维持性血液透析患者慢性牙周炎与蛋白质能量消耗相关性研究

The relationship between chronic periodontitis and protein energy wasting in maintenance hemodialysis patients

目的探讨维持性血液透析患者慢性牙周炎与蛋白质能量消耗相关性。方法纳入新疆医科大学第一附属医院98例维持性血液透析(maintenance hemodialysis,MHD)患者,采用患者自评-主观全面评定量表诊断不同程度蛋白质能量消耗(Protein energy wasting,PEW),采用社区牙周指数常规口腔检查方法诊断慢性牙周炎(Chronic periodontitis,CP),并检测超敏C反应蛋白(Hypersensitive c-reactive protein,hs-CRP)、白介素6(Interleukin-6,IL-6)及相关营养检测指标,建立多因素回归模型分析PEW的危险因素。结果MHD患者CP检出率为94.9%,重度CP组PEW的检出率为93.3%,重度PEW的患者均患牙周炎,中度牙周炎占35.3%,重度牙周炎64.7%。超敏C反应蛋白和铁蛋白随着牙周炎程度的加重而升高,重度牙周炎的MHD患者血肌酐、前白蛋白、总铁结合力较非CP组明显降低,多因素Logistic回归模型显示牙周炎为PEW的危险因素,合并牙周炎的MHD患者较无牙周炎的患者PEW的发生风险增加3倍。结论MHD患者慢性牙周炎检出率高,PEW与慢性牙周炎密切相关,临床工作中应该重视MHD患者牙周炎与PEW的综合干预和治疗。

Objective To investigate the relationship between Chronic periodontitis(CP)and Protein Energy Wasting(PEW)in Maintenance Hemodialysis patients.MethodsA total of 98 patients with MHD were enrolled from the First Affiliated Hospital of Xinjiang Medical University.PEW was assessed by Scored Patient-Generated Subjective Global Assessment(PG-SGA).CP diagnosed by using method of Community Periodontal Index(CPI).Blood parameters were measured including hypersensitive C-reactive protein,interleukin-6 and nutrition indicators.The impact of CP and PEW was determined by logistic regression with the multivariate models.ResultsThe CP detection rate was 94.9%in MHD patients.PEW was 93.3%in severe CP group,especially in severe PEW patients who all suffered from CP,in which moderate CP was 35.3%,and severe CP was 64.7%.Compared with non-CP group,hypersensitive C-reactive protein and ferritin were significantly increased in severe CP group.In severe CP group,the serum creatinine,prealbumin,and the total iron binding force were significantly lower than those in non-CP group.Multivariate Logistic regression model suggests that CP is a risk factor for PEW;CP group has 3 times higher the risk of PEW than that of non-CP group.ConclusionThe detection rate of CP in MHD patients was high.There was a close relationship between CP and PEW in MHD patients.Therefore,physicians should pay more attention to provide comprehensive instructions for treatment of CP and PEW.