现代中西医结合杂志
現代中西醫結閤雜誌
현대중서의결합잡지
MODERN JOURNAL OF INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE
2014年
27期
2968-2970,2982
,共4页
郑曼韬%包福祥%谢芸%杨加友%宋燕
鄭曼韜%包福祥%謝蕓%楊加友%宋燕
정만도%포복상%사예%양가우%송연
维持性血液透析%营养不良%炎症%基本医疗保障
維持性血液透析%營養不良%炎癥%基本醫療保障
유지성혈액투석%영양불량%염증%기본의료보장
maintenance hemodialysis%malnutrition%inflammation%basic medical insurance
目的：观察不同基本医疗保障下维持性血液透析（MHD）患者营养不良发生情况及炎症状态，并探讨两者的关系。方法维持性血液透析患者120例，按医保支付比例不同将患者分为城保组80例和非城保组（农保）40例。采用主观整体评估法（ SGA）对营养不良发生率进行评定；比较不同医保组的人体测量学指标，血清白蛋白、前白蛋白、转铁蛋白、血红蛋白、尿素氮、肌酐及尿素清除指数（Kt / V）；检测血清超敏 C 反应蛋白（ hs - CRP）、白细胞介素-6（IL -6）、肿瘤坏死因子α（TNF -α）水平，分析 CRP 水平与营养不良相关指标的关系。结果城保组的营养不良发生率为30%，非城保组为70%，2组比较有显著性差异（ P ﹤0.01）。城保组的营养相关指标比非城保组显著升高（P ﹤0.05），城保组、非城保组的慢性炎症标志物高于正常对照（P 均﹤0.05），但2组间炎症因子比较无显著性差异（ P ﹥0.05）。非城保组透析前、后 IL -6均显著高于城保组（P ﹤0.05）；CRP 升高组白蛋白、转铁蛋白、血红蛋白水平明显低于 CRP 正常组（ P ﹤0.05或0.01），SGA 评分明显高于 CRP 正常组（ P ﹤0.01）。结论不同医保下维持血液透析营养不良发生率不同，非城保MHD 患者营养不良发生率显著高于城保组，其营养状况更差。MHD 患者营养不良者均存在微炎症反应，MHD 患者营养不良与炎症反应有相关性，营养不良与 CRP 成正相关，即营养不良的程度越严重，CRP 值就越高。CRP 反应蛋白是反映维持性血液透析患者微炎症反应较好的预测指标，MHD 患者营养不良中血清 IL -6有较高水平，微炎症反应对血透患者营养不良有重要的影响。
目的：觀察不同基本醫療保障下維持性血液透析（MHD）患者營養不良髮生情況及炎癥狀態，併探討兩者的關繫。方法維持性血液透析患者120例，按醫保支付比例不同將患者分為城保組80例和非城保組（農保）40例。採用主觀整體評估法（ SGA）對營養不良髮生率進行評定；比較不同醫保組的人體測量學指標，血清白蛋白、前白蛋白、轉鐵蛋白、血紅蛋白、尿素氮、肌酐及尿素清除指數（Kt / V）；檢測血清超敏 C 反應蛋白（ hs - CRP）、白細胞介素-6（IL -6）、腫瘤壞死因子α（TNF -α）水平，分析 CRP 水平與營養不良相關指標的關繫。結果城保組的營養不良髮生率為30%，非城保組為70%，2組比較有顯著性差異（ P ﹤0.01）。城保組的營養相關指標比非城保組顯著升高（P ﹤0.05），城保組、非城保組的慢性炎癥標誌物高于正常對照（P 均﹤0.05），但2組間炎癥因子比較無顯著性差異（ P ﹥0.05）。非城保組透析前、後 IL -6均顯著高于城保組（P ﹤0.05）；CRP 升高組白蛋白、轉鐵蛋白、血紅蛋白水平明顯低于 CRP 正常組（ P ﹤0.05或0.01），SGA 評分明顯高于 CRP 正常組（ P ﹤0.01）。結論不同醫保下維持血液透析營養不良髮生率不同，非城保MHD 患者營養不良髮生率顯著高于城保組，其營養狀況更差。MHD 患者營養不良者均存在微炎癥反應，MHD 患者營養不良與炎癥反應有相關性，營養不良與 CRP 成正相關，即營養不良的程度越嚴重，CRP 值就越高。CRP 反應蛋白是反映維持性血液透析患者微炎癥反應較好的預測指標，MHD 患者營養不良中血清 IL -6有較高水平，微炎癥反應對血透患者營養不良有重要的影響。
목적：관찰불동기본의료보장하유지성혈액투석（MHD）환자영양불량발생정황급염증상태，병탐토량자적관계。방법유지성혈액투석환자120례，안의보지부비례불동장환자분위성보조80례화비성보조（농보）40례。채용주관정체평고법（ SGA）대영양불량발생솔진행평정；비교불동의보조적인체측량학지표，혈청백단백、전백단백、전철단백、혈홍단백、뇨소담、기항급뇨소청제지수（Kt / V）；검측혈청초민 C 반응단백（ hs - CRP）、백세포개소-6（IL -6）、종류배사인자α（TNF -α）수평，분석 CRP 수평여영양불량상관지표적관계。결과성보조적영양불량발생솔위30%，비성보조위70%，2조비교유현저성차이（ P ﹤0.01）。성보조적영양상관지표비비성보조현저승고（P ﹤0.05），성보조、비성보조적만성염증표지물고우정상대조（P 균﹤0.05），단2조간염증인자비교무현저성차이（ P ﹥0.05）。비성보조투석전、후 IL -6균현저고우성보조（P ﹤0.05）；CRP 승고조백단백、전철단백、혈홍단백수평명현저우 CRP 정상조（ P ﹤0.05혹0.01），SGA 평분명현고우 CRP 정상조（ P ﹤0.01）。결론불동의보하유지혈액투석영양불량발생솔불동，비성보MHD 환자영양불량발생솔현저고우성보조，기영양상황경차。MHD 환자영양불량자균존재미염증반응，MHD 환자영양불량여염증반응유상관성，영양불량여 CRP 성정상관，즉영양불량적정도월엄중，CRP 치취월고。CRP 반응단백시반영유지성혈액투석환자미염증반응교호적예측지표，MHD 환자영양불량중혈청 IL -6유교고수평，미염증반응대혈투환자영양불량유중요적영향。
