维持性血液透析患者呼吸功能损害与炎症、营养不良的关系

Study on the Relationships between Respiratory Function Impairments and Inflammation and Malnutrition in Maintenance Hemodialysis

目的:探讨维持性血液透析患者呼吸功能损害与炎症和营养不良的关系。方法:对45例维持性血透患者进行肺功能测定,并应用超敏C反应蛋白(hs-CRP)和改良主观全面营养评价法(MSGAN)对患者进行微炎症状态和营养不良的评估。结果:患者肺功能参数用力肺活量(FVC)、一秒用力呼气容积(FEV1.0)、呼气流量峰值(PEF)、一氧化碳肺弥散量(DLco)、25%肺活量最大呼气流量(V25)及50%肺活量最大呼气流量(V50)低于健康志愿者(对照组),呼吸肌功能指标:最大吸气压(MIP)和最大呼气压(MEP)也均低于对照组(P<0.01)。Pearson相关分析显示MSGAN测得的营养不良评分(malnutritionscore,MS)与FVC、FEV1.0、MIP、MEP、年龄、血清白蛋白(Alb)、hs-CRP及血清肌酐(SCr)相关(P<0.01或P<0.05);hs-CRP与FVC、FEV1.0、PEF、MIP、年龄、Alb、SCr、MS、MEP、血红蛋白(Hb)及前白蛋白(PA)相关(P<0.01或P<0.05)。MS和hs-CRP与性别、透析时间、V25、V50、DLco及血清钙、磷、全段甲状旁腺激素均无明显相关(P>0.05)。结论:维持性血液透析患者通气功能、弥散功能、小气道功能均明显下降,呼吸肌力亦明显下降,上述呼吸功能损害部分与微炎症状态和营养不良密切相关。

Objective： To study the relationships between respiratory function impairments and inflammation and malnutrition in maintenance hemodialysis. Methods： Pulmonary function test （PFT） was taken in 45 patients with maintenance hemodialysis （MHD）, and microinflammatory state and malnutrition assessment were measured by high-sensitivity C-reactive protein （hs-CRP） and modified quantitative subjective global assessment of nutrition （MSGAN）. Results： The PFT parameters including FVC, FEV1.0, PEF, DLco, V25, V50 and respiratory muscle function indexes including MIP and MEP were significantly lower in MHD patients than those in normal controls （P 〈 0.01）. Malnutrition score （MS） assessed MSGAN hy Pearson relativity analysis was significantly related to FVC, FEV10, MIP, MEP, age, serum albumin and hs-CRP （P 〈 0.01）, and related to serum creatinine （P〈 0.05）. hs-CRP was significantly related to FVC, FEV10, PEF, MIP, age, serum albumin, serum creatinine and MS （P 〈 0.01）, and related to MEP, hemoglobin and PA（P 〈 0.05）. No relationship was found between MS, hs-CRP and sex, duration of HD, V25, V50, Dido, calcium, phosphorus, and parathormone （P 〉 0.05）. Conclusion： Lung ventilation, pulmonary diffusing capacity, small airway fuction and respiratory muscle strength decrease significantly in MHD patients, which are associated with microinflammatory state and malnutrition.