不同方式血液透析患者血浆脂联素水平与炎症、营养状态相关性研究

目的：研究不同方式血液透析患者血浆脂联素（ADPN ）水平与营养、炎症状态的相关性。方法选择南方医科大学北滘医院肾内科行维持性血液透析治疗半年以上的患者84例，分为3组，低通量透析组（LFHD）25例、高通量透析组（HFHD）28例、高通量透析联合血液滤过组（HFHD＋ HDF）31例。于首次透析前及连续血液透析6个月后检测营养指标：总蛋白（TP）、清蛋白（Alb）、前清蛋白（PA）、血红蛋白（Hb）；炎症指标：C反应蛋白（CRP）、铁蛋白（Fer）；电解质及毒素指标：钾离子（K＋）、钠离子（Na＋）、钙离子（Ca2＋）、磷离子（P3＋）、尿素氮（BUN）、血清肌酐（Scr）、尿酸（UA）、全段甲状旁腺素（iPTH）、β2‐微球蛋白（β2‐MG）、半胱氨酸蛋白酶抑制剂C（Cys C）及血浆ADPN水平的变化，比较3组间ADPN和各实验指标差异及相关性。结果治疗前各组间指标无差异；治疗6个月后：HFHD、HFHD＋ HDF组ADPN水平较前升高（P＜0．05），高于LFHD组（P＜0．05）；LF‐HD组PA水平，HFHD组TP、PA水平及HFHD＋ HDF组PA、Hb水平均较前升高（P＜0．05），其中 HFHD、HFHD＋ HDF组Hb较LFHD组高（P＜0．05）；LFHD组β2‐MG较前升高（P＜0．05），HFHD组 Fer、CRP、CysC水平及 HFHD＋ HDF组 Fer、CRP、β2‐MG、CysC、BUN水平较前降低（P＜0．05），其中 HFHD、HFHD＋ HDF组 Fer、CRP、β2‐MG、CysC水平低于 LFHD组（P＜0．05）。相关分析显示，ADPN与PA、Alb呈正相关，ADPN与Fer、CRP、CysC、β2‐MG呈负相关。结论不同方式血透患者血浆ADPN水平存在差异，ADPN水平可作为预测血透患者微炎性反应、营养情况的有意义指标。

The relationship among plasma adiponectin,microinflammation and nutrition state in patients undergoing different ways of hemodialysis

Objective To investigate the correlation between plasma adiponectin level and microinflammation ,nutrition status in patients undergoing different blood purification treatment .Methods Totally 84 patients receiving maintenance hemodialysis over 6 months were randomly assigned to three groups for low‐flux hemodialysis(LFHD)group ,high‐flux hemodialysis(HFHD)group , high‐flux hemodialysis in combination with hemodiafiltration(HFHD+ HDF)group .The baseline and post treatment levels of total protein(TP) ,albumin(Alb) ,prealbumin(PA) ,hemoglobin(Hb) ,`ferritin(FER) ,C reactive protein(CRP) ,potassium(K+ ) ,sodium (Na+ ) ,calcium(Ca2+ ) ,phosphate(P3+ ) ,blood urea nitrogen(BUN) ,creatinine(Cr) ,urea acid(UA) ,intact parathyroid homone (iPTH) ,β2‐microglobulin(β2‐MG) ,cystatin C(Cys C) and adiponectin(ADPN) were compared among three groups .Results Be‐fore the treatment ,the levels of those biochemical indicators were of no significant difference among the three groups .After six months ,plasma ADPN level of HFHD ,HFHD+ HDF increased(P<0 .05) ,and were markedly higher than LFHD(P<0 .05) .In LFHD group ,serum PA ,β2‐MG increased(P<0 .05) after the treatment for six months .In HFHD group ,serum TP ,PA increased , and serum Fer ,CRP ,CysC decreased after the treatment(P<0 .05) .In HFHD+ HDF group ,serum PA ,Hb increased ,and serum Fer ,CRP ,β2‐MG ,Cysc ,BUN decreased after six months(P<0 .05) .After the treatment ,the serum Hb level of LFHD was lower than HFHD ,HFHD+ HDF(P<0 .05);the serum Fer ,CRP ,β2‐MG ,CysC of LFHD were higer than HFHD ,HFHD+ HDF(P<0 .05) .Correlation analysis showed that plasma ADPN level was inversely associated with Fer ,CRP ,CysC ,β2‐MG ,whereas was as‐sociated with PA ,Alb .Conclusion The different ways of hemodialysis could have an effect on the final levels of adiponectin in M HD patients .ADPN can be used as a meaningful indicator of microinflammation ,nutrition status in hemodialysis patients .