高龄男性慢性肾病患者血清C-反应蛋白的临床意义

目的探讨慢性肾病(CKD)高龄男性患者血清C-反应蛋白(CRP)与营养指标及CKD进展之间的关系。方法回顾性分析曾在某院住院并门诊随访且尚未透析的72例高龄男性CKD 5期患者,分为高GRP组28例,低GRP组44例,观察血清CRP、营养评估及肾功能指标等,探讨微炎性状态与营养状况及CKD进展之间的关系。结果排除感染、创伤等因素后,所纳入对象的平均血清CRP水平为0.64mg/dl(四分位间距0.32,1.05 mg/dl)。以0.8mg/dl为分割点,将其分为高CRP组(CRP≥0.8mg/dl)和低CRP组(CRP<0.8mg/dl)。高CRP组患者占38.9%,较之低CRP组,高CRP组多伴随心血管及外周动脉粥样硬化等疾病(P<0.05),主观综合营养评估(SGA)评分明显降低(P<0.01),促红细胞生成素(EPO)用量显著增加(P<0.01)。随访18个月后,高CRP组估算肾小球滤过率下降幅度明显(P<0.01),转入透析治疗的例数较多(P<0.05),发生心血管事件的例数也显著增多(P<0.05)。结论进入CKD 5期的高龄CKD患者存在血清CRP值轻度升高的微炎性状态,高CRP患者伴随心血管病及外周动脉粥样硬化的比例显著高于低CRP患者;持续的高CRP水平多伴随营养状况的下降,且易导致EPO效力的降低;CKD的进展与血清高CRP水平具有相关性。

The clinical significance of serum C-reactive protein in the very elderly with chronic kidney disease

Objective To investigate the relationship of CRP to nutritional condition and the renal function in the very elderly with end stage renal disease（ESRD）.Methods This was a retrospective cohort study using the clinical data of 89 very old patients（aged75～97） with ESRD.According to the level of serum CRP,the patients were divided into two groups：high CRP group（CRP≥ 0.8mg/dl） and low CRP group（0.8mg/dl）.The changes of nutritional parameters and the renal function were compared between two groups at baseline and 18 months of follow-up.Results Twenty-eight patients（38.9%） showed high CRP levels（≥0.8mg/dl）at baseline.After 18 months of follow-up,the patients with high CRP showed lower level of SGA score,furthermore they needed more ery thropoietin to maintain stable hemoglobin（P0.05）.The high CRP group had a faster decline in eGFR over the 18 months of follow-up duration（P0.05）.Conclusions High CRP levels in the very elderly with ESRD could predict the nutritional decline and poorer response to EPO.There are relationship between serum CRP and the progression of CKD.