超敏C反应蛋白与腹膜透析患者营养状态的关联

Relationship between high sensitivity CRP and nutritional status in peritoneal dialysis patients

目的:通过观察超敏C反应蛋白(hsCRP),并采用多种营养评价方法,以评价hsCRP在反映腹膜透析(PD)患者机体营养状态中的意义。方法:选取2015年5月至9月在南京军区南京总医院肾脏科行PD治疗的103例患者,测定其血清炎症因子hsCRP,根据hsCRP水平将PD患者分为hsCRP升高组(hsCRP>3 mg/L)和hsCRP正常组(hsCRP≤3 mg/L)。收集患者一般资料,采用生化指标、人体测量、生物电阻抗(BIA)及改良定量主观整体营养评估(MQ-SGA)评估患者营养状态,并根据MQ-SGA评分分为MQ-SGA>10分组和MQ-SGA≤10分组。结果:共纳入103例患者,其中MQ-SGA>10分组患者33例(32%),MQ-SGA>10分组hsCRP较MQ-SGA≤10分组明显升高,白蛋白、前白蛋白、标准蛋白分解率(nPCR)、上臂中部周径(MAC)、上臂中部肌肉周径(MAMC)、肱三头肌皮褶厚度(TSF)、瘦体重百分比(LBM%)及相位角(PA)均较MQ-SGA≤10组明显降低。26例(25.2%)患者血清hsCRP升高,相比hsCRP正常组,hsCRP升高组患者多种营养参数均下降,白蛋白、前白蛋白、nPCR、体质量指数(BMI)明显降低,MQ-SGA评分明显升高,BIA显示LBM%、PA均明显降低。多因素分析显示MQ-SGA评分、无脂肪的体质量指数(FFMI)、LBM%是hsCRP的独立影响因素。结论:hsCRP升高在PD患者中较为常见,并与人体测量、血生化检查、主观营养评价及人体成分分析测得营养参数均密切相关,提示检测血清hsCRP水平有助于判定PD患者营养状态。

Objective： Malnutrition is common in peritoneal dialysis（ PD） patients,previous studies suggest that inflammation is strongly associated with nutritional status in PD patients. High sensitivity CRP（ hsCRP） is one of the inflammatory markers,this study was aimed to explore the relationship between hsCRP and malnutrition and to what extent hsCRP could reflect nutritional status in PD patients. Methodology： One hundred and three PD patients were enrolled into this cross-sectional study. They were checked for hsCRP,and divided into two groups as the hsCRP 3 mg / L and the hsCRP≤3 mg / L according to the serum hsCRP level. Data collected included demographic data、laboratory examination variables、anthropometric measurement、Modified quantitative subjective global assessment（ MQ-SGA） score and bioelectrical impedance analysis,patients were also divided into two groups as MQ-SGA 10 and MQ-SGA≤10 according to the MQSGA score. Results： Of all 103 patients,32%（ 33 /103） belonged to the MQ-SGA 10 group,which had markedly lower album、prealbumin、normalized protein catabolic rate（ nPCR） 、Mid arm circumference（ MAC） 、arm muscle circumference（ AMC） 、triceps skinfold thickness（ TSF） 、lower lean body mass（ LBM%） 、phase angle（ PA） and higher hsCRP. 25. 2%（ 26 /103） patients had serum hsCRP over 3 mg/L,compared to the patient with lower serum hsCRP,the hsCRP 3 mg/L group had markedly lower album、prealbumin、nPCR、body mass index（ BMI） 、LBM% 、PA and higher MQ-SGA score。A multiple logistic regression analysis showed that MQ-SGA score、fat free mass index（ FFMI） 、LBM% were independent factors affecting inflammation. Conclusion： These data suggest that elevated hsCRP was common in PD patients. Hs CRP is strongly associated with nutritional status in peritoneal dialysis patients. Elevated hsCRP can be useful clues for the existence of malnutrition.