血清klotho蛋白、FGF23与腹膜透析患者营养状态相关性分析

目的 探究维持性腹膜透析患者血清klotho蛋白和FGF23水平与营养状态的关系。方法 选取2018年1月至2019年1月在本院治疗的持续性非卧床腹膜透析（CAPD）患者54例作为研究对象，根据改良定量主观整体评分法(MQsGA)，将CAPD患者分为3组, A组：营养良好组；B组：轻-中度营养不良组；C组：重度营养不良组。用酶联免疫吸附法检测血清klotho蛋白、成纤维细胞生长因子23（FGF23）水平。结果 本中心CAPD合并营养不良的概率为59.2%，重度营养不良概率为16.7%。与营养良好组比较，轻-中度营养不良组、重度营养不良组白蛋白、肌酐、血红蛋白、C反应蛋白(CRP)、甲状旁腺激素(PTH)、体质量指数（BMI）、上臂肌围(MAMC)、klotho及FGF23差异有统计学意义（P<0.05）；与轻-中度营养不良组比较，重度营养不良组白蛋白、肌酐、血红蛋白、PTH、klotho及FGF23差异有统计学意义（P<0.05）。相关性分析提示MQsGA评分与肌酐、血红蛋白、白蛋白及klotho呈负相关，与CRP、FGF23及PTH呈正相关。多元线性回归分析结果显示klotho、FGF23与腹膜透析营养状态存在相关性。结论 腹膜透析患者合并营养不良的发生率较高，血清klotho、FGF23水平与患者营养状况密切相关，血清klotho、FGF23水平是腹膜透析患者营养状态的独立危险因素。

Correlation between level of serum klotho protein,FGF23 and nutritional status of peritoneal dialysis patients

Objective To investigate the relationship between the level of serum klotho protein, FGF23 and nutritional status of patients with maintenance peritoneal dialysis. Methods A total of 54 patients with continuous ambulate peritoneal dialysis（CAPD） treated in our hospital from January 2018 to January 2019 were selected as the study subjects. CAPD patients were divided into three groups according to the Modified Quantitative Subjective Global Assessment (MQsGA).Group A: well nourished group; Group B: the mild to moderate malnutrition group; Group C: the severe malnutrition group. Serum levels of klotho protein and FGF23 were detected by ELISA. Results The incidence of CAPD combined with malnutrition in the center was 59.2%, and the incidence of severe malnutrition was 16.7%. Compared with the well nourished group, there were statistically significant differences in the levels of albumin, creatinine, hemoglobin, CRP, PTH, BMI, MAMC, klotho and FGF23 in the mild to moderate malnutrition group and the severe malnutrition group. There were statistically significant differences in albumin, creatinine, hemoglobin, PTH, klotho and FGF23 between the severe malnutrition group and the mild to moderate malnutrition group. Correlation analysis showed that MQsGA score was negatively correlated with the levels of creatinine, hemoglobin, albumin and klotho, while positively correlated with the levels of CRP, FGF23 and PTH. Multiple linear regression analysis showed that the levels of klotho and FGF23 were correlated with the nutritional status of peritoneal dialysis. Conclusion Patients with peritoneal dialysis have a higher incidence of malnutrition. Serum klotho and FGF23 levels are closely related to the nutritional status of patients, and serum klotho and FGF23 levels are independent risk factors for the nutritional status of peritoneal dialysis patients.