维持性血液透析患者的血清肝细胞生长因子与蛋白质-能量消耗的相关性研究

目的 探究维持性血液透析的终末期肾病（ESRD）患者的血清肝细胞生长因子（hepatocyte growth factor，HGF）水平与蛋白质-能量消耗（protein-energy wasting，PEW）的相关性。方法 入选2013年1月~2015年12月在笔者医院血液透析中心进行血液透析的符合纳入标准和排除标准的ESRD患者128例。应用主观全面营养评估法（SGA）对患者的营养状况进行评分，根据评分将患者分为A （营养良好）、B （轻-中度营养不良）、C （重度营养不良）三组。采用ELISA法检测并比较各组患者透析前血清HGF的水平。应用Pearson相关分析法分析血清HGF水平与患者SGA评分、年龄、性别、病程、透析时间、血清总蛋白、白蛋白、前白蛋白、肌酐、尿素氮、体重指数及上臂肌围等的相关性。应用Logistic多因素回归法分析血清HGF是否是ESRD患者发生PEW的独立影响因素。结果 （B+C）组、B组、C组患者的血清HGF的平均水平均明显高于A组患者（P<0.01），且C组患者的血清HGF的平均水平明显高于B组患者（P<0.01）；患者血清HGF水平与患者SGA评分呈负相关（r=-0.8791，P<0.01）。B、C两组患者的血清总蛋白、白蛋白、前白蛋白的水平以及体重指数、上臂肌围与A组相比均明显降低，差异均有统计学意义（P<0.05）。Pearson相关分析结果显示，血清HGF与与患者的血清总蛋白、白蛋白、前白蛋白水平以及体重指数、上臂肌围呈显著负相关（P<0.05）。Logistic多因素回归分析结果显示，血清HGF水平（OR=2.143，95% CI：2.096~2.193，P=0.004）和上臂肌围（OR=0.032，95% CI：0.015~0.164，P=0.012）是维持性血液透析ESRD患者发生PEW的独立影响因素。结论 维持性血液透析的ESRD患者发生蛋白质-能量消耗时血清HGF水平增加，血清HGF可能成为判断维持性血液透析的ESRD患者发生蛋白质-能量消耗的指标之一。

Association of Serum Hepatocyte Growth Factor with Protein-energy Wasting in Maintenance Hemodialysis End-stage Renal Disease Patients

Objective To investigate the relationship between serum hepatocyte growth factor (HGF) and protein-energy wasting (PEW) of maintenance hemodialysis (MHD) patients.Methods Total of 128 end-stage renal disease (ESRD) patients with maintenance hemodialysis (MHD) admitted in our hospital from January 2013 to December 2015 were enrolled in this study.These patients were classified into three groups according to their subjective global assessment(SGA)scores:A group (well nourished),B group (moderately malnourished) and C group (severely malnourished). Serum HGF level was determined by ELISA, and the differences in serum HGF levels among patients of A,B,C groups were assessed. The relationships between HGF and SGA scores as well as other biochemical and physical markers in MHD patients were analyzed by Pearson''s correlation method. Logistic regression was performed to analyzed the association between serum HGF and PEW state.Results Serum HGF level in B,C,(B+C) groups was significantly higher than A group (P<0.01),and C group was also significantly higher than B group(P<0.01).Moreover, the level of serum total protein, albumin,prealbumin, the index of BMI and arm muscle circumference decreased significantly in B and C group than A group(P<0.05),and these markers were also notably higher in C group compared to B group(P<0.05).The level of serum creatinine and urea nitrogen had no statistical difference.The results of Pearson''s correlation revealed that HGF level was negatively associated with SGA scores as well as the level of serum total protein, albumin, prealbumin, the index of BMI and arm muscle circumference(P<0.05),and had no significant correlation with age,gender, sick time, hemodialysis time, serum creatinine and urea nitrogen. Logistic regression showed that serum HGF(OR=2.143,95% CI:2.096-2.193,P=0.004)and arm muscle circumference (OR=0.032,95% CI:0.015-0.164,P=0.012)were independent indicators for PEW in MHD patients.Conclusion Serum HGF level was positively correlated with PEW in MHD patients.Serum HGF may act as a potential indicator for PEW in MHD patients.