微炎症状态和蛋白能量消耗在维持性腹膜透析人群中的特点

The inflammatory state and protein-energy wasting in the maintenance peritoneal dialysis population

目的探讨微炎症状态和蛋白质能量消耗(PEW)在维持性腹膜透析(MPD)患者中发病特点,分析其相关性。方法选择2012年3月至2015年9月该院收治的MPD患者96例。采用改良SGA法、汉化营养不良原炎症评分(SMI)评分和清蛋白(Alb)进行营养评估,微炎症状态评估采用酶联免疫吸附试验(ELISA)法检测血浆超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平,同时检测Alb、血清总蛋白(TP)、前清蛋白(PA)、血红蛋白(Hb)、转铁蛋白(TF)、血肌酐(Scr)、血尿素氮(BUN)、血清胆固醇(Tch)等指标。结果 MPD患者PEW发生率36.50%,其中大于65岁患者占62.86%,透析龄大于2年患者占57.10%,糖尿病肾病患者占40.00%;MPD患者hs-CRP>5 mg/L占58.33%,其中大于65岁患者占42.86%,透析龄大于2年患者占60.71%,糖尿病肾病患者占32.14%。PEW组糖尿病肾病患者、年龄、透析龄、hs-CRP、TNF-α、IL-6高于非PEW组,而BMI、TP、Alb、PA、Hb、Tch、中臂围(MAC)、中臂肌围(MAMC)的比例低于非PEW组(均P<0.05);hsCRP>5mg/L组年龄、透析时间、TNF-α、IL-6高于hs-CRP≤5 mg/L组,而TP、Alb、PA、TF、Hb、Kt/V≥1.72的比例低于hsCRP≤5mg/L组(均P<0.05)。校正性别、年龄、透析龄影响因素,MPD患者hs-CRP水平与Alb、PA、TF、Tch、Scr、TG水平呈不同程度负相关;患者IL-6水平分别与Alb、PA、TF、Tch、TG呈不同程度负相关;患者TNF-α水平与Alb、PA、TF、TG、Tch水平呈不同程度负相关(均P<0.05)。多因素分析显示,高龄、透析龄、微炎症状态、低蛋白血症是PEW的独立危险因素(P<0.05)。结论 MPD患者PEW、微炎症状态发生率高,PEW、微炎症状态发生具有高龄、透析龄长的特点,糖尿病患者更易并发PEW、微炎症状态,高龄、透析龄、微炎症状态、低蛋白血症是PEW的独立危险因素。

Objective To investigate micro-inflammatory state and protein-energy wasting （PEW） states in maintenance peritoneal dialysis（MPD） patients, then analysis of the correlation between them. Methods Ninty-six cases of MPD patients in this Hospital were selected from March 2012 to September 2015. The status of nutrition were assessed by Quantitative Subjective and global Assessment（SGA）,malnutrition-inflammation score（MIS） and albumin（Alb）,micro-inflammatory state was assessed by en zyme-linked immunoassay（ELISA） method serum hypersensitive c-reactive protein （hs- CRP）, tumor necrosis factor-α（TNF-α） ,interleukin-6 （IL-6）. At the same time,various serological markers like serum Alb, serum total protein（TP）, serum prealbumin（PA）, hemoglobin（Hb） ,transferrin（TF） ,serum creatinine（Scr） ,urea nitrogen（BUN） ,cholesterol（Tch） were measured. Results The incidence of PEW in MPD patients was 36.50% ,among which 62.86% of them were over 65 years old,57.10%/oo were over 2 years of dialysis time and 40.00% with diabetic nephropathy. MPD patients with hs-CRP〉5 mg/L accounted for 58.33% ,of which over 65 year old accounted for 42.86 %, MPD age longer than 2 years accounted for 60.71%, 32.14 % of them with diabetic nephropathy. The proportion of diabetic nephropathy,average age, dialysis duration time, hs-CRP, TNF-α and IL- 6 in PEW group were higher than non-PEW group（P〈0. 05） ;BM,TP,Alb,PA,Hb,TCh,MAC and MAMC were lower han non-PEW group（P〈0. 05）. Corn pared with the hs-CRP≤5 mg/L group,average age, the time of dialysis duration, TNF-α, IL-6 were higher and TP, Alb, PA, TF, Hb,the proportion of Kt/V≥1. 72 were lower in the hs-CRP〉5 mg/L group. After the correction of age,sex,dialysis ages,it was found that the level of hs-CRP in MPD patients was negatively correlated with the level of Alb,PA,TF,Tch,Scr,TG;The level of IL-6 was negatively correlated with the levels of Alb,PA,TF,Tch,TG. The level of TNF-α in MPD patients showed different degrees of negative correlation with the leves of Alb, PA, TF, TG, Tch（all P〈0. 05）. Multivariate analysis showed that elderly, the time of dialysis duration,the microinflammatory state,and hypoalbuminemia were the independent risk factors of PEW. Conclusion PEW and micro-inflammatory state are very common in PHD patients. Patients with longer duration of dialysis, elderly or associated with diabetic nephropathy are more likely to suffer PEW and micro-inflammatory. Elderly,the time of dialysis duration,micro- inflammatory state,hypoalbuminemia are the independent risk factors of PEW.