血液透析患者甲状旁腺激素水平与营养的关系研究

The relationship between serum level of parathyroid hormone and nutritional status of patients in mainte-nance hemodialysis

目的探讨血液透析患者甲状旁腺素与营养状况的关系,为提高患者透析充分而改善患者营养状况提供临床依据。方法①选择中山大学附属第一医院肾内科112例血液透析患者,测定患者透析前血清甲状旁腺(PTH)、血清白蛋白(ALB)、血红蛋白(Hb)、C-反应蛋(CRP)、转铁蛋白(TF);②人体指数学测量:肱二头肌皮褶(BSF)、肱三头肌皮褶(TSF)、上臂中部周径(MAC)、握力(HGS);③使用改良整体主观评估法(modifiedquantitativesubjectiveglobalassessment,MQSGA)评估患者营养状况;④测定患者透析前血清IGF-1、IGFBP3;⑤根据相关公式计算上臂中部肌肉周径(MAMC)、上臂中部肌肉面积(AMA);⑥统计分析PTH与各营养指标之间的直线相关和回归关系。结果PTH与MQSGA呈正相关(P<0.01),与ALB、MAC、MAMC、AMA呈负相关(P<0.05),与Hb呈显著负相关(P<0.001);PTH与MQSGA、Hb、MAMC、AMA之间存在回归关系(P<0.05)。结论PTH是影响血液透析患者营养状况的重要尿毒症毒素。

Objective To study the relationship between parathyroid hormone （PTH） and nutritional status of patients in maintenance hemodialysis. Methods①serum PTH, ALB, Hb , Creactive protein, transferrin were examined; ② anthropometric indices including biceps skin fold（BSF）, triceps skin fold（TSF） and mid arm circumference （MAC） were measured ③nutritional status of the patients were evaluated with modified quantitative subjective global assessment （MQSGA）： ④insulin-like growth factor-1 （IGF-1） and insulin-like growth factor blnding protein-3 （IGFBP-3） were assessed ⑤ mid arm muscle circumference（MAMC） and bone-free arm muscle area（AMA） were calculated according to its formula： ⑥the relationship between PTH and nutritional status were analysed. Results There were positive correlation between PTH and MQSGA （P〈0.01） and negative correlations between PTH and ALB, MAC, MAMC, AMA（P〈0.05）. A signifi- cant negative correlation was found between PTH and Hb（P〈0.01）. There were regression relations between PTH and MQSGA, Hb, MAMC, AMA （P〈0.05）.Condusion PTH can impact nutritional status of hemodialysis patients.