腹膜透析患者C反应蛋白水平与营养不良及心血管疾病的相关性

目的探讨腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）患者C反应蛋白水平的改变及炎症反应与营养不良及心血管疾病的关系。方法检测健康对照者、尿毒症非透析患者和持续性非卧床腹膜透析（CAPD）患者C反应蛋白（CRP）,血清白蛋白（Alb）,血红蛋白（Hb）,血清铁蛋白（SF）,血清前白蛋白（PA）等指标。并根据CAPD患者CRP水平将其分为正常组（CRP〈10mg/L）,异常组（CRP〉10mg/L）,观察2组之间的差别。结果尿毒症非透析组和CAPD组CRP水平均高于对照组[（12.14±5.92）mg/L与（13.92±4.67）mg/L比（5.37±2.15）mg/L,t=8.16,t=12.95,P〈0.001],CAPD组CRP水平高于尿毒症非透析组[（13.92±4.67）mg/L比（12.14±5.92）mg/L,t=2.70,P〈0.01]。CAPD患者CRP水平与营养不良指标Alb,Hb,PA成负相关,有统计学意义（r=-0.44,P=0.007;r=-0.57,P=0.002;r=-0.36,P=0.010）,CRP水平与改良定量的整体营养评估（MQSGA）呈正相关,有统计学意义（r=0.26,P=0.048）。CAPD患者CRP水平升高组的心血管疾病发生率高于CRP正常组（？2=3.86,P〈0.05）,CRP水平与心脏超声检查指标左房内径（LAD）、左室舒张末内径（LVDd）、室间隔厚度（IVST）、左室后壁后度（LVPWT）呈正相关（r=0.315,P=0.028;r=0.252,P=0.049;r=0.297,P=0.035;r=0.349,P=0.020）有统计学意义,与左室射血分数（LVEF）呈负相关（r=-0.281,P=0.041）,有统计学意义。结论 CAPD患者存在CRP水平升高的炎症反应,且高于尿毒症非透析患者,CAPD患者营养不良及心血管疾病与慢性炎症状态相关。

The correlation of C-reactive protein level with malnutrition and cardiovascular disease in peritoneal dialysis patients

Objective To discuss the correlation of C-reactive protein（CRP） with malnutrition and cardiovascular diseases in peritoneal dialysis patients.Method C-reaction protein（CRP）,serum albumin（Alb）,hemoglobin（Hb）,serum ferritin（SF）,and serum prealbumin（PA） were assayed in healthy control subjects,uremic patients without dialysis,and continuous ambulatory peritoneal dialysis（CAPD） patients.The CAPD patients were then divided into CAPD normal group（CRP10mg/L）,and CAPD abnormal group（CRP 10mg/L）.Results CRP level was higher in uremic patients without dialysis and CAPD patients than in healthy controls（12.14 ± 5.92 mg/L,13.92 ± 4.67 mg/L,and 5.37 ± 2.15 mg/L,respectively;t=8.16 t= 12.950,P0.001）.and was higher in CAPD patients than in uremic patients without dialysis（13.92 ± 4.67 mg/L and 12.14 ± 5.92 mg/L,respectively;t =2.700,P0.01）.In CAPD patients,CRP level was negatively correlated with Alb（r=-0.440,P =0.007）,Hb（r=-0.570,P =0.002） and PA（r =-0.360,P =0.010）.CRP level was positively correlated with MQSGA（r=0.260,P =0.048）.The prevalence of cardiovascular disease was higher in CAPD abnormal group than in CAPD normal group（P0.05）.CRP level was positively correlated with LAD（r= 0.315,P =0.028）,LVDd（r=0.252,P =0.049）,IVST（r=0.297,P=0.035）,and LVPWT（r=0.349,P=0.020）,and was negatively correlated with LVEF（r=-0.281,P=0.041）.Conclusions Serum CRP level is increased in CAPD patients,indicating the presence of inflammation.Serum CRP level is higher in CAPD patients than in uremic patients without dialysis.Malnutrition and cardiovascular diseases in CAPD patients are correlated with the chronic inflammation status.