The objective of this work is to carry out a comparative estimation of an impact of anti-hypertension therapy upon the contents of anti-inflammatory cytokines (factor of tumour necrosis – α – FTN-α, interleukin-1b, IL-1b, IL-6, soluble receptor of IL-6) in blood serum of patients with hypertensive type of chronic glomerulonephritis (CGN).
Methods and materials. 96 patients with hypertensive type of CGN with disease period of 1 to 10 years without disturbance of kidney function (GFR > 60 ml/min) have been under observation. The average age of patients equaled 44,3 ± 5,8 years. Diagnosis CGN was established according to anamnesis and clinical-laboratory research. On average, daily proteinuria did not exceed 0,5 ± 0,2 g/day among the studied patients. Average speed of glom erular filtering equaled 83,5 ± 2,2 ml/min. Arterial hypertension (AH) among patients with CGN was defined according to recommendations of Russian scientific society of cardiologists (2010). Control group was formed of 30 healthy donors aged from 35 to 50 years. Contents of FTN-α,IL-1b, IL-6, IL-6 were studied via method of immune-ferment analysis. Patients with nephrogenic arterial hypertension received zenophenoril in dose of 15-30 mg/day, felodipine 10-20 mg/day, or combination of them, depending on a degree of arterial hypertension, as hypertensive therapy. According to recommendations of Worldwide organization of healthcare, the purpose of hypertensive therapy was to achieve target level of arterial pressure (systolic arterial pressure < 14 mm of murcury, diastolic arterial pressure < 90 mm of mercury). Evaluation of indexes of immune state was carried out two times: at the first visit and in 6 months after therapy. Statistic processing of the received data was carried out with programme complex Statistica 8,0 for Windows.
Results and discussions. Defining initial level of anti-inflammatory cytokines showed a reliably higher content of them among patients with CGN of the III degree of AH. Among patients of this group serum concentration of FTN-αwas 4,1 ± 0,3 times (p < 0,01), IL-1b – 3,9 ± 0,5 times (p < 0,01), IL-6 – 3,5 ± 0,4 times (p < 0,01) higher than control indexes (FTN-α – 32,4 ± 3,6 pg/ml, IL-1b – 35,8 ± 4,1 pg/ml, IL-6 – 15,8 ± 3,9 pg/ml). Besides, among patients of this group level of FTN-αwas 1,4 ± 0,2 times (p < 0,05), IL-1b – 1,5 ± 1,2 times (p < 0,05), and IL-6 – 1,4 ± 0,3 times (p < 0,05) higher than those of patients with CGN of the II degree of AH. Lower serum concentration of the studied cytokines was revealed among patients with the I degree of AH (duration of CGn less than a year). The research results have revealed an increase in content of IL-6 in all analyzed groups of patients. Maximum level of LI-6 (1546,2 ± 11,4 mg/l) was found in blood serum of patients with CGN of the II degree of AH that was 1,5 ± 0,4 (p < 0,05) times higher than this index of the control group (1008 ± 18,3 mg/l) and exceeded this index of patients with the I and II degree of AH by 36,5 ± 1,2 % (p < 0,05) and 22,4 ± 0,8 % (p < 0,05) correspondingly.
Defining serum concentration of anti-inflammatory cytokines among patients with nephrogenic arterial hypertension against the therapy has provided the following results. Among patients with CGN of the I degree of AH level of anti-inflammatory cytokinemy has decreased significantly. It is proved by the decrease in average concentration of FTN-α – 2,2 ± 0,1 times (р < 0,05), IL-1β – 1,9 ± 0,2 times (р < 0,05), IL-6 – 2,1 ± 0,2 times (p < 0,05); IL-6 – 1,2 ± 0,2 times (p < 0,05), compared to the initial data. A similar dynamics of the studied indications was achieved with usage of felodipine without any reliable differences between the compared groups: level of FTN-αdecreased 2,1 ± 0,2 times (p < 0,05), IL-1β –1,7 ± 0,2 tines (p < 0,05), IL-6 – 2,3 ± 0,3 times (p < 0,05); IL-6 1,4 ± 0,3 times (р < 0,05). The results of therapy with felodipine (20 mg/day) under the II degree of AH showed a decrease in level of FTN-αby 29,5 ± 4,5 % (p < 0,05), IL-1β – by 30,2 ± 3,2 % (p < 0,05), IL-6 – by 12,6 ± 2,1 % (p < 0,05), IL-6 by 9,8 ± 1,2 % (p < 0,05), and did not have any statistic differences with the level of anti-inflammatory cytokinemy that was defined after using preparation zophenopril (30 mg/day) among patients of a similar group. Prescribing combination of anti-hypertensive preparations felodipine + zophenopril to patients with CGN of the II group of AH was attended by a significant decrease in anti-inflammatory cytokinemy: level of FTN-αdecreased 2,6 ± 0,3 times (р < 0,05), IL-1β – 2,3 ± 0,2 times (p < 0,05), IL-6 – 2,6 ± 0,8 times (p < 0,05), IL-6 – 1,6 times (p < 0,05). Among patients with the II degree of AH in 6 months after using combination of zenophenopril (30 mg/day) and felodipine (20 mg/day) has shown a reliable decrease in serum concentration of anti-inflammatory cytokines: contents of FTN-αdecreased 1,4 ± 0,5 times (p < 0,05), IL-1β –1,3 ± 0,3 times (p < 0,05), IL-6 –1,4 ± 0,3 times (р < 0,05), рIL-6р – 1,4 ± 0,6 times (p < 0,05).
Resume. Contents of anti-inflammatory cytokines in blood serum are increased under hypertensive type of CGN, and it increases along with a severity of arterial hypertension. Zophenopril and felodipne have a similar anti-inflammatory effect under CGN. Using zophenopril in combination with felodipine is attended by an increase in resolving effect of a therapy over inflammatory cytokinemy under hypertensive type of CGN.
The work was submitted to International Scientific Conference «Fundamental and applied research in medicine», France (Paris), 14-21, October, 2012, came to the editorial office on 18.10.2012.