腹膜透析患者血清CHI3L1、FABP4水平和容量超负荷及蛋白质能量消耗的相关性研究

The relationships between serum CHI3L1, FABP4, volume overload and protein energy wasting in peritoneal dialysis patients

目的探讨腹膜透析患者血清CHI3L1、FABP4、容量超负荷及蛋白质能量消耗的相关性。方法本研究纳入160例临床状况稳定、在北京大学第三医院腹膜透析中心规律随访的腹膜透析患者。通过ELISA方法测定血清CHI3L1及FABP4浓度。根据多频生物电阻抗原理测定患者体成分,以水负荷(overdydration,OH)值来评估腹膜透析患者的容量负荷状态,OH值≥2L为容量超负荷,OH值<2L为容量正常。纳入分析的生化指标包括血清白蛋白、尿毒氮、血肌酐、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等。根据蛋白质能量消耗(protein energy wasting,PEW)诊断标准,将入组腹膜透析患者分为蛋白质能量消耗组(PEW组)和非蛋白质能量消耗组(非PEW组)。结果腹膜透析患者血清CHI3L1和FABP4水平呈正相关(r=0.273,P=0.001)。血清CHI3L1水平与容量超负荷呈负相关(r=-0.191,P=0.020),与肌肉重量呈负相关(r=-0.443,P=0.000)。血清FABP4水平与容量超负荷呈负相关(r=-0.172,P=0.040),与肌肉重量呈负相关(r=-0.188,P=0.025)。与容量正常组相比,容量超负荷组的血清CHI3L1水平更低(289.6±117.9ng/ml比335.3±119.3ng/ml,t=2.349,P=0.020),FABP4水平也更低[152.0(131.6,194.6)ng/ml比170.0(132.0,374.9)ng/ml,z=-2.051,P=0.040]。容量超负荷患者的PEW发生率更高(61.7%比42.3%,χ~2=5.756,P=0.013),但是PEW组和非PEW组的CHI3L1、FABP4水平无显著性差异。Logistic回归分析提示PEW的独立危险因素是容量负荷(OR=2.744,95%CI 1.190~6.327,P=0.018)、血清白蛋白(OR=0.837,95%CI 0.734~0.955,P=0.008)和肌肉重量(OR=0.936,95%CI0.891~0.982,P=0.007)。结论腹膜透析患者的血清CHI3L1、FABP4水平显著升高,首次发现两者呈正相关且均与容量超负荷呈负相关,并与肌肉量负相关;PEW发生的独立危险因素是低白蛋白血症、低肌肉量及容量超负荷,而与CHI3L1、FABP4水平无关。

Objective To investigate the association between serum CHI3L1, FABP4, volume overload and protein energy wasting （PEW） in peritoneal dialysis （PD） patients. Methods A total of 160 clinically stable PD patients in Peking University Third Hospital were enrolled in this study. Serum CHI3L1 and FABP4 levels were measured by ELISA method. Volume overload was assessed by multiple-frequency bioelectrical impedance analysis to evaluate overhydration （OH） value. OH〉2 liters is volume overload, and OH 〈2 liters is a normal volume status. Biochemical indices, such as serum albumin, blood urea nitrogen, serum creatinine, serum triglycerides, total cholesterol lipoprotein, low density lipoprotein cholesterol, and high density li- poprotein cholesterol were determined with standard methods. PD patients were divided into PEW group and non-PEW group according to the PEW diagnosis criteria. Results Serum CHI3L1 and FABP4 levels were positively correlated （r=0.273, P=0.001） in PD patients. Serum CHI3L1 levels were negatively correlated with volume overload （r=-0.191, P=0.020） and muscle mass （r=-0.443, P=0.000）; FABP4 levels were also negatively correlated with volume overload （r=-0.172, P=0.040） and muscle mass （r=-0.188, P=0.025）. Compared to PD patients with normal volume load, those with volume overload had lower CHI3L1 levels （289.6±117.9 ng/ml vs. 335.3±119.3 ng/ml, t=2.349, P=0.020）, lower serum FABP4 levels [152.0 （131.6, 194.6） ng/ ml vs. 170.0 （132.0, 374.9） ng/ml, z=-2.051, P=0.040] and higher prevalence of PEW （61.7% vs. 42.3%, x2=5.756, P=-0.013）. However, there were no significant differences in serum CHI3L1 and FABP4 levels between PEW and non-PEW group. Logistic regression found that volume overload （OR=2.744, 95% CI 1.190- 6.327, P=0.018）, serum albumin （OR=0.837, 95% CI 0.734-0.955, P=0.008） and muscle mass （OR=0.936, 95% CI 0.891-0.982, P=0.007） were the independent risk factors for PEW. Conclusions Serum CHI3L1 and FABP4 levels were significantly higher in PD patients as compared with normal controls. We firstly verified that CHI3L1 and FABP4 were positively correlated, and both were negatively correlated with volume overload. Volume overload, low serum albumin and low muscle mass were the independent risk factors for PEW, but CHI3L1 and FABP4 levels were not included in the risk factors for PEW.