维持性血液透析尿毒症患者微炎症状态及预后相关性研究

Study on microinflammatory status and prognosis correlation in uremic patients on maintenance hemodialysis

目的探讨研究维持性血液透析(MHD)尿毒症患者微炎症状态及临床预后的相关性。方法回顾性分析2019年5月至2020年5月于本院行MHD治疗的70例尿毒症患者的临床资料,分为预后不良患者与预后良好患者,各35例。收集预后不良与预后良好患者的炎症因子[C反应蛋白(CRP)、血清β2微球蛋白(β2-MG)]、贫血[红细胞计数(RBC)、血红蛋白(Hb)、红细胞比容(HCT)、网织红细胞计数(Rtc)]及营养指标[血清白蛋白(ALB)、血清铁蛋白(SF)、体重指数(BMI)],采用单因素和多因素Logistic回归分析影响患者预后的危险因素。结果预后不良与预后良好患者β2-MG水平、HCT、Rtc、BMI比较差异无统计学意义;预后不良患者CRP水平明显高于预后良好患者,RBC、Hb、血清ALB、SF水平均低于预后良好患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,CRP水平高、ALB水平低是导致MHD尿毒症患者预后不良的独立影响因素(OR>1,P<0.05)。结论MHD治疗的尿毒症患者微炎症状态及临床预后存在密切关系,其机体炎症因子、贫血指标及营养指标均出现明显变化,且CRP水平高、Alb水平低是导致患者出现不良预后的风险因素,临床可结合上述指标落实相关监测工作,对促进患者预后改善具有应用价值。

Objective To investigate the correlation between microinflammatory status and clinical prognosis in uremia patients undergoing maintenance hemodialysis(MHD).Methods The clinical data of 70 uremia patients who received MHD treatment in our hospital from May 2019 to May 2020 were retrospectively analyzed,and they were divided into poor prognosis patients and good prognosis patients,with 35 cases in each group.The inflammatory factors(C-reactive protein[CRP],serumβ2 microglobulin[β2-mg]),anemia(red blood cell count[RBC],hemoglobin[Hb],erythrocyte specific volume[HCT],reticulocyte count[Rtc])and nutritional indexes(serum albumin[ALB],serum ferritin[SF],body mass index[BMI])were collected in patients with poor prognosis and good prognosis.Univariate and multivariate Logistic regression were used to analyze the risk factors affecting the prognosis of patients.Results There was no significant difference inβ2-MG level,HCT,Rtc and BMI between patients with poor prognosis and those with good prognosis;the level of CRP in patients with poor prognosis was significantly higher than that in patients with good prognosis,and the levels of RBC,Hb,serum ALB and SF were lower than those in patients with good prognosis,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that high CRP level and low ALB level were independent influencing factors for poor prognosis of MHD uremia patients(OR>1,P<0.05).Conclusion There is a close relationship between microinflammation status and clinical prognosis in uremia patients treated with MHD,with significant changes in inflammatory factors,anemia indicators and nutritional indicators,and high CRP level and low Alb level are risk factors leading to poor prognosis,clinical monitoring can be carried out based on the above indicators.It is useful for improving the prognosis of patients.