锌-α2-糖蛋白水平变化与维持性血液透析患者营养不良的关系

Relation between the change of zinic-a2-glycoprotein levels and malnutrition of patients with maintenance hemodialysis

目的探讨锌-α2-糖蛋白（ZAG）水平变化与维持性血液透析患者营养不良的关系。方法选取50例维持性血液透析患者为血液透析（MHD）组，30例对照组选自健康体检者（肾小球滤过率〉60ml／min）。应用酶联免疫吸附试验（ELISA）法检测受试者血清ZAG水平、相关生化及人体测量学指标。采用改良定量主观整体评估法（MQSGA）将MHD组患者分为营养不良组与营养正常组，比较两组患者间血清ZAG水平的差异。结果血清ZAG水平MHD组患者（90．10±17．70）mg／L较对照组（50．10±14．80）mg／L明显升高（t=10．86，P〈0．01）。对照组血清ZAG水平与瘦素（LP）呈负相关（r=-0．492，P〈0．01），与甘油三酯（TG）呈正相关（r=0．445，P〈0．05），MHD患者组血清ZAG与体质量指数（BMI）、白蛋白（Alb）、LP均呈负相关（r=-0．386，-0．362，-0．461，P均〈0．01），与MQSGA评分呈正相关（r=0．276，P〈0．05）。MHD患者中营养不良组血清ZAG（98．00±20．60）mg／L比营养正常组血清ZAG（82．90±10．50）mg／L明显升高（t=3．22，P〈0．01）。结论MHD患者组血清ZAG水平明显高于对照组，血清ZAG水平的升高在营养不良患者中表现更为明显，与MHD患者营养不良的发生密切相关，可作为MHD患者营养风险的独立预测指标。

Objective To discuss the relation between the change of zinic-α2-glycoprotein （ZAG） levels and nutritional status of patients with maintenance hemodialysis. Methods 50 cases with maintenance hemodialysis were selected as maintenance hemodialysis group （MHD group）, 30 healthy controls as normal group（ glomerular filtration rate 〉 60 ml/min）. ELISA method was applied to test all serum ZAG levels, biochemical and anthropometric indicators. Nutritional statues of patients with MHD were assessed by modified quantitative subjective global assessment （MQSGA）. The difference of serum ZAG levels between malnutrition group and normal nutrition group was compared. Results Serum ZAG （90.10 ± 17.70） mg/L level of MHD group was higher than serum ZAG （ 50.10 ± 14.80） mg/L level of normal group （ t = 10. 86, P 〈 0. 01 ）. The ZAG serum levels negatively correlated with leptin （ r = - 0. 492, P 〈 0.01 ）, positive correlated with triacylglyceride in controls （ r = 0. 445, P 〈 0.05 ）. Related analysis of serum ZAG level of patients with MHD indicated that ZAG had negative correlation with BMI, Alb and Lp（r = -0. 386,r = - 0. 362,r = -0. 461 ,P 〈0.01 ） ,positive correlated with MQSGA score in controls （ r = 0. 276, P 〈 0.05 ）. Serum ZAG （ 98.00 ± 20.60 ） mg/L level of malnutrition group among MHD patients was higher than serum ZAG （ 82.90 ± 10.50） mg/L level of normal nutrition group （ t = 3.22, P 〈 0.01 ）. Conclusion Serum ZAG level of MHD group is significantly higher than normal group, serum ZAG level is negatively correlated with BMI, Alb and Lp, among Alb and Lp are the independent influencing factors, malnourished patients with MHD showed more significant increase of serum ZAG level, so the change of serum ZAG was related with malnutrition, which can be taken as an independent predictor of nutritional risk of MHD patients.