非糖尿病腹膜透析患者血清鸢尾素水平变化及其影响因素

Changes and Influencing Factors of Serum Irisin Level in Non-diabetic Peritoneal Dialysis Patient

目的评估腹膜透析对终末期肾病(ESRD)患者血清鸢尾素水平的影响,并寻找其与透析充分性、胰岛素抵抗、营养状况和骨代谢状态的关系。方法选取2018年6月至2019年12月于郑州大学第一附属医院诊断为ESRD、行腹膜透析置管术并规律随访的腹膜透析患者。患者均无糖尿病。收集患者腹膜透析手术前和接受规律腹膜透析治疗3个月及以上的血清标本、临床资料和生化指标。采用酶联免疫吸附法检测患者血清鸢尾素水平。根据血清鸢尾素水平变化情况分为鸢尾素升高组和鸢尾素降低组。对正态分布资料采用t检验和Pearson相关分析,对非正态分布资料采用秩和检验和Spearman相关分析。采用多重线性逐步回归分析探讨腹膜透析患者血清鸢尾素水平变化的独立影响因素。结果共纳入46例患者,腹膜透析前血清鸢尾素水平为19.13(16.44,22.83)μg·L^(-1),规律腹膜透析后血清鸢尾素水平为20.27(17.79,22.86)μg·L^(-1),差异无统计学意义(P>0.05)。其中25例患者规律腹膜透析后血清鸢尾素水平[21.21(20.06,23.83)μg·L^(-1)]较腹膜透析前[17.25(15.64,19.05)μg·L^(-1)]升高(P<0.05),21例患者规律腹膜透析后血清鸢尾素水平[(18.58±2.93)μg·L^(-1)]较腹膜透析前[(22.76±3.77)μg·L^(-1)]下降(P<0.05)。规律腹膜透析后,鸢尾素升高组总尿素清除指数(Kt/V)、残肾Kt/V较鸢尾素降低组高,血尿素氮、血肌酐较鸢尾素降低组低(P<0.05)。相关性分析显示:规律腹膜透析后血清鸢尾素水平变化值与血肌酐变化值呈负相关(r=-0.382,P=0.009),与透析充分性指标[总Kt/V、残肾Kt/V、残肾内生肌酐清除率(Ccr)]呈正相关(r=0.427、0.445、0.404,P<0.05),与腹膜Ccr呈负相关(r=-0.360,P=0.014)。血清鸢尾素水平变化值与空腹血糖变化值、甘油三酯葡萄糖乘积指数(TyG)变化值、老年营养风险指数(GNRI)变化值无关(P>0.05)。血清鸢尾素水平变化值与骨转换标志物血钙变化值呈负相关(r=-0.334,P=0.023),与血全段甲状旁腺激素(iPTH)变化值、碱性磷酸酶变化值无关(P>0.05)。多重线性逐步回归分析显示,残肾Kt/V(β=3.903,P=0.036)、血钙变化值(β=-4.492,P=0.047)与规律腹膜透析后血清鸢尾素水平变化值独立相关。结论非糖尿病ESRD患者腹膜透析后血清鸢尾素水平变化不一,保留的残余肾功能有助于提高血清鸢尾素水平,血清鸢尾素水平可能受腹膜透析患者血钙的影响。

Objective To evaluate the effect of peritoneal dialysis on serum irisin with end stage renal disease(ESRD)and to seek the relationship of serum irisin with dialysis adequacy,insulin resistance,nutritional status and bone metabolism.Methods The patients who were diagnosed as ESRD,received peritoneal dialysis and followed up regularly from June 2018 to December 2019 in the First Affiliated Hospital to Zhengzhou University were selected.None of the patients had diabetes.The serum samples,clinical data and biochemical indexes of the patients were collected before peritoneal dialysis and receiving dialysis for more than 3 months.Serum samples were tested for irisin levels by enzyme-linked immunosorbent assay.According to the changes of irisin levels,the patients were divided into irisin increasing group and irisin decreasing group.The t-test and Pearson correlation were used for normal distribution data,and rank-sum test and Spearman correlation were used for non-normal distribution data.Multiple stepwise regression analysis showed the independent influencing factors of serum irisin levels in patients.Results A total of 46 patients were enrolled.The serum irisin level before peritoneal dialysis was 19.13(16.44,22.83)μg·L^(-1),while that after regular peritoneal dialysis was 20.27(17.79,22.86)μg·L^(-1),with no statistical difference(P>0.05).Among them,the serum irisin level of 25 patients after regular peritoneal dialysis[21.21(20.06,23.83)μg·L^(-1)]was higher than that[17.25(15.64,19.05)μg·L^(-1)]before peritoneal dialysis(P<0.05),and the serum irisin level of 21 patients after regular peritoneal dialysis[(18.58±2.93)μg·L^(-1)]was lower than that[(22.76±3.77)μg·L^(-1)]before peritoneal dialysis(P<0.05).After regular peritoneal dialysis,the total urea clearance index(Kt/V)and residual kidney Kt/V in irisin increasing group were higher than those in irisin decreasing group,while the blood urea nitrogen and blood creatinine were lower(P<0.05).Correlation analysis showed that after regular peritoneal dialysis,the change of serum irisin level was negatively correlated with the change of blood creatinine(r=-0.382,P=0.009),and the change of serum irisin level was positively correlated with adequacy indexes[total Kt/V,residual kidney Kt/V,residual kidney creatinine clearance(Ccr)](r=0.427,0.445,0.404,P<0.05),and it was negatively correlated with peritoneal Ccr(r=-0.360,P=0.014).There was no correlation between the change of serum irisin level and the changes of fasting blood glucose,triglyceride-glucose index(TyG)and geriatric nutritional risk index(GNRI)(P>0.05).The change of serum irisin level was negatively correlated with the change of bone turnover marker(blood calcium)(r=-0.334,P=0.023),but not related to the changes of blood intact parathyroid hormone(iPTH)and alkaline phosphatase(P>0.05).Multiple linear stepwise regression analysis showed that residual kidney Kt/V(β=3.903,P=0.036)and the change of serum calcium(β=-4.492,P=0.047)were independently correlated with the change of serum irisin level after regular peritoneal dialysis.Conclusion The changes of serum irisin level are different in non-diabetic patients with ESRD after peritoneal dialysis.Preserved residual renal function contributes to increase the level of serum irisin.Serum irisin may be influenced by serum calcium in peritoneal dialysis patients.