氨甲酰血红蛋白在评价维持性血液透析患者营养状态中的意义

Evaluation of nutritional status in patients on maintenance hemodialysis by determining carbamylated hemoglobin

目的:探讨氨甲酰血红蛋白(CarHb)在评价维持性血液透析患者营养状态中的意义。方法:采用高效液相色谱法检测30例维持性血透患者、51例非透析慢性肾衰竭患者和36名健康人的CarHb(μgCV/gHb);血透组计算透前血尿素氮与CarHb比值(BUN/CarHb),并与血清白蛋白(Alb)、校正蛋白质分解率(nPCR)作相关性分析;采用主观综合营养评估(SGA)法评估受试者的营养状态。结果:血透组CarHb高于对照组[(102.5±28.9)vs(30.0±6.1)],低于非透析慢性肾衰竭组(139.9±52.0),差异显著(P<0.01)。非透析慢性肾衰竭患者CarHb与血尿素氮、肌酐呈显著正相关(P<0.01);血透患者CarHb与透前血尿素氮、肌酐无相关性,但BUN/CarHb比值与Alb、nPCR呈显著正相关(P<0.01)。SGA评估显示,血透组营养状况越差,BUN/CarHb比值越低(P<0.01)。结论:BUN/CarHb比值是评价血透患者营养状态的一个可靠指标。

Objective：To evaluate the nutritional status in patients on maintenance hemodialysis by determining carbamylated hemoglobin （CarHb）. Methods： CarHb was measured by high-performance liquid chromatography （HPLC） in 30 patients who were on maintenance hemodialysis（ HD）, 51 non-dialysis patients with chronic renal failure（CRF） and 36 healthy controls.The correlation between BUN/CarHb ratio in hemodialysis group and serum albumin （Alb） and the normalized protein catabolicr ate （nPCR） was analyzed. The nutritional status was determined by subjective global assessment （SGA）. Results： CarHb in hemodialysis group was significantly higher compared with that in control group（El102.5±28.9 ] vs [30.0±6. 1]μg CV/gHb, P〈0.01）, and lower compared with that of non-dialysis uremic patients （[102.5±28.9] vs [139.9±52.0]μg CV/g Hb,P〈0.01）. There was a positive correlation between CarHb,BUN and Scr in non-dialysis uremic patients（P〈0.01）. The BUN/CarHb ratio was positively correlated with serum Alb and nPCR （P〈0.01）in the hemodialysis group. Assessment by SGA demonstrated that the worse the nutritional status was, the lower the BUN/CarHb ratio was in hemodialysis subjects（P〈0.01）. Conclusion： The BUN/CarHb ratio is a reliable index for assessment of nutritional status in hemodialysis patients.