维持性血液透析患者血清klotho蛋白水平与营养状况的关系

The association of klotho protein and nutrition status for maintenance hemodialysis patients

目的探究维持性血液透析(MHD)患者血清klotho蛋白水平与营养状况的关系。方法选取本院2016年6月至2016年11月治疗的维持性血液透析患者100例作为研究组,根据主观综合性营养评估(SGA)法将研究组分为三组:A组:营养良好组28例,B组:轻中度营养不良组44例,C组:重度营养不良组28例,并选取同期健康体检者60例作为对照组,采用微主观综合性营养评估(SGA)法评价两组患者营养的状况,采用ELISA法测定两组对象血清klotho蛋白水平,并对两组患者相关生化指标测定。利用Pearson相关分析法分析血清klotho蛋白水平与相关生化指标的相关性。结果研究组患者合并营养不良的发生率为72%(72/100),明显高于对照组的18.32%(11/60)(P<0.05);且不同营养状况A、B、C三组血清各指标水平存在组间差异(P<0.05),与A组相比较,B组及C组患者BMI、ALB、Hb、MAMC、klotho蛋白水平均降低,PTH、FGF-23升高,差异有统计学意义(P<0.05);与B组相比,C组患者Scr、ALB、Hb、MAMC、klotho蛋白水平均降低,PTH、FGF-23升高,差异有统计学意义(P<0.05);血清klotho蛋白水平与ALB、MAMC、Hb呈正相关(P<0.05);与BMI无相关性(P=0.165);与Scr、BUN、FGF23、PTH呈负相关(P<0.05)。结论维持性血液透析患者合并营养不良的发生率很高,血清klotho蛋白水平的低表达与患者营养状况密切相关,为尿毒症患者合并营养不良的诊断、治疗提供了新依据。

Objective To explore the association between klotho protein and nutrition status for maintenance hemodialysis patients. Methods From June 2016 to November 2016, 100 patients who received maintenance hmodialysis were divided into three groups, group A: 28 cases in good nutrition group, group B: 44 cases in mild and moderate malnutrition group, and group C: 28 cases in severe malnutrition group in our hospital and 60 health controls were enrolled in our study. Subjective global assessment of nutritional status(SGA) was used to assess the nutrition status between two groups, the level of serum klotho protein was measured by ELISA, and other related· biochemical indexes were detected. Pearson correlative analysis was used to analyze the relationship between serum klotho protein and related biochemical indexes. Results There was a significant difference of the incidence of malnutrition between study group and control group (72%>18.32%, P<0.05), and there was significant difference of biochemical indexes among different nutrition status of groups A, B and C (P<0.05), compared with A group, the level of ALB, Hb, MAMC, klotho protein and BMI were lower in group B and C, and the level of PTH and FGF-23 was higher (P<0.05). Compared with group B, the level of Scr, ALB, Hb, MAMC, klotho protein was lower, and the level of PTH and FGF-23 was higher (P<0.05). Serum klotho protein was positively related with ALB, MAMC and Hb (P<0.05), and negatively related with Scr, BUN, FGF23 and PTH (P<0.05), while there was no relationship between serum klotho protein and BMI (P=0.165). Conclusions There is a high incidence of malnutrition in maintenance hemodialysis patients, and the low expression of serum klotho protein may be related with maintenance hemodialysis patients, which may provide a new basis for the diagnosis and treatment of malnutrition in uremic patients.