非透析糖尿病肾病患者血清钙镁比值影响因素分析及其与营养状态的相关性

Influencing factors of serum Ca/Mg ratio and its relation with nutritional status in patients with non-dialysis dependent diabetic kidney disease

目的:探讨非透析糖尿病肾病患者的营养状态与血清钙镁比值(Ca/Mg)的相关性。方法:选择2017年1月至2019年6月于上海市第八人民医院肾内科就诊非透析糖尿病肾病患者139例,根据其血清Ca/Mg大小分为:低Ca/Mg组(Ca/Mg≤3.5,n=32)、中Ca/Mg组(3.5<Ca/Mg<4.5,n=56)、高Ca/Mg组(Ca/Mg≥4.5,n=51)。检测各组患者生化指标,分析患者的营养状态与血清Ca/Mg的相关性。结果:随着Ca/Mg的升高,非透析糖尿病肾病患者白蛋白(Alb)、血红蛋白(Hb)水平呈升高趋势,主观综合营养评价法(SGA)评分中营养不良患者比例呈降低趋势,差异均有统计学意义(P<0.05)。Spearman相关性分析显示,非透析糖尿病肾病患者血清Ca/Mg与年龄(r=-0.199)、高敏C反应蛋白(hsCRP)水平(r=-0.294)、尿素氮(BUN)水平(r=-0.328)、血清肌酐(SCr)水平(r=-0.366)负相关(P<0.05);与估算肾小球滤过率(eGFR,r=0.266)、全段甲状旁腺激素(iPTH,r=0.101)、Alb(r=0.193)及Hb水平(r=0.266)正相关(P<0.05);与性别、三酰甘油(TG)、胆固醇(TC)、尿白蛋白肌酐比值(ACR)等指标无显著相关性。多因素线性回归分析显示,非透析糖尿病肾病患者血清Ca/Mg与hsCRP水平及年龄负相关,与Alb、Hb及iPTH水平正相关(P<0.05)。多因素logistic回归显示,血清Ca/Mg与非透析糖尿病肾病患者营养不良的发生存在独立相关关系(HR=0.506,95%CI 0.267~0.961,P=0.038)。结论:非透析糖尿病肾病患者的营养状态与血清Ca/Mg相关,血清Ca/Mg可能是该类患者发生营养不良的独立危险因素。

Objective:To analyze the relationship between nutritional status and serum Ca/Mg ratio in patients with non-dialysis-dependent diabetic kidney disease.Methods:A total of 139 patients with non-dialysis diabetic kidney disease who visited Shanghai Eighth People’s Hospital from January 2017 to June 2019 were selected and divided into three groups according to serum Ca/Mg ratio:group A(≤3.5,n=32),group B(3.5-4.5,n=56)and group C(≥4.5,n=51).Biochemical indexes of patients in each group were detected,and the correlation between nutritional status and serum Ca/Mg ratio was analyzed.Results:With the increase of Ca/Mg ratio,the levels of albumin(Alb)and hemoglobin(Hb)significantly increased(P<0.05),while the proportion of malnourished patients in the subjective global assessment of nutrition(SGA)score showed a decreasing trend(P<0.05).Spearman correlation analysis showed that the serum Ca/Mg ratio was negatively correlated with age(r=-0.199),the level of high-sensitivity C-reactive protein(hsCRP,r=-0.294),blood urea nitrogen(BUN,r=-0.328)and serum creatinine(SCr,r=-0.366),and it was positively correlated with the level of eGFR(r=0.266),intact parathyroid hormone(iPTH,r=0.101),Alb(r=0.193)and Hb(r=0.266).The above correlations were all statistically significant(P<0.05).However,the serum Ca/Mg ratio had no correlation with gender and the levels of albumin/creatinine ratio(ACR),total cholesterol(TC),or triglyceride(TG).The multivariate linear regression analysis result showed that serum Ca/Mg ratio was negatively correlated with hsCRP level and age,but positively correlated with Alb,Hb,and iPTH levels.Multivariate logistic regression showed that the Ca/Mg ratio was independently associated with the risk of malnutrition in non-dialysis patients with diabetic kidney disease(HR=0.506,95%CI 0.267-0.961,P=0.038).Conclusions:Serum Ca/Mg ratio was correlated with nutritional status in non-dialysis patients with diabetic kidney disease,and it might be used for the assessment of nutritional status in patients with non-dialysis diabetic kidney disease.