微炎症状态和蛋白能量消耗在维持性腹膜透析人群中的特点

目的 探讨微炎症状态和蛋白质能量消耗(PEW)在维持性腹膜透析(MPD)患者中发病特点,分析其相关性.方法 选择2012年3月至2015年9月该院收治的MPD患者96例.采用改良SGA法、汉化营养不良原炎症评分(SMI)评分和清蛋白(Alb)进行营养评估,微炎症状态评估采用酶联免疫吸附试验(ELISA)法检测血浆超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平,同时检测Alb、血清总蛋白(TP)、前清蛋白(PA)、血红蛋白(Hb)、转铁蛋白(TF)、血肌酐(Scr)、血尿素氮(BUN)、血清胆固醇(Tch)等指标.结果 MPD患者PEW发生率36.50％,其中大于65岁患者占62.86％,透析龄大于2年患者占57.10％,糖尿病肾病患者占40.00％;MPD患者hs-CRP＞5 mg/L占58.33％,其中大于65岁患者占42.86％,透析龄大于2年患者占60.71％,糖尿病肾病患者占32.14％.PEW组糖尿病肾病患者、年龄、透析龄、hs-CRP、TNF-α、IL-6高于非PEW组,而BMI、TP、Alb、PA、Hb、Tch、中臂围(MAC)、中臂肌围(MAMC)的比例低于非PEW组(均P＜0.05);hs-CRP＞5 mg/L组年龄、透析时间、TNF-α、IL-6高于hs-CRP≤5 mg/L组,而TP、Alb、PA、TF、Hb、Kt/V≥1.72的比例低于hs-CRP≤5 mg/L组(均P＜0.05).校正性别、年龄、透析龄影响因素,MPD患者hs-CRP水平与Alb、PA、TF、Tch、Scr、TG水平呈不同程度负相关;患者IL-6水平分别与Alb、PA、TF、Tch、TG呈不同程度负相关;患者TNF-α水平与Alb、PA、TF、TG、Tch水平呈不同程度负相关(均P＜0.05).多因素分析显示,高龄、透析龄、微炎症状态、低蛋白血症是PEW的独立危险因素(P＜0.05).结论 MPD患者PEW、微炎症状态发生率高,PEW、微炎症状态发生具有高龄、透析龄长的特点,糖尿病患者更易并发PEW、微炎症状态,高龄、透析龄、微炎症状态、低蛋白血症是PEW的独立危险因素.

The inflammatory state and protein-energy wasting in the maintenance peritoneal dialysis population

Objective To investigate micro-inflammatory state and protein-energy wasting (PEW) states in maintenance peritoneal dialysis(MPD) patients,then analysis of the correlation between them.Methods Ninty-six cases of MPD patients in this Hospital were selected from March 2012 to September 2015.The status of nutrition were assessed by Quantitative Subjective and global Assessment(SGA),malnutrition-inflammation score(MIS) and albumin(Alb),micro-inflammatory state was assessed by enzyme-linked immunoassay(ELISA) method serum hypersensitive c-reactive protein (hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6).At the same time,various serological markers like serum Alb,serum total protein(TP),serum prealbumin(PA),hemoglobin(Hb),transferrin(TF),serum creatinine(Scr),urea nitrogen(BUN),cholesterol(Teh) were measured.Results The incidence of PEW in MPD patients was 36.50％,among which 62.86 ％ of them were over 65 years old,57.10％ were over 2 years of dialysis time and 40.00％ with diabetic nephropathy.MPD patients with hs-CRP＞5 mg/L accounted for 58.33％,of which over 65 year old accounted for 42.86％,MPD age longer than 2 years accounted for 60.71％,32.14％ of them with diabetic nephropathy.The proportion of diabetic nephropathy,average age,dialysis duration time,hs-CRP,TNF-α and IL-6 in PEW group were higher than non-PEW group(P＜0.05);BM,TP,Alb,PA,Hb,TCh,MAC and MAMC were lower ban non-PEW group(P＜0.05).Compared with the hs-CRP≤5 mg/L group,average age,the time of dialysis duration,TNF-α,IL-6 were higher and TP,Alb,PA,TF,Hb,the proportion of Kt/V≥1.72 were lower in the hs-CRP＞5 mg/L group.After the correction of age,sex,dialysis ages,it was found that the level of hs-CRP in MPD patients was negatively correlated with the level of Alb,PA,TF,Tch,Scr,TG;The level of IL-6 was negatively correlated with the levels of Alb,PA,TF,Tch,TG.The level of TNF-α in MPD patients showed different degrees of negative correlation with the leves of Alb,PA,TF,TG,Tch(all P＜0.05).Multivariate analysis showed that elderly,the time of dialysis duration,the microinflammatory state,and hypoalbuminemia were the independent risk factors of PEW.Conclusion PEW and micro-inflammatory state are very common in PHD patients.Patients with longer duration of dialysis,elderly or associated with diabetic nephropathy are more likely to suffer PEW and micro-inflammatory.Elderly,the time of dialysis duration,microinflammatory state,hypoalbuminemia are the independent risk factors of PEW.