慢性肾脏病PEW患者IPTH与脂肪和肌肉代谢指标的相关性

Correlation between IPTH and fat and muscle metabolic markers in PEW patients with chronic kidney disease

目的探讨慢性肾脏病(CKD)患者合并蛋白质-能量消耗(PEW)的临床特征及血清全段甲状旁腺激素(IPTH)与脂肪、肌肉分解代谢指标之间的相关性。方法横断面研究分析2016年9月至2017年5月于兰大二院肾内科收治的CKD患者65例。通过搜集患者的基线生化资料,饮食情况和脂肪、肌肉测量指标,对入选者进行PEW评估。比较两组患者的人口资料学、实验室相关检查、人体测量学相关指标。同时进行Spearman相关性分析以明确在CKD患者及PEW患者中,IPTH与脂肪、肌肉分解代谢指标的相关性。结果患者平均年龄为(47.83±14.99)岁,男性42例(64.62%)。与非PEW组相比,PEW组患者年龄大(P=0.021),肾功能差(血清肌酐:P=0.028,肾小球滤过率:P=0.010),血清营养学相关指标(血清白蛋白:P=0.024,血清总胆固醇:P=0.008,血清甘油三酯:P=0.006,血清低密度脂蛋白:P=0.020)和脂肪、肌肉相关测量参数均较低下,差异有统计学意义(体重:P=0.007,BMI:P=0.002,体脂肪:P=0.002,体脂比:P=0.010,右上肢体脂肪:P=0.005,左上肢体脂肪:P=0.005,躯干体脂肪:P=0.002,右下肢体脂肪:P=0.002,左下肢体脂肪:P=0.002,内脏脂肪面积:P=0.029,上臂围度:P=0.004,上臂肌肉周长:P=0.009,大腿围:P=0.016)。Spearman法分析发现在CKD患者中,IPTH与肾功能,脂肪、肌肉相关测量参数均呈负相关(P<0.05)。在PEW组中,IPTH亦与脂肪、肌肉相关测量参数呈负相关,BMI(r=-0.556,P=0.009),腰臀比(r=-0.577,P=0.006),肥胖程度(r=-0.574,P=0.007),上臂围度(r=-0.485,P=0.026)。结论 CKD合并PEW患者脂肪、肌肉含量低下。IPTH与脂肪、肌肉相关测量参数呈负相关性。在临床治疗中,需及时纠正患者IPTH水平,以改善患者PEW状态。

Objective To investigate the clinical features of protein-energy wasting(PEW)in patients with chronic kidney disease(CKD)and the correlation between serum intact parathyroid hormone(IPTH)and fat,muscle catabolism.Methods The single-center cross-sectional study selected sixty five patients with CKD from September 2016 to May 2017 at the Second Affiliated Hospital of Lanzhou University.The baseline biochemical data,diet and fat,muscle measurements of the patients were collected,and performed PEW assessment on patients.Demographic data,laboratory-related examinations,and anthropometric indicators were compared between the two groups.Spearman correlation analysis was performed to determine the correlation between IPTH and fat and muscle catabolism markers in CKD and PEW patients,respectively.Results The mean age was(47.83±14.99)years old,and 64.62%were male.Compared with non-PEW group,patients in PEW group were older(P=0.021)and had poor renal function(serum creatinine:P=0.028,eGFR:P=0.010).Serum nutrition related indicators(albumin:P=0.024,total cholesterol:P=0.008,triglyceride:P=0.006,low-density lipoprotein:P=0.020)and fat and muscle related measurement parameters(weight:P=0.007,BMI:P=0.002,fat mass:P=0.002,percent body fat:P=0.010,right arm fat mass:P=0.005,left arm fat mass:P=0.005,trunk fat mass:P=0.002,right leg fat mass:P=0.002,left leg fat mass:P=0.002,visceral fat area:P=0.029,midarm circumference:P=0.004,midarm muscle circumference:P=0.009,thigh circumference:P=0.016)were significantly different between groups.Spearman analysis showed that IPTH was negatively correlated with renal function,fat and muscle related parameters in CKD patients(P<0.05).In the PEW group,IPTH was also negatively correlated with fat and muscle related measurement parameters,including BMI(r=-0.556,P=0.009),waist-to-hip ratio(r=-0.577,P=0.006),obesity degree(r=-0.574,P=0.007)and midarm circumference(r=-0.485,P=0.026).Conclusion The study confirmed that CKD and PEW patients had low fat and muscle content,and IPTH was negatively correlated with fat and muscle related measurement parameters.In clinical treatment,the patient′s IPTH level needs to be corrected in time to improve the patient′s PEW status.