甲状旁腺素水平对维持性血液透析患者微炎性反应及营养状态的影响  

Effects of serum levels of parathyroid hormone on microinflammatory and nutritional status in maintenance hemodialysis patients

作　　者：张黎明[1] 邬碧波[1] 唐琦[1] 贾洁爽[1] 

机构地区：[1]上海市闸北区中心医院肾内科,200070

出　　处：《中国医师进修杂志（内科版）》2008年第5期8-11,共4页Chinese Journal of Postgraduates of Medicine

基　　金：上海市卫生局科技发展基金（054122）;上海市闸北区卫生局科研基金（2005重点学科01）

摘　　要：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。Objective To investigate the effects of parathyroid hormone（PTH）on mieroinflammatory and nutritional status in maintenance hemodialysis （MHD）patients. Methods Ninety-eight MHD patients were selected, who had 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 electroehemilu minescence 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 （ Alia ）, 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 significandy 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 FrH showed significantly positive correlations with the levels of CRP,IL-1β , IL-6, TNF-αa, lipoprotein（a） [Lp（a）] , serum phosphorus and ages of MHD（P 〈 0.05 or 〈 0.01 ）.The levels of intact FrH 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 cor

关 键 词：血液透析 甲状旁腺素 炎症 营养 

分 类 号：R459.5[医药卫生—治疗学] R725.6[医药卫生—临床医学]