MHD患者体内C反应蛋白、胃促生长素与营养指标的关系

目的：探讨维持血液透析（MHD）患者体内 C 反应蛋白、血浆胃促生长素水平与营养指标的相关性。方法选择本院2012年4月-2013年6月接受透析治疗的维持性血液透析患者82例为观察组，且按照患者入组时血清高敏 C 反应蛋白水平（hs-CRP）分为微炎症组（n ＝39例）和非微炎症组（n ＝43），另选择健康志愿者50例为对照组。对所有受试者的 hs-CRP、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）等炎症因子水平、血浆总多肽胃促生长素水平，以及营养状态指标进行分析。结果 MHD 患者在炎症因子水平、整体营养状态和人体学指标，以及总多肽胃促生长素（ghrelin）水平方面均与对照组存在统计学差异（P ﹤0.05），微炎症组与非微炎症组在血红蛋白（Hb）、血清白蛋白（ALB）、前白蛋白（PA）、转铁蛋白（TF）、肱三头肌皮褶厚度（TSF）、中臂围（MAC）、铁蛋白（Ferritin）、hs-CRP、IL-6和 TNF-α方面存在统计学差异（P ﹤0.05）；MHD 患者共出现营养不良35例（42.6％），其中微炎症组22例（62.8％），非微炎症组13例（37.2％）；相关性分析：hs-CRP 分别与 ALB、PA、TF、Ferritin、TSF 和 MAC 呈负相关（P ﹤0.05），与 IL-6和 TNF-α呈正相关（P ﹤0.01），血浆 ghrelin 与 TG、ALB 和 PA 呈负相关（P ﹤0.05或 P ﹤0.01），hs-CRP 和 ghrelin 均与 SGA 呈正相关（P ﹤0.05或 P ﹤0.01）。结论维持血液透析患者营养状态普遍较差，应注意改善体内微炎症状态。其中 hs-CRP 和血浆 ghrelin 均是反映体内营养状态的有效指标，可用于评估 MHD患者的营养状况和预后。

The correlation of hs-CRP and ghrelin to nutrition index in patients with maintenance hemodialysis

Objective To explore the correlation of hs-CRP and ghrelin to nutrition index in patients with maintenance hemodialysis（MHD）. Methods Observation group included 82 cases with MHD in the period from April,2012 to June,2013, according to the level of hs-CRP of the patients,observation group was subdivided into 2 subgroups：miro-inflammation group（n = 39） and non-micro-inflammation group（n = 43）;50 healthy volunteers were selected to be the control group;hs-CRP,IL-6,TNF-α,ghrelin, and nutrition index of all the cases were detected and analyzed. Results There existed a difference of statistical significance in inflammation levels,overall nutritional status,human markers and plasma ghrelin between the 2 groups（P ﹤ 0. 05）,while a difference of statistical significance in Hb,ALB,PA,TF,TSF,MAC,Ferritin,hs-CRP,IL-6 and TNF-α between the 2 subgroups（P ﹤ 0. 05）;malnutrition was found in 35 cases（42. 6% ）in observation group,including 22 cases（62. 8% ）in micro-inflammation group and 13 cases（37. 2% ）in non-micro-inflammation group;the correlation analysis indicated that hs-CRP was in negative correlation to ALB, PA,TF,Ferritin,TSF and MAC but in positive correlation to IL-6 and TNF-α（P ﹤ 0. 05 or P ﹤ 0. 01）;ghrelin was in negative correction to TG,ALB and PA;both hs-CRP and ghrelin were in positive correlation to SGA（P ﹤ 0. 05 or P ﹤ 0. 01）. Conclusions Patients with MHD generally have poor nutritional status and micro-inflammation need to be improved;hs-CRP and ghrelin,as the effective index of nutrition,can be applied o evaluate the nutritional status and prognosis of the patients with MDH.