| Objective: To analyze the association between micro-inflammatory state in maintenance hemodialysis(MHD) patients and active vitamin D, and calcitriol therapy for micro-inflammatory state in patients with MHD so as to provide new clinical evidences for improving quality of life and reducing complications and mortality of MHD patients. Method: Case-control study method is used, a total of 90 patients who accepted maintenance hemodialysis treatment from April 2013 to May 2014 were selected. Clinical baseline data of all selected patients mainly including age, gender, primary disease, dialysis time, vascular access condition, dialysis frequency and blood pressure were collected. Lab-measuring indexes included as follow: C-reactive protein(CRP), Interleu-kin 6(IL-6), 25(OH) D3, hemoglobin(HB), albumin(ALB), creatinine(Scr), calcium(Ca), phosphorus(P), intact parathyroid hormone(i PTH) and carotid intima-media thickness(IMT) and atheromatous plaque which detected by color ultrasonography. According to data of the CRP tested three times a week before being selected, the average of the CRP higher than 10 mg/L were classified into micro-inflammation group, while it lower or equal to 10mg/L were classified into non-inflammation group. And the micro-inflammation group was randomly divided into two sub-groups: control and treatment. All the patients were conducted regular hemodialysis therapy 2 to 3 times a week for 4 hours. On basic regular hemodialysis and original drug treatments, the treatment group took orally 0.25μg calcitriol before going to bed every day for 12 weeks. Data were analyzed with SPSS17.0 statistical software package for statistical processing. Results: 1. Relationship between Micro inflammation and serum 25(OH) D3 levels: Among selected 90 MHD patients, CRP in 58 patients was higher than 10mg/L and micro-inflammation incidence was 64.44%. The number of patients with levels of serum 25(OH) D3 higher or equal to 30ng/ml was 27, that higher to 15ng/m L and lower 30ng/m L was 33 and that lower or equal to 15ng/ml was 30. The proportion of enough, insufficient, deficient of 25(OH) D3 were 30%, 36.67% and 33.33% respectively. Compared CRP among patients with different levels of 25(OH)D3, we found that CRP in the insufficient of 25(OH)D3 group was 12.38±3.27mg/L and in the deficient group was 14.26± 4.52mg/L, which both higher than that in the sufficient group(8.83±2.79mg/L)(P<0.05). There was no statistical difference between the insufficient group and deficient group(P>0.05). 2. Comparison between the Micro inflammation group and non-inflammation group:(1) Base-line data comparison: dialysis frequency of the micro-inflammation group was much lower than that of the non-inflammatory group(2.43±0.5times per week vs. 2.69±0.47 times per week, P<0.05). And systolic/diastolic pressure were 147(103-181)/80.8±12.4mm Hg respectively of the micro inflammation group, which were both higher than that of the non-inflamematory group which were 138(95-176) /73.6±14.3mm Hg(P<0.05). However, there was no obvious difference with respect to gender, age, primary disease, and vascular access condition and dialysis time in both groups(P > 0.05).(2) Serum and imaging index comparison: Nutrient indexes of ALB and HB in micro- inflammation group were both significantly lower than that in non-inflammation group(ALB: 30.89±4.25mg/L vs. 36.63±4.14mg/L, P<0.01; HB: 83(62-133) mg/L vs. 94.5(73-124) mg/L, P<0.01). Carotid intima-media thickness(IMT) and atheromatous plaque formation rate in micro-inflammation group were higher than that in non-inflammation group(IMT: 1.14±0.33 mm vs. 0.87±0.28 mm, P<0.01; Carotid atheroma tous plaque: 36.2% vs. 6.25%, P<0.01). Concerning Scr, Ca, P and i PTH there were no statistically significant difference between the two groups(P>0.05).(3) Correlation analysis: CRP was negatively associated with 25(OH) D3, HB and ALB whereas IL-6, systolic pressure, diastolic pressure and IMT were positively correlated with CRP. However, CRP had no significant association with Scr, i PTH, Ca, P, age and dialysis time. 3. Effect of Calcitriol on maintenance hemodialysis patients:(1) The impact of calcitriol on micro- inflamemation: Before gave calcitriol, CRP and IL-6 in the control group and the treatment group were compared and results showed there were no significant differences between the two groups(CRP: 17.93±2.83mg/L vs. 16.68±3.4mg/L, P>0.05; IL-6: 74.89±52.37pg/ml vs. 84.64±44.14 pg/ml, P> 0.05). Compared to the control group after gave calcitriol, index of CRP and IL-6 in the treatment group were decreased significantly(10.48±2.31mg/L vs. 17.31±1.82mg/L, P<0.05; 55.78(15.77-135.76)pg/ml vs.70.57±44.89pg/ml, P<0.05).(2) The impact of calcitriol on ALB, HB, IMT and blood pressure: Before gave calcitriol, changes of the ALB, HB, IMT and blood pressure showed no significant differences between the control and treatment group(P>0.05). However, index of HB, ALB were significantly elevated in the treatment group after gave calcitriol as compared with controls(98.17±20.81 mg/L vs. 86.79±14.53mg/L, P<0.05; 36(32.6-40.5)mg/L vs. 32.23±3.42mg/L, P<0.05), but the systolic blood pressure was significantly lower than that in control group(136.1±12.8mm Hg vs. 144(98-170) mm Hg, P<0.05). With respect to IMT, diastolic blood pressure, there were no significant differences between the two groups(P > 0.05).(3) The impact of calcitriol on Ca, P and i PTH: Before gave calcitriol, there were no significant differences of Ca, P and i PTH between the control and treatment group(P>0.05). Content of Ca in the treat-ment group was significantly higher than that in the control group after gave calcitriol(2.21±0.53mmol/L vs. 1.95± 0.46mmol/L, P< 0.05). In contrast, Content of i PTH was dropped obviously than that in the control group(236.28± 33.6pg/ml vs. 275.9(150.8-600) pg/ml, P<0.05). And there was no significant differences about changes of P between the two groups(P>0.05). Conclusions: 1. Micro-inflammation states are wide-spread in MHD patients, which are closely associated with vitamin D deficiency. 2. Micro-inflammation state prone to exist in various complications such as atherosclerosis, malnutri-tion, anemia, hypertension and so on. 3. Calcitriol has a significant improvement on micro-inflammation status. At the same time, it can prevent malnutrition, anemia, hypertension and other complications. |
