C-反应蛋白在尿毒症维持性血液透析患者中的临床意义

Clinical Significance of C-reactive Protein in Patients Undergoing Maintenance Hemodialysis due to Uremia

目的:探讨尿毒症维持性血液透析患者C-反应蛋白(CRP)与营养状态、贫血及感染的关系。方法:68例尿毒症维持性血液透析患者于透析日空腹采血测定血红蛋白(Hb)、红细胞压积(Hct)、转铁蛋白(TF)、血清总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)和CRP,记录重组人促红细胞生成素(rHuEPO)用量,观察C-反应蛋白与其之间的关系。结果:血清CRP增高组rHuEPO用量、Epo／Hct比值均显著高于CRP正常组(P<0．01);Hb、Hct、Alb均显著低于CRP正常组(P<0．01);两组间年龄、性别、体重及Kt／V指标未见显著差异。感染组CRP水平明显高于非感染组CRP水平(P<0．01)。感染组Hb、Alb及TF明显低于非感染组(P<0．01),感染组PA也明显低于非感染组(P<0．05);两组间年龄、性别及体重等其它指标无显著差异。CRP水平与Hb、Alb、PA、TF呈负相关(P<0．01)。结论:尿毒症血液透析患者CRP水平普遍增高,CRP升高是预测rHuEPO疗效的理想指标,监测CRP水平可能对于调整rHuEPO用量以达到有效纠正贫血具有一定的临床应用价值;同时尿毒症血液透析患者CRP水平可反映贫血、营养不良及炎症反应,贫血、营养不良与炎症反应有一定的关系。

Objective： To investigate the C-reactive protein level and its correlation with malnutrition, anemia and infection in patients undergoing maintenance hemodialysis due to Uremia. Methods： Sixty-eight patients on maintenance hemodialysis due to uremia were studied. Blood samples were collected on the same day on hemodialysis at fast and the levels of Hb, Hot, TF, TP, AIb, PA, and CRP were determined. The dose of rHuEPO was recorded, and the relation between CRP and rHuEPO was observed. Results：Within the group of serum CRP rising, the dose of rHuEPO and the rate of EPO/Hct were larger than that within the group which have nomal CRP （P〈0.01）. The former had lower level of Hb, Hot and AIb than the latter（P〈 0.01）. But age,sexual,weight and Kt/V have no significant difference. The level of CRP in infection group was higher than that in non- infection group significantly （P〈0.01）. The level of Hb ,AIb and TF was lower than that in non- infection group significantly （P〈0.01）, The level of PA was lower than that in non- infection group significantly （P〈0.05） ;but age, sexual and weight were no significant different, and the level of serum CRP had a negative relation with Hb （P〈0.01）. The level of CRP had a negative correlation with the level of Hb,AIb,PA and TF（P〈0.01）. Conclusion：The level of CRP rises popularly among the patients undergoing maintenance hemodialysis due to uremia, and the rising of CRP can predict the effect of rHuEPO ideally. The level of CRP can reflect the anemia, malnutrition and inflammation reactions, there are certain relations between anemia, malnutrition and inflammation reactions.