病蛋白尿和炎症的治疗作用

摘要

目的评价阿托伐他汀对血压控制正常的高血压肾病患者蛋白尿和炎症的治疗作用.方法52例血压已控制正常的高血压肾病患者随机给与阿托伐他汀(10mg)或安慰剂治疗3个月,观察血压(SBP/DBP)、血浆C-反应蛋白(CRP)、白介素-1β(IL-1β)、血脂(TG、TC、HDL-C、LDL-C)、肌酐(Cr)、肌酐清除率(Ccr)、24 h尿蛋白(U-pro)和尿酸(UA)的变化.结果治疗3个月后,阿托伐他汀组的TC(3.93±0.58)vs(5.41±0 77)mmol/L、LDL-C(2.44±0.43)vs(3.49±0.66)mmol/L、CRP(2.59±1.02)vs(3.66±1.39)mg/L、IL-1β(98.79±24.06)vs(126.09±30.11)ng/L和U-pro(510 32±320.69)vs(748.34±411.60)ng/d较安慰剂组均显著降低(P＜0.05～0.01),而两组间的Cr、Ccr无明显改变(P＞0.05).多元线性回归分析显示,U-pro与Ccr(P=0.000)、Cr(P=0.000)、TC(P=0.000)和CRP(P=0.025)呈线性相关,阿托伐他汀组的尿蛋白减少量(△U-pro)与△CRP(P=0.000)、△Cr(P=0.013)呈线性相关.结论炎症参与了高血压肾病的肾脏损害,阿托伐他汀能通过抗炎作用减轻高血压肾病的蛋白尿.%[Objective] To study the effects of atorvastatin on proteinuria and inflammation in hypertensive nephropathy with well-controlled hypertension. [Methods] A total of 52 patients with hypertensive nephrophathy,whose blood pressure had been well-controlled (＜140/90 mmHg), were received either atorvastatin (10 mg/d, n =26)or placebo (n =26) treatment for three months randomly. Plasma C-reactive protein(CRP), interleukin-1β(IL-1 β),triglycerides, total cholesterol(TC), HDL cholesterol, LDL cholesterol, creatinine, creatinine clearance (Ccr), proteinuria and uric acid were measured at the beginning and at the end of this study. [Results] Baseline characteristics of patients between atorvastatin and placebo groups were similar (P ＞0.05). After 3 months treatment, TC (3.93±0.58)vs (5.41±0.77) mmol/L, LDL-C (2.44±0.43) vs (3.49±0.66) mmol/L, CRP (2.59±1.02) vs (3.66±1.39) mg/L, IL-1β (98.79±24.06) vs (126.09±30.11) ng/L, and proteinuria (510.32±320.69) vs (748.34±411.60) mg/d in atorvastatin group were lowered significantly compared to that in placebo group (all P ＜0.05～0.01). In contrast, creatinine clearance and creatinine were stable between the 2 groups (P ＞0.05). Multiple linear regression analysis showed that proteinuria vas linearly correlated with creatinine clearance, TC, creatinine and CRP signifiantly (P=0.000, 0.000,0.000 and 0.025, respectively) and that in atorvastatin group the change of proteinuria was correlated with the changes of CRP and creatinine significantly (P =0.000 and 0.013, respectively). [Conclusions] Inflammation plays an important role in the pathogenesis of renal impairment in hypertensive nephropathy. In addition to its primary function of antilipidemia, atorvastatin has an additive effect on reducing proteinuria for hypertensive nephropathy with well-controlled hypertension through its anti-inflammation.