高通量透析对维持性血液透析患者血浆瘦素及营养状况的影响

Effects of high-permeable dialysis on serum leptin and nutritional status in maintenance hemodialysis patients

目的探讨高通量透析(HPD)对慢性肾衰竭(CRF)患者血浆瘦素(Leptin)及其营养状况的影响。方法将维持性透析组18例CRF患者随机分为HPD组和低通量透析(LPD)组各9例,未透析组CRF患者9例,10例健康者作为对照组,分别测定各组治疗前及透析组第24次透析后的Leptin、视黄醇结合蛋白(RBP)、前白蛋白(PA)、转铁蛋白(TRF)、血白蛋白(Alb)、血红蛋白(Hb),以及体质量指数(BMI),分析各指标相关性。结果3个月后,与LPD组比较,HPD组Leptin明显降低,营养指标明显改善(P<0.05);CRF患者早期TRF下降明显(P<0.05),存在高Leptin血症,营养指标均下降(P<0.05,<0.01);透析组Leptin与BMI、RBP、Alb呈相关性(P<0.05)。结论高Leptin血症与CRF患者营养状况有关,HPD能有效清除Leptin,改善患者的营养状况;TRF可能是反映早期CRF患者营养状况的指标之一。

[Objective] To research the effects of high-permeable dialysis （HPD） on serum leptin and nutritional status in chronic respiratory failure （CRF）patients. [Methods] Eighteen dialysis CRF patients were divided randomly into two groups of 9 HPD and 9 low-permeable hemodialysis （LPD）. Nine without dialysed CRF patients and 10 normal peoples were enrolled as control group. Serum leptin, retinol-binding protein （RBP）, prealbumin （PA）, transferrin （TRF）, albumin （ALb）,haemoglobin （Hb）, and body mass index （BMI） were detected before treatment in the four groups and after the 24th dialysis in dialysis groups. The correlations between the indexes were analyzed. [Results] Compared with LPD, leptin in HPD reduced remarkably and patients＇ nutritional indexes improved remarkably after 3 months dialysis （P〈0. 05）; In early CRF, TRF was reduced remarkably （P〈0. 05）, high rleptine existed （P〈0. 05） and all nutritional indexes were reduced remarkably （P〈 0. 05, 〈0. 01））; Serum leptin was correlated positively with BMI, RBP and albumin in dialysed patients （P〈 0. 05）. [Conclusion] High leptin is correlated with nutritional status in CRF patients. HPD can efficiently remove serum leptin and improve patient＇s nutritional status; TRF may be one of the indexes which reflect nutritional status in early CRF patients.