血液透析患者微炎症状态与骨骼肌消耗性营养不良的临床研究

目的:明确血液透析患者循环炎症因子水平与营养状态及骨骼肌消耗的关系。方法:选择年龄和性别匹配的维持性血液透析患者62例,依据血清高敏C反应蛋白(high sensitivity C reactive protein,CRP)水平将患者分为两组:微炎症状组(CRP≥5 mg/L)、非微炎症状态组(CRP<5 mg/L)。主观全面营养评价法(SGA)评估患者营养状态,采集人体测量学数据,收集临床生化指标,Elisa方法检测CRP、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)等炎症因子水平,核磁共振(MRI)图像分析测量患者右下肢骨骼肌含量,分析肌肉横截面积(cross-sectional area,CSA)。结果:微炎症状态组的体重和体质量指数略低于非微炎症状态组,但SGA分值、人体测量学指标差异均无统计学意义;微炎症状态组的CRP和IL-6水平明显升高,但TNF-α在两组间差异无统计学意义;该组的血清白蛋白、前白蛋白、转铁蛋白水平显著降低,血红蛋白和红细胞比积略低于非炎症状态组,血脂、电解质等差异无统计学意义;MRI显示两组患者的肌肉组织均呈不同程度的萎缩,皮下脂肪分布不均匀,局部变薄,但微炎症状态组的肌肉萎缩更显著,肌肉横截面积(CSA)降低(P<0.05)。结论:持续性循环炎症因子水平升高所导致的机体微炎症状态,可引起血透患者营养指标降低,使血红蛋白更难达标,并加剧透析相关性骨骼肌消耗。微炎症状态可能是引起或加剧透析患者营养不良的重要原因。

Micro -Inflammatory Status Enhanced Muscle Wasting Related Malnutrition in Hemodialysis Patients

Objective：To investigates serum inflammatory cytokines level, nutritional condition, and muscle wasting in pa- tients underlying maintenance hemedialysis （HD）. Methods ：62 HD patients were selected with gender and age matched, then divid- ed into 2 groups according to the C reaetive protein （CRP） level： with -inflammatory group, or non -inflammatory group. The nutri- tion condition was valued by Subjective Global Assessment of Nutritional Status （SGA）, biochemical index was collected, and inflam- matory cytokine such as tumor necrosis factor alpha （ TNF - α）, interleukin - 6 （ IL - 6 ） were measured by Elisa with their serum samples. The muscle mass was measured by scan cross - section area （CSA） of right lower limb using magnetic resonance imaging （MRI）. Results：The body weight and body mass index showed a.little decrease in with -inflammatory group, but there was no signifi- cantly difference in SGA and Anthropometry data between the 2 groups. In with -inflammatory group, the CRP and IL -6 elevated companied with low level of serum albumin, pre - albumin, transferrin, and hemoglobin, Hematocrit. The blood lipid and electrolyte showed no difference. When observed the muscle mass by MRI, we found muscle presented atrophy at a certain extent, and the sub- cutaneous adipose tissue was thin and asymmetric in the 2 groups. In addition, the change was much more severe in with - inflamma- tory group. When we analyzed the cross - sectional area （CSA） of MRI, the data showed muscle CSA was significantly decrease （ P 〈 0.05 ） in the fourth layer of MRI images. Conclusion： A Persistent elevated levels of circulating inflammatory cytokines lead to a micro -inflammatory status in patients underlying hemodialysis. This status induced nutritional markers decreased, and the hemoglo- bin was harder to reach the treatment target, exacerbating hemodialysis - related skeleton muscle atrophy. The micm - inflammatorystatus might be a main cause for muscle wasting related malnutrition in CKD.