血液透析患者血清klotho蛋白水平与营养状况的关系

Relationship between serum klotho protein level and nutritional status in hemodialysis patients

目的探讨血液透析患者血清klotho蛋白水平与营养状况的关系。方法选取2016年3月~2018年12月南京中医药大学沭阳附属医院(以下简称“我院”)收治的终末期肾脏疾病患者113例作为观察组,根据改良主观综合营养评估法(MQSGA)将观察组分为A组(营养正常,32例)、B组(轻中度营养不良,48例)、C组(重度营养不良,33例)。另选取同期于我院体检的90名健康志愿者作为对照组。比较两组人体学指标、血清学指标及营养状况。采用Pearson相关性分析klotho蛋白与人体学指标、血清学指标及营养状况的相关性。结果观察组体重指数(BMI)、皮褶厚度(TSF)、上臂围(MAMC)、白蛋白(Alb)、血红蛋白(Hb)、klotho蛋白显著低于对照组,差异有统计学意义(P<0.05)。血肌酐(Scr)、尿素氮(BUN)、甲状旁腺激素(PTH)、成纤维细胞生长因子-23(FGF-23)、MQSGA评分均显著高于对照组,差异有统计学意义(P<0.05)。不同营养不良程度的血液透析患者各指标比较,差异有统计学意义(P<0.05)。血液透析患者klotho蛋白与TSF、MAMC、Alb、Hb呈正相关(r=0.642、0.446、0.453、0.536,P<0.05),而与Scr、BUN、PTH、FGF-23、MQSGA评分呈负相关(r=-0.392、-0.382、-0.412、-0.439、-0.526,P<0.05)。结论血液透析患者中存在血清klotho蛋白低表达情况,且表达水平与患者营养状况密切相关,临床可考虑将其作为治疗血液透析合并营养不良患者的新方向。

Objective To investigate the relationship between serum Klotho protein level and nutritional status in hemodialysis patients.Methods A total of 113 patients with end-stage renal disease admitted to Shuyang Affiliated Hospital of Traditional Chinese Medicine of Nanjing University(“our hospital”for short)from March 2016 to December 2018 were selected as observation group.According to the modified subjective comprehensive nutrition assessment(MQSGA),the observation group was divided into group A(well-nourished,32 cases),group B(mild to moderate malnutrition,48 cases),and group C(severe malnutrition,33 cases).Another 90 healthy volunteers examined in our hospital during the same period were selected as control group.The anthropological indicators,serological indicators and nutritional status between two groups were compared.Pearson correlation was used to analyze the correlation between Klotho protein and anthropological indicators,serological indicators and nutritional status.Results The body mass index(BMI),skin fold thickness(TSF),upper arm circumference(MAMC),albumin(Alb),hemoglobin(Hb)and klotho protein in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05),while serum creatinine(Scr),urea nitrogen(BUN),parathyroid hormone(PTH),fibroblast growth factor 23(FGF-23),MQSGA were higher than those of the control group,and the differences were statistically significant(P<0.05).Comparison of various indicators of hemodialysis patients with different levels of malnutrition,and the differences were statistically significant(P<0.05).Klotho protein was positively correlated with TSF,MAMC,Alb and Hb in hemodialysis patients(r=0.642,0.446,0.453,0.536,P<0.05),however,it negatively correlated with Scr,BUN,PTH,FGF-23 and MQSGA scores(r=-0.392,-0.382,-0.412,-0.439,-0.526,P<0.05).Conclusion There is a low expression of serum klotho protein in hemodialysis patients,and the expression level is closely related to the nutritional status of patients.It can be considered clinically as a new direction for treating hemodialysis patients with malnutrition.