皮质醇节律性与血液透析病人蛋白质-能量消耗的相关性研究

Correlation between Cortisol Rhythm and Protein-Energy Wasting in Hemodialysis Patients

目的探讨血液透析病人皮质醇昼夜节律性与蛋白质-能量消耗的相关性。方法选择我院维持性血透患者62例,主观营养评分(SGA)等级均为A级,按照皮质醇检测结果分为皮质醇节律正常组及节律异常组,两组均按照维持性血液透析病人营养摄入标准严格饮食控制3个月,比较相同饮食下各组营养不良-炎症评分(MIS)、血清白蛋白、总蛋白、胆固醇、甘油三酯、转铁蛋白、铁蛋白、未饱和铁、血红蛋白、红细胞计数的组间及前后差异。结果在基础水平一致的前提下,比较两组3个月后各个营养指标,皮质醇节律正常组的血红蛋白水平高于异常组(P<0.05),其余指标无差异。组内比较,皮质醇节律异常组所有营养指标均有不同程度降低,其中血清白蛋白、红细胞计数、总蛋白下降有统计学意义(P<0.05),营养炎症评分明显升高(P<0.01)。皮质醇节律正常组内所有营养指标均无明显改变。结论血液透析患者皮质醇节律性的紊乱消失可能导致蛋白质肌肉消耗加快,营养状态进一步恶化。提示皮质醇节律性可以作为血液透析病人营养状态的预测指标,有助于临床早期甄别预后差及具有营养不良高危倾向的患者。

Objective To investigate the relationship between the circadian rhythm of cortisol and protein-energy wastin of the hemodialysis patients. Methods Collected 62 maintenance hemodialy-sis patients in our hospital,whose subjective nutrition score （SGA） reached or aboved the level of A, according to the results of cortisol detection,it was divided into the normal cortisol rhythm group and the abnormal cortisol rhythm group, twogroups were keeped the same alimentary control in accordance with the maintenance hemodialysis patients＆#39; nutrition intake standard for 3 months, find the differences in the nutritional indices between groups or from start to finish, such asmal-nutrition-inflammation score,albumin, total protein, cholesterol, triglyceride, siderophilin, ferritin,Un-saturated iron,hemoglobin,red blood cell count. Results Under the premise of the same level of the foundation, the nutrition index of the two groups were compared after 3 months,only hemoglobin has obvious differences （P〈0.05）, The normal cortisol rhythm group was higher than the abnormal group. But when compared with the group, all nutritional indexes were decreased in the abnormal cortisol rhythm group, abumin, red blood cell count and total protein decreased sig-nificantly（P〈0.05）, the score of nutrition inflammation was significantly higher （P〈0.01）. No obvious changes in all nutritional index in the normal cortisol rhythm group. Conclusion Disorder of cor-tisol rhythm in hemodialysis patients,may speed up protein muscle consumption, lead to deteriora-tion in nutritional status. The cortisol rhythm can be used as a predictive indicator of nutritional status in hemodialysis patients, it is helpful for the diagnosis of patients with poor prognosis and high risk of alnutrition.