CAJ | 학술논문

目的通过观察维持性血液透析(MHD)患者的血清全段甲状旁腺素(PTH)水平以及微炎性反应和营养指标的变化,探讨PTH对MHD患者微炎性反应及营养状态的影响.方法选择透析龄超过3个月的MHD患者98例(MHD组),健康对照者60例(对照组),用电化学发光免疫法(ECLIA)检测血清全段PTH水平.同时检测微炎性反应指标:CRP、IL-1β、IL-6、IL-8、TNF-α;营养状态使用改良定量整体主观评估法(MQSGA)进行评分,检测人体学指标:肱三头肌皮褶厚度(TSF)、上臂围(MAC),并计算上臂肌围(MAMC)和相对体重(RBW).分析PTH对MHD患者微炎性反应及营养状态的影响.结果 MHD组患者血清全段PTH水平为(353.46±102.41)ng/L,较对照组[(57.45±5.76)ng/L].显著升高(P<0.01),且CRP、TNF-α、IL-1β、IL-6、IL-8水平均显著高于对照组,差异有统计学意义(P<0.01或<0.05);MHD组患者RBW、TSF、MAC和MAMC与对照组比较均显著降低(P<0.05或<0.01),而MQSGA评分较对照组显著升高,差异有统计学意义(P<0.01);直线相关分析结果显示,MHD患者血清全段PTH水平与血清CRP、IL-1β、IL-6、TNF-α、脂蛋白(a)、磷水平及透析龄呈正相关(P<0.05或<0.01),与RBW、MAC、MAMC、白蛋白、Hb、TC呈负相关(P<0.01或<0.05),而与MQSGA评分呈正相关(P<0.05.结论 MHD患者PTH升高不仅影响骨代谢,还可通过影响患者摄食、增加蛋白质分解代谢、抑制骨髓红细胞生成等作用来影响患者的营养状态,同时还可能加重微炎性反应状态.PTH可能在营养不良-炎性反应-动脉粥样硬化综合征的发生机制中起着重要的作用.
목적 통과관찰유지성혈액투석(MHD)환자적혈청전단갑상방선소(PTH)수평이급미염성반응화영양지표적변화,탐토PTH대MHD환자미염성반응급영양상태적영향.방법 선택투석령초과3개월적MHD환자98례(MHD조),건강대조자60례(대조조),용전화학발광면역법(ECLIA)검측혈청전단PTH수평.동시검측미염성반응지표:CRP、IL-1β、IL-6、IL-8、TNF-α;영양상태사용개량정량정체주관평고법(MQSGA)진행평분,검측인체학지표:굉삼두기피습후도(TSF)、상비위(MAC),병계산상비기위(MAMC)화상대체중(RBW).분석PTH대MHD환자미염성반응급영양상태적영향.결과 MHD조환자혈청전단PTH수평위(353.46±102.41)ng/L,교대조조[(57.45±5.76)ng/L].현저승고(P<0.01),차CRP、TNF-α、IL-1β、IL-6、IL-8수평균현저고우대조조,차이유통계학의의(P<0.01혹<0.05);MHD조환자RBW、TSF、MAC화MAMC여대조조비교균현저강저(P<0.05혹<0.01),이MQSGA평분교대조조현저승고,차이유통계학의의(P<0.01);직선상관분석결과현시,MHD환자혈청전단PTH수평여혈청CRP、IL-1β、IL-6、TNF-α、지단백(a)、린수평급투석령정정상관(P<0.05혹<0.01),여RBW、MAC、MAMC、백단백、Hb、TC정부상관(P<0.01혹<0.05),이여MQSGA평분정정상관(P<0.05.결론 MHD환자PTH승고불부영향골대사,환가통과영향환자섭식、증가단백질분해대사、억제골수홍세포생성등작용래영향환자적영양상태,동시환가능가중미염성반응상태.PTH가능재영양불량-염성반응-동맥죽양경화종합정적발생궤제중기착중요적작용.
Objective To investigate the effects of parathyroid hormone(PTH)on microinflammatory and nutritional status in maintenance hemodialysis(MHD)patients.Methods Ninety-eight MHD patients were selected,who hod undergone hemodialysis for at least three months before the study and were in a stable clinical status without signs of infection or disease activity.The serum level of intact PTH was measured by electrochemiluminescence immunoassay(ECLIA),while the serum levels of interleukin(IL)-1β,IL-6,IL-8 and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA).The levels of C-reactive protein(CRP),albumin(Alb),pre-albumin(PA),hemoglobin(Hb)and lipids were measured.Body measurement and modified quantitative subjective global assessment(MQSGA)was done simultaneously.Correlation analysis between serum PTH level and the parameters for inflammation and nutrition Was performed.Results The serum levels of intact PTH in MHD patients[(353.46±102.41)ng/L]were significantly higher than those in the control people[(57.45±5.76)ng/L,P<0.01],and the serum levels of IL-1β,IL-6,IL-8,TNF-α and CRP were significantly higher in MHD patients than those in the control people(P<0.01 or <0.05).Relative body weight(RBW),triceps skin fold thickness(TSF),mid-arm circumference(MAC)and mid-arm muscle circumference(MAMC)in MHD patients decreased significantly(P<0.05 or <0.01),while the score of MQSGA increased markedly(P<0.01).The levels of intact PTH showed significantly positive correlations with the levels of CRP,IL-1β, IL-6,TNF-α, lipoprotein(a) [Lp(a)] , serum phosphorus and ages of MHD(P<0.05 or <0.01 ).The levels of intact PTH showed significantly negative correlations with RBW, MAC, MAMC, Alb, Hb and total cholesterol(TC) in MHD patients (P<0.01 or <0.05) . And there was also significantly positive correlation between PTH and MQSGA in MHD patients (P<0.05). Conclusion PTH is probably involved in the presence and the progression of malnutrition-inflammation-atherosclerosis syndrome in MHD patients.