血清IL-6、FGF-23水平与慢性肾衰竭血透患者蛋白质-能量消耗发生的关系

Relationship between Serum IL-6,FGF-23 Levels and Protein-energy Wasting in Hemodialysis Patients with Chronic Renal Failure

目的探讨慢性肾衰竭(CRF)血液透析(简称血透)患者血清白细胞介素-6(IL-6)、成纤维细胞生长因子-23(FGF-23)表达水平,并分析二者与患者发生蛋白质-能量消耗(PEW)的关系。方法选择2018年8月~2021年8月医院收治的150例CRF患者作为研究对象,全部患者均接受维持性血透治疗并随访24周,依据随访结束时患者PEW的发生情况将患者分为发生组与未发生组;入院时设计患者基线资料调查表,比较两组患者初始基线资料、实验室指标;重点分析初始血清IL-6、FGF-23水平与CRF血透患者发生PEW的关系。结果150例CRF血透患者PEW发生率为24.67%(37/150);发生组患者透析不充分占比高于未发生组,初始血肌酐(Scr)、C反应蛋白(CRP)、IL-6、FGF-23水平显著高于未发生组,差异有统计学意义(P<0.05);logistics回归分析结果显示,透析不充分以及初始Scr、CRP、IL-6、FGF-23水平高是CRF血透患者发生PEW的危险因素(OR>1,P<0.05);绘制决策曲线,结果显示,在高风险阈值0.0~1.0范围内血清IL-6、FGF-23联合预测CRF血透患者发生PEW的净收益率>0,有临床意义;限制性立方样条分析结果显示,IL-6、FGF-23与CRF血透患者发生PEW的关联强度成线性剂量反应关系(P<0.05)。结论血清IL-6、FGF-23水平与CRF血透患者PEW的发生有关。

Objective To investigate the levels of serum interleukin-6(IL-6)and fibroblast growth factor-23(FGF-23)in hemodialysis patients with chronic renal failure(CRF),and to analyze the relationship between them and protein-energy wasting(PEW).Methods 150 patients with CRF treated in the hospital from August 2018 to August 2021 were selected as the research subjects.All patients received maintenance hemodialysis and were followed up for 24 weeks.According to the occurrence of PEW at the end of follow-up,the patients were divided into occurrence group and non occurrence group;the baseline data questionnaire of patients was designed at admission,and the initial baseline data and laboratory indexes of patients in the two groups were compared;the relationship between the initial serum levels of IL-6 and FGF-23 and pew in hemodialysis patients with CRF was mainly analyzed.Results The incidence of PEW in 150 hemodialysis patients with CRF was 24.67%(37/150);compared with the non occurrence group,the proportion of insufficient dialysis in the occurrence group was higher,and the levels of initial blood creatinine(SCR),C-reactive protein(CRP),IL-6 and FGF-23 were significantly higher,the differences were statistically significant(P<0.05);the results of Logistic regression analysis showed that,insufficient dialysis,high levels of initial SCR,CRP,IL-6 and FGF-23 were the risk factors of PEW in hemodialysis patients with CRF(OR>1,P<0.05);the results from the decision curve showed that,in the range of high risk threshold 0.0~1.0,the combination of serum IL-6 and FGF-23 can predict the net benefit rate of PEW in hemodialysis patients with CRF,which was of clinical significance;by restricted cubic spline analysis,the results showed that,there was a linear dose-response relationship between IL-6 and FGF-23 and PEW in hemodialysis patients with CRF(P<0.05).Conclusion The levels of serum IL-6 and FGF-23 are related to the occurrence of PEW in hemodialysis patients with CRF.