胰岛素样生长因子-1与腹膜透析患者营养状况

Insulin like growth factor-1 and nutritional condition of patients with peritoneal dialysis

目的 （１）探讨胰岛素样生长因子１（ＩＧＦ１） 与腹膜透析营养状况的关系。（２） 探讨透析充分性、腹膜转运特性、残余肾功能对腹膜透析患者营养状况和血胰岛素样生长因子１ 水平的影响。方法 收集３６ 例持续性不卧床腹膜透析（ＣＡＰＤ）患者，采血测ＢＵＮ、Ｃｒ、白蛋白、补体、转铁蛋白、ＩＧＦ１，并纪录身高、体重对患者进行营养评估。测定残余肾功能、２４ 小时透析液肌酐与血肌酐浓度比值（Ｄ／Ｐ） 、总肌酐清除率（Ｔｃｒ）、尿素清除指数（Ｋｔ／Ｖ）。结果 （１） 患者血ＩＧＦ１ 水平与白蛋白、转铁蛋白、补体密切相关，血白蛋白高者ＩＧＦ１ 水平亦高。（２）Ｔｃｒ≥６０ Ｌ·周－１·（１．７３ｍ２）－１ 组ＩＧＦ１、转铁蛋白、白蛋白显著高于Ｔｃｒ＜６０ Ｌ·周－１·（１－７３ｍ２） －１组。Ｄ／Ｐ≥０－８１ 组白蛋白显著低于０－６５≤Ｄ／Ｐ＜ ０－８１、Ｄ／Ｐ＜ ０－６５ 组。残余肾功能高于２ ｍｌ／ｍｉｎ 组ＩＧＦ１、白蛋白水平显著高于残余肾功能小于２ｍｌ／ｍｉｎ 组。结论 （１）ＩＧＦ１ 是评价腹膜透析营养状况的早期敏感指标。（２） 透析充分性、腹膜转运特性、残余肾功能是影响腹膜透析患者营养状况的重要因素。

Objective (1) To explore the relationship between insulin like growth factor 1 (IGF 1) and nutritional condition of patients with peritoneal dialysis (PD). (2) To study the influence of adequacy, transmitting feature of peritoneum, remnant renal function on nutritional condition and IGF 1 level of PD patients.Methods Body weight, height, BUN, Scr, albumin, complement, transferrin and IGF 1 were measured in 32 CAPD patients to evaluate their nutritional conditions; meanwhile, remnant renal function, ratio of creatinine concentrations of 24 hour dialysate to Scr (D/P), total creatinine clearance (Tcr) and urea clearance index (Kt/V) were determined. Results (1) There was a close correlation between IGF 1 and albumin, transferrin, complement. (2) IGF 1, albumin and transferrin increased significantly in Tcr≥60 L·wk -1 ·(1.73m 2) -1 group than that in Tcr < 60 L·wk -1 ·(1.73m 2) -1 group. Serum albumin level decreased significantly in D/P ≥0.81 group than that in 0.65≤D/P<0.81, D/P<0.65 groups. IGF 1 and albumin increased significantly in remnant renal function >2ml/min group than that in < 2ml/min group. Conclusion (1) IGF 1 is a sensitive early marker to evaluate nutritional condition in peritoneal dialysis. (2) Adequacy, transmitting feature of peritoneum and remnant renal function are important factors affecting on nutritional condition of PD patients.