复方α-酮酸对老年腹膜透析患者微炎性状态的调控作用观察

Observation on the effect of compound α-keto acid in regulating microinflammatory state in elderly patients undergoing peritoneal dialysis

目的研究复方α-酮酸对老年腹膜透析患者微炎性状态的调控作用。方法将40例老年腹膜透析患者以随机数字表法分为观察组、对照组,两组均20例,两组均在腹膜透析基础上采取控压、纠正贫血、调节钙磷代谢等常规干预方法,观察组另给予复方α-酮酸口服,3次/天,连用3个月。比较两组干预3个月后临床疗效,分组记录超敏-C反应蛋白(Hs-CRP)表达,并比较两组营养指标前白蛋白(PA)、血清白蛋白(ALB)、血红蛋白(HGB)、主观营养评估(SGA评分)差异,设定SGA评分为因变量,Hs-CRP为自变量,观察营养状态与微炎性状态的相关性。结果观察组总有效率高于对照组,但差异无统计学意义(连续性校正χ2=2.294,P=0.130);治疗后观察组Hs-CRP与治疗前及对照组治疗后比较降低,差异有统计学意义(P<0.05),对照组治疗前后差异无统计学意义(P>0.05);观察组治疗后PA、ALB、HGB均显著上升,较治疗前及对照组治疗后差异有统计学意义(P<0.05);治疗后组间比较,观察组SGA评分与对照组比较显著较低(P<0.05),对照组治疗前后差异无统计学意义(P>0.05);将SGA评分作为因变量,设定Hs-CRP为自变量,进行线性回归性分析,Hs-CRP与SGA评分呈负相关关系(r=-0.722,P=0.000),即Hs-CRP越高,SGA评分越低,患者营养状况越差。结论老年腹膜透析患者体内存在不同程度的微炎性状态,且微炎性状态与腹膜透析患者营养不良有相关性,复方α-酮酸辅助治疗可增强肾病患者干预疗效,并对微炎性状态有良好的调控作用,因此可改善患者营养状态,可能使腹膜透析患者预后获益。

Objective To study the effect of compound α-keto acid in regulating microinflammatory state in elderly patients undergoing peritoneal dialysis. Methods Forty elderly patients who underwent peritoneal dialysis in our hospital between February 2012 and February 2015 were randomized into observation group and control group,20 cases in each. Both groups were treated with pressure-controlling,anemia-correcting,calcium and phosphorus metabolism-regulating and other routine intervention methods,based on peritoneal dialysis. The observation group was treated with oral compound α-keto acid,3 times/d,lasting for 3 months. Clinical curative effect was compared between the two groups after 3 months of intervention. Expression of high-sensitivity C-reactive protein（Hs-CRP） was recorded. Nutritional indicators pre-albumin（PA）,serum albumin（ALB）,transferrin（TRF）,hemoglobin（HGB） and subjective nutritional assessment（SGA score） were compared between the two groups. With SGA score as the dependent variable and Hs-CRP as the independent variable,the correlation between nutritional status and microinflammatory state was observed. Results The total response rate in observation group was higher than that in control group,difference was not statistically significant（correction for continuity χ2=2. 294,P = 0. 130）. After treatment,hs-CRP in observation group was lower than that in control group（P〈0. 05）. There were no significant differences in control group before and after treatment（P〈0. 05）. After treatment,PA,ALB and HGB in observation group were significantly increased. Compared with those before treatment and those in control group after treatment,there were significant differences（P〈0. 05）. After treatment,SGA score of observation group was significantly lower than that of control group（P〈0. 05） while there was no significant difference in control group before and after treatment（P〈0. 05）; with SGA score as the dependent variable and Hs-CRP as the independent variable,linear regression analysis showed that Hs-CRP was negatively correlated with SGA score（r =-0. 722,P = 0. 000）,namely,the higher Hs-CRP was,the lower SGA score was,the worse the nutritional status of patients was. Conclusion There are different degrees of microinflammatory state in elderly patients undergoing peritoneal dialysis. Microinflammatory state and malnutrition are well correlated. Compound α-keto acid assisted therapy can strengthen intervention effect in patients with nephropathy,and effectively regulate microinflammatory state. Therefore,the nutritional status can be changed to benefit the prognosis of patients.