慢性肾脏病5期患者炎性反应与营养不良的临床观察

目的 探讨慢性肾脏病(CKD)5期患者机体炎性反应和营养状态的变化及其相互关系.方法 90例CKD 5期患者分为非透析(ND)组、血液透析(MHD)组和腹膜透析(CAPD)组,每组各30例,检测其炎性反应指标血浆高敏C反应蛋白(hs-CRP)和营养指标(血浆白蛋白、血红蛋白),并与30例健康体检者(健康对照组)进行比较.结果CKD 5期患者血浆hs-CRP水平高于健康对照组(P<0.01),MHD组和CAPD组患者血浆hs-CRP水平均高于ND组(P<0.05),MHD组与CAPD组患者血浆hs-CRP水平比较差异无统计学意义.血浆白蛋白<35 g/L和血红蛋白<90 g/L的CKD 5期患者血浆hs-CRP增高更为明显,且血浆hs-CRP水平与血浆白蛋白和血红蛋白呈负相关(r=-0.535,P<0.01;r=-0.220,P<0.05).结论 CKD 5期患者血浆hs-CRP水平增高,且与血浆白蛋白和血红蛋白之间存在负相关,炎性反应可能是导致或加重CKD患者营养不良的原因之一.

Clinical observation of inflammation and malnutrition in patients with stage V chronic kidney disease

Objective To explore the variation of the plasma high-sensitive C reactive protein (hs-CRP) levels and analyze the relationship between inflammation and malnutrition in the patients with stage V chronic kidney disease (CKD). Methods Ninety patients with stage V CKD were enrolled. The patients were divided into three groups according to their treatment, no dialysis (ND) group, hemodialysis (MHD) group and continuous ambulatory peritoneal dialysis (CAPD) group. Plasma hs-CRP, albumin and hemoglobin were detected. Results The levels of plasma hs-CRP were significantly increased in the patients with stage V CKD compared with normal individuals (P< 0.01). It showed a significant difference between MHD group, CAPD group and ND group (P < 0.05), while no significant difference was found between MHD group and CAPD group. The plasma hs-CRP levels increased in the patients with lower plasma albumin (< 35 g/L) or lower hemoglobin (< 90 g/L). Levels of plasma hs-CRP showed a negative relationship with plasma albumin and hemoglobin (r =- 0.535, P < 0.01 ;r =-0.220, P < 0.05). Conclusions Plasma hs-CRP levels increase in patients with stage V CKD, and there is a negative relationship between hs-CRP and plasma albumin and hemoglobin. Inflammation may be a factor of malnutrition in patients with CKD.