血液透析患者踝臂指数与微炎症状态、营养状况的关系

Relationship between the ankle-brachial index and micro-inflammation,nutritional status in maintenance hemodialysis patients

目的 探讨血液透析患者踝臂指数与微炎症状态、营养状况的相关关系.方法 选择本院行血液透析患者115例.将踝臂指数（ABI）＜ 0.90作为筛查亚临床外周动脉疾病（PAD）的方法,根据ABI值分为低ABI组（ABI ＜0.90）、正常ABI组（ABI≥0.9）.检测指标包括：（1）微炎症指标：白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α、超敏C反应蛋白（hs-CRP）;（2）营养状况指标：使用改良定量SGA评估法（MQSGA）,并测定血清白蛋白（Alb）、前白蛋白（PA）、血清转铁蛋白（TF）.分析ABI与微炎症状态、营养状况的相关关系.结果 （1）低ABI组hs-CRP、IL-6、TNF-α、MQSGA高于正常ABI组,Alb低于正常ABI组,差异有统计学意义（P＜0.01）;（2）双变量相关分析结果显示：ABI与年龄、透析龄、hs-CRP、IL-6、TNF-α、MQSGA呈明显负相关（r=-0.699、-0.588、-0.716、-0.603、-0.590和-0.591,P＜0.01）,与Alb呈明显正相关（r=0.691,P＜0.01）;（3）年龄、透析龄、hs-CRP、Alb、MQSGA为ABI下降的独立危险因素.结论 血液透析患者有较高的PAD发生率,微炎症状态、营养不良可能与PAD的发生密切相关.

Objective To investigate the correlation between the ankle-brachial index（ABI） and micro-inflammation, nutritional status in hemodialysis patients. Methods One hundred and fifteen cases of hemodialysis patients were recruited. ABI less than 0.90 was used to screen subclinical peripheral arte- rial disease （PAD）. All cases were divided into low ABI group （ABI 〈 0.90） and normal ABI group （ABI ≥ 0. 9 ）. Detected indicators included ： （ 1 ） Micro-inflammatory markers ： interleukin （IL） -6, tumor necrosis factor （TNF） -α, high-sensitivity C -reactive protein （hs-CRP） ; （ 2 ） Nutritional status indicators ： MQSGA e- valuation form, serum albumin（ Alb ） , prealbumin （ PA ）, serum transferrin （ TF ）. The correlation between ABI and micro-inflammation, nutritional status was analysed. Results （ 1） Levels of Hs-CRP, IL-6, TNF- α, MQSGA in low ABI group were significantly higher than those in normal AB! group, while the levels of Albumin in low ABI group were significantly lower than those in normal ABI group （ P 〈 0.01 ） ; （2） The results of Bivariate correlation analysis showed that ABI was negatively correlated with age, duration of di- alysis, hs-CRP, IL-6 ,TNF-α, MQSGA（ r = - 0. 699, - 0. 588, - 0. 716, - 0. 603, - 0. 590, - 0. 591, P 〈 0.01 ）, and positively correlated with Alb （ r = 0. 691, P 〈 0.01 ） ; （ 3 ） Age, duration of dialysis, hs-CRP, Alb, MQSGA were independent risk factors for ABI decline. Conclusion Hemodialysis patients have a higher incidence of PAD. Micro-inflammation, malnutrition may be closely related to the incidence of PAD.