维持性血液透析患者微炎症状态对营养状况的影响

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者微炎症状态对营养状况的影响。方法选择2008年12月-2012年10月泰安市中心医院血液净化中心行MHD的患者40例作为血透组,另选查体中心22名健康人作为对照组,所有受检对象禁食10 h后于清晨空腹采取上肢静脉血,血液透析患者为透析前采静脉血,检测以下血清炎症因子的水平:高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子α(tumor necrosis factorsα,TNF-α)、白介素6(interleutin 6,IL-6)。将MHD患者分为血透A组(hs-CRP≤3 mg/L)12例和血透B组(hs-CRP>3 mg/L)28例,并比较两组炎症因子hs-CRP、IL-6、TNF-α与白蛋白(Albumin,Alb)、前白蛋白(Pre-albumin,PA)、转铁蛋白(Transferrin,TF)及主观综合性营养评估(subjective global assessment,SGA)的相关性。计量资料用t检验,数据间的相关性采用Pearson相关分析法,P<0.05为差异有统计学意义。结果血透组hs-CRP[(5.97±2.85)mg/L]、IL-6[(21.22±9.67)pg/ml、TNF-α[(27.96±11.72)pg/ml]水平均高于对照组[(2.37±1.26)mg/L、(12.32±3.39)、(13.26±6.73)pg/ml],差异均有统计学意义(均P<0.05)。血透A组炎症因子IL-6[(11.45±6.84)pg/ml]和TNF-α[(17.35±11.20)pg/ml]的水平均显著低于血透B组[(26.71±9.32)、(35.39±10.59)pg/ml],差异均有统计学意义(均P<0.05)。而相关的营养指标即Alb、PA、TF水平及SGA评分血透B组[(26.73±4.45)、(0.21±0.08)、(1.74±0.35)g/L、(13±4)分]均明显低于血透A组[(37.26±5.62)、(0.33±0.21)、(2.38±0.17)g/L、(21±3)分],差异均有统计学意义(均P<0.05)。血透组炎症因子hs-CRP、IL-6、TNF-α水平与Alb、PA、TF及SGA评分均呈负相关(均P<0.05),而与三头肌皮褶厚度(triceps skinfold fat,TSF)、上臂肌围(midarm musclecircllmference,MAMC)和BMI无明显相关性(均P>0.05)。结论 MHD患者普遍存在微炎症状态,且微炎症状态与营养不良的发生有关。

Effects of microinflammatory state on nutritional status of patients on maintenance hemodialysis

Objective To discuss the influence of the level of inflammatory factors on the nutritional status in patients on maintenance hemodialysis（MHD）.nethods Forty patients on MHD treated in blood purification center of Tai＇an Central Hospital from December 2008 to October 2012 were selected as hemodialysis group and 22 healthy subjects from the health examination center as the controls.After a 10-h fasting,venous blood samples were collected in both groups in the morning and also collected in patients on MHD before hemodialysis.Both groups were tested for the level of inflammatory factors,including hs-CRP,TNF-α and IL-6.Forty cases on MHD were divided into two groups：group A（n=12,hs-CRP≤3 mg/L） and group B （n=28,hs-CRP〉3 mg/L）, both of which were compared for the correlation of hs-CRP, IL-6 and TNF-α with Alb,PA,TF and SGA.T-test was used for measurement data and Pearson＇s correlation analysis for the correlation between data.The result of P〈0.05 was statistically significant.Results Compared with the healthy controls[（2.37 ± 1.26）mg/L,（12.32 ± 3.39）,（13.26 ± 6.73）pg/ml].the level of hs-CRP,IL-6 and TNF-α was obviously higher in hemodialysis group[（5.97 ± 2.85）mg/L,（21.22 ± 9.67）,（27.96 ± 11.72）pg/ml]（all P〈O.O5）.The serum level of IL-6 and TNF-α was （11.45 ± 6.84）pg/ml and（17.35 ± 11.20）pg/ml respectively in group A,which was significantly higher than that in group B[（26.71 ± 9.32）,（35.39 ± 10.59）pg/mI]（both P〈0.05）,but the serum levd of AIb,PA and TF,and SGA scores in group B[（26.73 ± 4.45）,（0.21 ± 0.08）,（1.74 ± 0.35）g/L, 13 ± 4] were significantly lower than those in group A[（37.26 ± 5.62）, （0.33 ± 0.21）,（2.38 ± 0.07）g/L,21 ± 3]（all P〈0.05） .The serum levd of hs-CRP, IL-6 and TNF-α was negatively correlated with serum Alb,PA,TF and SGA（ allP〈0.05）,but showed no correlation with TSF,MAMC and BMI（all P〈0.05）.Conclusion There is microinflammatory state in patients on MHD,which is related to the occurrence of malnutrition.