Objective It is to observe the malnutrition incidence and the inflammation state of patients with maintenance hemodialysis(MHD)for different basic medical insurance,and approach the relationship of them. Methods 120 patients with MHD were divided into city insurance group(80 cases)and not city insurance group(40 cases)according to the different medical insurance payment ratio. The incidence of malnutrition were assessed by subjective global assessment method(SGA);the anthropometry index,serum albumin,prealbumin,transferrin,hemoglobin,urea nitrogen,creatinine,urea clearance in-dex(Kt / V)in different medical insurance were compared;the levels of serum hypersensitive C - reactive protein( hs -CRP),interleukin - 6(IL - 6)and tumor necrosis factor - α(TNF - α)were detected,and the relationship between the lev-el of hs - CRP and the relevant indicators of malnutrition were analyzed. Results The incidence of malnutrition was 30% in city insurance group and 70% in not city insurance group,there was significant difference between the two groups(P ﹤ 0. 01). The nutrition index of city insurance group was markedly higher than that of not city insurance group(P ﹤ 0. 05). The chronic inflammatory markers of city insurance group and not city insurance group were markedly higher than that of normal controls (all P ﹤ 0. 05),but there was no significant difference between the two groups(P ﹥ 0. 05). The IL - 6 levels in not city in-surance group before and after dialysis were significantly higher than that in city insurance group(P ﹤ 0. 05);the levels of al-bumin,transferrin and hemoglobin of elevated CRP group was markedly lower than that of normal CRP group( P ﹤ 0. 05 or 0. 01),and the SGA score was markedly higher than that of normal CRP group( P ﹤ 0. 01). Conclusion The incidences of malnutrition for MHD under different medical insurance are different,the incidences of not city insurance group is markedly higher than that of city insurance group,and with poor nutritional status. Micro inflammation is existed in all patients with MHD malnutrition,malnutrition in patients with MHD has correlation with inflammation,and malnutrition is positively relatedwith CRP,namely,more serious of malnutrition degree,the CRP value is higher. CRP is a better indicator of in patients with MHD,the serum IL - 6 have higher levels in MHD patients of malnutrition,micro inflammatory reaction plays an important in-fluence in MHD patients with malnutrition.
