高龄男性慢性肾病患者血清C-反应蛋白的临床意义  

The clinical significance of serum C-reactive protein in the very elderly with chronic kidney disease

作　　者：刘旭利[1] 程庆砾[1] 刘胜[1] 王小丹[1] 赵佳慧[1] 李青霖[1] 张晓英[1] 

机构地区：[1]解放军总医院南楼临床部肾脏病科,北京100853

出　　处：《中华保健医学杂志》2013年第2期118-120,共3页Chinese Journal of Health Care and Medicine

基　　金：国家自然科学基金(30772296;81170312)

摘　　要：目的探讨慢性肾病(CKD)高龄男性患者血清C-反应蛋白(CRP)与营养指标及CKD进展之间的关系。方法回顾性分析曾在某院住院并门诊随访且尚未透析的72例高龄男性CKD 5期患者,分为高GRP组28例,低GRP组44例,观察血清CRP、营养评估及肾功能指标等,探讨微炎性状态与营养状况及CKD进展之间的关系。结果排除感染、创伤等因素后,所纳入对象的平均血清CRP水平为0.64mg/dl(四分位间距0.32,1.05 mg/dl)。以0.8mg/dl为分割点,将其分为高CRP组(CRP≥0.8mg/dl)和低CRP组(CRP<0.8mg/dl)。高CRP组患者占38.9%,较之低CRP组,高CRP组多伴随心血管及外周动脉粥样硬化等疾病(P<0.05),主观综合营养评估(SGA)评分明显降低(P<0.01),促红细胞生成素(EPO)用量显著增加(P<0.01)。随访18个月后,高CRP组估算肾小球滤过率下降幅度明显(P<0.01),转入透析治疗的例数较多(P<0.05),发生心血管事件的例数也显著增多(P<0.05)。结论进入CKD 5期的高龄CKD患者存在血清CRP值轻度升高的微炎性状态,高CRP患者伴随心血管病及外周动脉粥样硬化的比例显著高于低CRP患者;持续的高CRP水平多伴随营养状况的下降,且易导致EPO效力的降低;CKD的进展与血清高CRP水平具有相关性。Objective To investigate the relationship of CRP to nutritional condition and the renal function in the very elderly with end stage renal disease（ESRD）.Methods This was a retrospective cohort study using the clinical data of 89 very old patients（aged75～97） with ESRD.According to the level of serum CRP,the patients were divided into two groups：high CRP group（CRP≥ 0.8mg/dl） and low CRP group（0.8mg/dl）.The changes of nutritional parameters and the renal function were compared between two groups at baseline and 18 months of follow-up.Results Twenty-eight patients（38.9%） showed high CRP levels（≥0.8mg/dl）at baseline.After 18 months of follow-up,the patients with high CRP showed lower level of SGA score,furthermore they needed more ery thropoietin to maintain stable hemoglobin（P0.05）.The high CRP group had a faster decline in eGFR over the 18 months of follow-up duration（P0.05）.Conclusions High CRP levels in the very elderly with ESRD could predict the nutritional decline and poorer response to EPO.There are relationship between serum CRP and the progression of CKD.

关 键 词：C-反应蛋白 营养状况 肾功能 老年人 慢性肾病 

分 类 号：R692[医药卫生—泌尿科学]