慢性肾脏病患者循环生长分化因子15和人体成分分析营养状态的相关性研究

Circulating growth differentiation factor15 and nutritional status by bioelectrical impedance analysis in patients with chronic kidney disease

目的:探讨慢性肾脏病(CKD)患者血浆中循环生长分化因子15(growth differentiation factor 15,GDF15)水平和营养状态的相关性.方法:纳入231例未进入透析治疗的CKD患者.所有研究对象分别使用生物电阻抗人体成分分析进行营养状态评估.使用酶联免疫吸附法检测循环血浆GDF15浓度.结果:CKD 1~2期患者80例,CKD 3期69例,CKD 4~5期82例.随着估算的肾小球滤过率(eGFR)下降,患者血浆GDF15浓度逐渐增加,血红蛋白、血清白蛋白、全身蛋白质和相位角(phase angle,PA)逐渐减少.GDF15浓度和相位角、血清白蛋白和前白蛋白等营养评估指标呈明显负相关.Logistic回归分析显示:经多因素校正后,GDF15浓度最高者发生营养不良的风险是最低浓度组的15.32倍(OR=15.32,95%CI 3.94~59.53,P<0.001).结论:在CKD患者中,随着肾脏疾病进展,营养不良比例逐渐增加.GDF15可作为CKD患者营养不良的有效独立预测指标.

Objective:To explore the correlation of circulating growth differentiation factor 15(GDF15) and nutritional status in chronic kidney disease(CKD) patients. Methodology:The current study included 231 CKD patients without dialysis. All participants were experienced bioelectrical impedance analysis to evaluate nutritional status. Plasma GDF15 concentration was measured by an enzyme-linked immunosorbent assay. Results:In 231 patients, 80 were CKD stage 1~2,69 were CKD stage 3 and 82 were CKD stage 4~5. Plasma GDF15 level was lowest in CKD stage 1~2 group and highest in CKD stage 4~5 group. As eGFR decreased, the hemoglobin, serum albumin, body protein and phase angle reduced. Higher GDF15 concentrations were significantly associated with decreased phase angle at 50 Hz and serum albumin. Compared with patients in the lowest quartile, the highest quartile of GDF15 had a 15.32-fold increased risk of malnutrition after adjusting for confounding factors(OR=15.32,95%CI 3.94~59.53,P<0.001). Conclusion:The proportion of malnutrition patients increased with the progress of kidney disease. GDF15 can be an independent predictor for malnutrition in CKD.