维持性血液透析患者丙型肝炎病毒感染与营养不良-炎症综合征的相关性

Association of Hepatitis Cvirus Infection and Malnutrition-inflammation Complex Syndrome in Maintenance Hemodialysis Patients

目的:采用营养不良-炎症评分(malnutrition inflammation score,MIS)系统,观察维持性血液透析(mainte-nance hemodialysis,MHD)患者丙型肝炎病毒(HCV)感染与营养不良-炎症综合征(malnutrition-inflammation complex syn-drome,MICS)的关系。方法:对12例HCV感染和112例对照组(无HCV/HBV感染)MHD患者进行MIS评分,了解其营养和炎症状况,包括:人体测量学指标、生化指标(包括血清白蛋白、转铁蛋白、铁蛋白、未饱和铁,总胆固醇、肾功能等)及血常规(红细胞、血红蛋白)、炎症指标(包括超敏C反应蛋白、白细胞介素-6、肿瘤坏死因子-α等)。统计患者进入观察期8个月前后MIS评分情况,分析HCV感染与炎症和营养状态的相关性。结果:HCV感染组较非HCV感染组患者的透析龄[(72.50±40.29)月vs(43.40±44.32)月,P<0.01]、肝硬化发生率(16.67%vs0.01%,P<0.05)、总MIS积分(6.73±2.57vs5.01±2.34,P<0.05)、谷丙转氨酶(ALT)(21.5±17vs14.0±8.0,P<0.01)、谷草转氨酶(AST)(21.0±23.0vs13.0±7.0,P<0.01)和铁蛋白浓度(384.28±132.49vs173.34±89.47,P<0.001)均患者显著增加,而白细胞计数、白蛋白、总胆固醇、低密度脂蛋白(LDL)等则显著低于非HCV感染组;HCV感染仅与透析时程呈正相关(OR:1.14,95%CI:1.04～1.25,P=0.005),而与白蛋白(OR:0.96,95%CI:0.95～0.9,P=0.011)、总胆固醇水平(OR:0.98,95%CI:0.98～0.99,P=0.016)呈负相关;观察结束时总MIS积分(6.95±3.33vs5.50±2.28,P<0.05),MIS6(0.66±0.73vs0.26±0.62,P<0.05)和MIS7(0.98±0.95vs0.53±0.71,P<0.05)评分也显著高于非感染组。结论:伴有HCV感染的MHD患者存在更为严重的MICS,并且随HCV感染时间的增加营养状况有恶化趋势。

Objective：To evaluate the association of hepatitis C virus（HCV） infection and malnutrition inflammation complex syndrome（MICS） by calculation of the malnutrition-inflammation score（MIS）.Methods：The study enrolled 12 patients（9.68%） in the active HCV group and 112 patients（90.32%） in the non-HCV group.The two or three weekly HD sessions of all patients were followed for 8 months.The MIS was assessed using 10 components,7 from the conventional subjective global assessment of nutrition and 3 additional elements,body mass index,serum albumin and total iron-binding capacity and the inflammatory parameters such as high sensitive C reactive protein（hs-CRP）,interleukin-6（IL-6） and tumor necrosis factor alpha（TNF-α）.Results：The active HCV group had significantly longer dialysis vintage,higher total MIS score,higher level of alanine amiotransferase（ALT）,aspartate aminotransferase（AST） and ferritin,but lower white blood cells（WBCs）,serum albumin,total cholesterol and low-density lipoprotein（LDL） than the non-HCV group.The HCV infection was positively related to dialysis vintage,negatively related to albumin and total cholesterol.The MIS scores tend to be worse as the HCV infection continued.Conclusion：MHD patients with active HCV infections have more severe MICS-associated metabolic and physiological disease than MHD patients without active HCV infection.