| Objective:1.To investigate the relationship between hemodialysis hypotension(IDH)and microinflammation state in maintenance hemodialysis(MHD)patients.2.To observe the effect of total glucosides of paeony on the microinflammatory state and IDH in MHD patients.Methods:Part I:According to the inclusion criteria,a retrospective analysis was implemented on 90 patients with maintenance hemodialysis in the blood purification center of our hospital from January 2018 to June 2018,who were allocated into the IDH group and none-IDH group in line with the appearance of IDH during these 12weeks.SPSS 25.0 software was applied to analyzing the data including Hypersensitive C reactive protein(hs-CRP),serum Albumin(Alb)and Hemoglobin(Hb)levels,collected at week 1,week 6,and week 12.T-test was used for normal distribution data,and Wilcoxon rank sum test was used for non-normal distribution data.Logistic regression analysis was performed on the indicators with differences in univariate analysis.P<0.05 was considered statistically significant.Part?:According to the inclusion criteria,from July 2018 to August 2019,in the blood purification center of our hospital,a total of 80 patients who met the criteria were selected and randomly divided into the treatment group and the control group.The treatment group received TGP capsules orally(1.2g/time,2 times/day)for 18weeks,while the control group was blank.Blood samples were collected before and after the treatment.Venous blood was collected uniformly before dialysis to detect the levels of interleukin-6(IL-6),tumor necrosis factor alpha(TNF-?),h S-CRP,Alb,and Hb.According to the blood pressure data of MHD patients monitored by the blood purification center of our hospital,the IDH incidence of patients in the 18weeks before the treatment and the IDH incidence of patients in the 18 weeks during treatment were calculated.According to the standard operating procedures for hemodialysis,blood samples of fasting blood were collected before treatment,at the 13th week and after the experiment for the detection of liver function[Alanine Aminotransferase(ALT)].Fasting venous blood samples were collected before the treatment,week 5,week 9,week 13,and after the treatment to detect Blood routine indicators[White blood cell count(WBC),HB,Platelet count(PLT)]and observe adverse reactions.The 80 enrolled patients was traced from the beginning of the treatment to 24weeks after the end of the treatment(a total of 42 weeks),and the IDH time of 80patients was recorded.SPSS 25.0 software was used for data analysis,c~2 test/Fisher exact probability method was used for counting data,T-test was used for normal distribution measurement data,and Wilcoxon rank sum test was used for non-normal distribution measurement data.For comparison between multiple samples,one-way ANOVA was used for measurement data consistent with normal distribution and homogeneous variance,Kruskal-Wallis test was used for measurement data not normally distributed or heterogeneous variance,and LSD test was used for pair-wise comparison between groups.The Kaplan-Meier method was used for single factor survival analysis.P<0.05 was considered statistically significant.Results:Part?:1.A total of 90 patients were included in the observation,including1 death,59 patients with IDH and 30 patients without IDH.2.Time points in the observation,the hs-CRP of IDH group was higher than that of non-IDH group,and the difference was statistically significant(P<0.05).Alb of IDH group was lower than non-IDH group,and the difference was statistically significant(P<0.05).There was no significant difference in Hb level between the two groups,and the difference was not statistically significant(P(29)0.05).Logistic regression analysis indicated that hs-CRP and Alb were correlated with the occurrence of IDH(P(27)0.05),and high hs-CRP level and low Alb level were independent risk factors for IDH occurrence.Part?:1.In this stage,80 patients meeting the criteria were selected,11 patients were withdrawn,and 69 patients were completed,including 34 in the treatment group and 35 in the control group.2. Changes in IL-6 and TNF-?:(1)After therapy,IL-6 and TNF-?in the treatment group decreased compared with that before treatment,and the difference was statistically significant(P<0.05).There was no significant change in the control group(P>0.05).(2)After therapy,IL-6 and TNF-?in the treatment group blew than those in the control group,and the statistically differences was significant(P<0.05).3. Change of hs-CRP:(1)After therapy,hs-CRP in the treatment group reduced compared with that before treatment,and the difference was statistically significant(P<0.05).The control group increased than that before treatment with statistically difference(P<0.05).(2)After therapy,level of hs-CRP in the treatment group was under that in the control group,and the difference was statistically significant(P<0.05).4. Changes in Alb:(1)Compared with that before therapy,Alb in the treatment group increased after treatment,demonstrating statistically significant difference(P<0.05).Alb in the control group decreased,and the difference was statistically significant(P<0.05).(2)After therapy,the Alb of the treatment group was higher than that of the control group,and the difference was statistically significant(P<0.05).5. Hb change:There was no significant difference in Hb level between the treatment group and the control group before and after therapy(P>0.05).6. Incidence of IDH:(1)During the 18weeks of treatment period,the incidence of IDH in the treatment group was lower than that before treatment,and the difference was statistically significant(P<0.05).There was no significant change in the control group(P>0.05).(2)During the 18 weeks of treatment period,the incidence of IDH in the treatment group was lower by comparison with that in the control group,and the difference was statistically significant(P<0.05).7. Prognosis:Survival analysis manifested no difference between the treatment group and the control group(Log Rank test P(29)0.05).8. Adverse reactions:1 patient(2.94%)of the treatment group had abdominal pain and 2 patients(5.88%)had diarrhea.There was no significant difference in WBC,Hb,PLT and ALT in the treatment group before,during and after the treatment(P(29)0.05).There was no significant difference in WBC,Hb,PLT and ALT between treatment group and control group(P(29)0.05).Conclusion:1.Hemodialysis hypotension of MHD patients is associated with microinflammation,in which high hs-CRP level and low albumin level are independent risk factors for IDH.2.Total glucosides of paeony can reduce the levels of IL-6,TNF-?and hs-CRP in MHD patients,increase the level of Alb in MHD patients,and improve microinflammation state.3.Total glucosides of paeony maybe reduce IDH incidence in MHD patients by improving microinflammation. |
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