终末期肾脏病患者血液透析前后血浆鸢尾素水平的变化

Changes of irisin in patients with end-stage renal disease before and after hemodialysis

目的观察血液透析患者透析前后血浆鸢尾素（Irisin）的变化，及糖尿病、蛋白能量消耗患者血浆Irisin变化的差异。方法收集2016年9月至2016年11月在山西省人民医院接受维持性血液透析（MHD）患者的临床资料（n=33）。按原发病病因分为糖尿病组（It=14）和非糖尿病组（n=19）。按是否有蛋白能量消耗分为能量消耗组（n=17）和非能量消耗组（n=16）。酶联免疫吸附法（ELISA）检测患者血浆Irisin水平，应用非参数检验比较各组患者HD前后血浆Irisin的变化。结果与透析前相比，33例MHD患者透析后血浆Irisin水平降低，差异有统计学意义[0．666（0．218，1．365）ng／L比0．977（0．202，1．820）ng／L，P=0．01]；糖尿病组患者透析前后血浆Irisin水平的差异无统计学意义；非糖尿病组患者透析前后血浆Irisin水平差异有统计学意义[0．666（0．178，1．351）ng／L比0．913（0．100，1．497）ng／L，P〈0．05]。蛋白能量消耗组患者透析前后血浆Itrisin水平差异无统计学意义。非糖尿病组与糖尿病组患者透析后血浆Irisin的差异亦无统计学意义。结论终末期肾脏病MHD患者透析后血浆Irisin水平下降，糖尿病及蛋白能量消耗对血浆Irisin水平无显著影响。

Objective To observe the changes of irisin in patients before and after hemodialysis （HD）, as well as the differentiation of irisin change in patients with diabetes mellitus and protein energy waste. Methods Clinical parameters of patients on maintenance hemodialysis （MHD） in Shanxi People＇s Hospital from September 2016 to November 2016 were collected. A total of 33 cases were enrolled 14 cases of diabetic MHD group and 19 cases of non-diabetic MHD group as divided according to etiology. Based on the presence of protein energy waste, patients were also grouped into 17 cases with and 16 cases without protein waste. Before and after HD, the non parametric test was used to compare the changes of irisin in each group. Results After HD, the irisin value of 33 patients with ERSD decreased, with the difference being statistically significant [0.666（0.218, 1.365） ng/L vs 0.977（0.202, 1.820） ng/L, P=0.01]. The difference was not statistically significant in the diabetes MHD group; statistically significant in the non diabetes group [0.666（0.178, 1.351） ng/L vs 0.913（0.100, 1.497） ng/L, P 〈 0.05]; and not statistically significant in the protein energy group. The irisin of diabetic MHD group and non- diabetic MHD group were compared after HD： the difference was not statistically significant. Conclusions After HD, plasma irisin levels were reduced in patients with end-stage renal disease. Diabetes and protein wasting effects are not important for irisin at HD.