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投稿时间：2018-01-15 网络发布日期：2018-06-20
投稿时间：2018-01-15 网络发布日期：2018-06-20
中文摘要: 目的 探讨血液透析和腹膜透析对终末期肾病患者血清炎症水平及营养状态的影响,并分析炎症因子水平变化与营养指标的关系。方法 选取2015年3月至2017年3月收治的终末期肾病患者80例作为研究对象进行回顾性研究。根据透析方式不同分为血液透析组(32例)和腹膜透析组(48例),两组患者均接受至少6个月的透析治疗。观察两组患者治疗前后血清炎症因子［C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α］和营养指标［主观综合营养评估(SGA)、白蛋白(Alb)、血红蛋白(Hb)、血清总蛋白(TP)］变化情况;并根据CRP水平将两组患者进一步分为高炎症亚组和低炎症亚组,分析炎症因子与营养指标的关系。结果 治疗前,两组患者血清CRP、IL-6、TNF-α水平和SGA、Alb、Hb、TP水平比较,差异均无统计学意义(P>0.05)。治疗后,两组患者血清CRP、IL-6、TNF-α水平和SGA、Alb、Hb、TP水平均较治疗前明显升高(P<0.05);且腹膜透析组患者血清CRP、IL-6、TNF-α水平明显低于血液透析组(P<0.05),SGA评分、Alb、Hb、TP水平明显高于血液透析组(P<0.05)。治疗后,终末期肾病患者(腹膜透析组和血液透析组)低炎症亚组SGA、Alb、Hb、TP水平均高于高炎症亚组(P<0.05)。相关分析显示,CRP水平与SGA评分、Alb、Hb、TP水平分别呈负相关(P<0.05);IL-6和TNF-α水平与SGA评分、Alb、Hb分别呈负相关(P<0.05),与TP无明显相关性(P>0.05)。结论 腹膜透析和血液透析均会加重终末期肾病患者微炎症状态,其中血液透析更为严重,且炎症严重程度能够反映患者的营养状况。
Abstract:Objective To investigate the influence of hemodialysis and peritoneal dialysis on serum inflammatory factor level and nutritional status in patients with end-stage renal disease (ESRD) and study the relationship between levels of inflammatory factors and nutritional indicators. Methods Eighty ESRD patients treated from March 2015 to March 2017 were selected as study objects and were divided into hemodialysis group(n=32)and peritoneal dialysis group(n=48). All patients received dialysis treatment for at least 6 months. The changes of serum inflammatory factors levels including C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α)and nutritional indexes [including subjective global assessment (SGA), serum albumin (Alb), hemoglobin (Hb), total protein (TP)] were measured before and after treatment in two groups. According to CRP level, all patients were divided into high inflammation subgroup and low inflammation subgroup, and the relationship between inflammatory factors and nutritional index was analyzed. Results Before treatment, there were no significant differences in serum levels of CRP, IL-6, TNF-α and SGA, Alb, Hb and TP between two groups (all P>0.05). After treatment, the levels of CRP, IL-6 and TNF-α were significantly higher than those before treatment in both two groups and were significantly lower in peritoneal dialysis group than those in hemodialysis group (all P<0.05). SGA score, levels of Alb, Hb and TP in peritoneal dialysis group were significantly higher than those in hemodialysis group (all P<0.05). After treatment, SGA score, levels of Alb, Hb and TP in low inflammation subgroup were significantly higher than those in high inflammation subgroup (all P<0.05). Correlation analysis showed that CRP was negatively correlated with SGA score, Alb, Hb and TP, repectively(all P<0.05); IL-6 and TNF-α were negatively correlated with SGA score, Alb and Hb, respectively (all P<0.05), but was not correlated with TP(P>0.05). Conclusion Both peritoneal dialysis and hemodialysis can aggravate the state of micro inflammation in ESRD patients, especially in patients receiving hemodialysis. The severity of inflammation can reflect the nutritional status of the patients.
keywords: End-stage renal disease Hemodialysis Peritoneal dialysis Inflammatory factor Nutritional status
文章编号： 中图分类号： 文献标志码：A
基金项目:陕西省自然科学研究计划项目(2015JC2-13)
附件
| Author Name | Affiliation |
| SHANG Yu*, TAN Feng | *Xi′an Medical University, Xi′an, Shaanxi 710000, China |
引用文本：
尚瑜,谭峰.终末期肾病不同透析方式患者血清CRP、IL-6、TNF-α水平及与营养指标的关系[J].中国临床研究,2018,31(6):749-752,756.
尚瑜,谭峰.终末期肾病不同透析方式患者血清CRP、IL-6、TNF-α水平及与营养指标的关系[J].中国临床研究,2018,31(6):749-752,756.