CKD4期患者营养状态与肠道黏膜免疫屏障的关系及中药结肠透析干预的疗效  

Relationship between nutritional status and intestinal mucosal immune barrier in patients with stage Ⅳ chronic kidney disease: Curative effect of Chinese herbal colon dialysis

作　　者：郝娜[1] 杨洪涛[1] 

机构地区：[1]天津中医药大学第一附属医院肾病科,天津市300382

出　　处：《世界华人消化杂志》2017年第10期940-945,共6页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81673909~~

摘　　要：目的探讨慢性肾脏病(chronic kidney disease,CKD)相关营养不良与肠黏膜免疫屏障功能的相关性,观察中药结肠透析的治疗效果.方法本研究通过MQSGA量表评价患者营养状态,通过检测CKD患者粪便slg A含量来研究其的肠黏膜免疫屏障功能,评价其相关性;将284例CKD4期患者分为治疗组(口服中药汤剂+自愿接受中药结肠透析治疗)和对照组(仅口服辨证中药汤剂组),观察治疗前后中医症状积分及临床化验指标,初步分析天津中医药大学第一附属医院中药结肠透析应用成效.结果研究显示CKD4期患者存在肠道黏膜免疫屏障功能障碍,肠道slgA水平作为黏膜免疫屏障功能的评价指标与患者营养状态评分呈负向相关的关系,随白蛋白、血红蛋白水平降低而升高,相关系数r=-0.533(P<0.05),与血肌酐、尿素氮水平呈正相关,相关系数r=0.486(P<0.05),随中医证候积分减低而降低,相关系数r=0.419(P<0.05).中医证候积分较高(即症状明显)患者,其营养状态评分与slgA表达量呈线性相关,相关系数r=-0.823(P<0.05),提示营养状态与肠道黏膜免疫屏障功能明显相关,且随肾脏病进展相关性逐步增加.结论本研究证实可以通过研究肠道内slgA水平来评估肠黏膜免疫屏障功能.中药结肠透析可通过改善CKD4期患者肠黏膜免疫屏障功能,改善患者的营养状况,从而改善预后,提高患者生存质量,延缓CKD进展.AIM To investigate the relationship between chronic kidney disease（CKD） related malnutrition and intestinal mucosal immune barrier function.METHODS The MQSGA scale was used to assess the nutritional status of patients,and slgA content in feces was determined to assess the intestinal mucosal barrier function.The correlation between the nutritional status and intestinal mucosal barrier function was then analyzed.Two hundred and eighty-four patients with stage IV CKD（CKD4） were divided into a study group[oral traditional Chinese medicine（TCM）decoction ＋ Chinese herbal colon dialysis]and a control group（oral TCM decoction alone）.TCM symptoms and clinical laboratory tests were compared between the two groups.RESULTS Patients with CKD4 had intestinal mucosal immune barrier dysfunction.There was a negative correlation between intestinal mucosal barrier function and the nutritional status of patients （r =-0.533,P〈0.05）.With the decrease in the levels of albumin and hemoglobin,slgA content in feces increased.slgA content in feces had a positive correlation with serum creatinine and urea nitrogen levels（r = 0.486,P〈0.05）.slgA content in feces decreased with the decrease in TCM syndrome score（r = 0.419,P〈0.05）.In patients with a high TCM syndrome score,there was a linear correlation between slgA content and nutritional status（r =-0.823,P〈0.05）.CONCLUSION The intestinal mucosal immune barrier function can be assessed by determining the level of slgA in the gut.Chinese herbal colon dialysis can improve the intestinal mucosal immune barrier function and the nutritional status in patients with CKD4,thus delaying the progression of CKD and improving the prognosis and quality of life of patients.

关 键 词：营养不良 肠道黏膜免疫屏障 中药结肠透析 

分 类 号：R692[医药卫生—泌尿科学]