血液透析患者PCT水平与透析充分性、微炎症状态及营养不良的关系研究  

Relationship of procalcitonin levels with dialysis adequacy, microinflammation and malnutrition in maintenance hemodialysis patients

作　　者：杨丽莉[1] 陈琦 王鸣[1] 赵宁[1] 

机构地区：[1]杭州市第一人民医院肾内科,310006

出　　处：《浙江医学》2017年第24期2225-2227,2246,共4页Zhejiang Medical Journal

基　　金：浙江省科技计划项目(2014C33237);杭州市科技发展计划项目(20140733Q10)

摘　　要：目的分析维持性血液透析患者血清降钙素原(PCT)水平与透析充分性、微炎症状态及营养不良的关系。方法选取行维持性血液透析治疗的慢性肾脏病患者120例为观察组,另择同期行健康体检者120例为对照组。观察组患者行透析前后检测血清尿素氮水平,计算尿素清除率(Kt/V)以评估透析充分性,并根据Kt/V将观察组患者分为透析充分组(Kt/V≥1.2,69例)和透析不充分组(Kt/V<1.2,51例)。比较观察组与对照组及透析充分组与透析不充分组PCT、hs-CRP、Hb、血清白蛋白水平;分析观察组患者PCT水平与超敏C反应蛋白(hs-CRP)、Hb、血清白蛋白水平及Kt/V的相关性;分析PCT水平对血液透析充分性的评估价值。结果观察组患者PCT、hs-CRP水平均高于对照组(均P<0.05),Hb、血清白蛋白水平均低于对照组(均P<0.05)。与透析充分组相比,透析不充分组患者PCT、hs-CRP水平均增高(均P<0.05),血清白蛋白水平降低(P<0.05),两组患者Hb水平比较无统计学差异(P>0.05)。相关性分析显示,观察组患者PCT水平与hs-CRP呈正相关(r=0.580,P<0.05),与Hb(r=-0.462)、血清白蛋白(r=-0.528)、Kt/V(r=-0.554)均呈负相关(均P<0.05)。ROC曲线分析得出,当PCT水平为0.243 ng/ml时,判断透析是否充分的灵敏度为0.85,特异度为0.51,是最理想的透析充分性判断点。结论维持性血液透析患者血清PCT水平升高提示透析不充分,微炎症状态、营养不良加重。Objective To analyze the relationship of serum procalcitonin(PCT)level with dialysis hundred adequacy,and microinflammation MHD and malnutrition in patients with maintenance hemodialysis(MHD).Methods study.One twenty patients(study after group)dialysis and was 120 healthy subjects calculate(control Kt/V.group)According were included Kt/V in the MHD Blood urea nitrogen(BUN)level before and(Kt/V≥examined to to value,patients were divided into adequacy group(Kt/V<1.2,n=51).The levels of PCT,hs-CRP,hemoglobin and albumin were compared1.2,n=69)and non-adequacy group between study group and control group,and in between adequacy was group and The nonvalue adequacy group.The correlation the of PCT with hs-CRP,MHD hemoglobin,albumin and Kt/V study group analyzed.of hsPCT CRP for identifying dialysis adequacy higher,in patients was assessed by ROC curve analysis.lower Results Serum PCT and levels in study group were while(all P<0.05).Compared to the adequacy group,serum serum was hemoglobin PCT and CRP albumin levels were were than those in control group lower(all P<0.05),however there and hs-levels higher,serum and hemoglobin level was in non-adequacy group(P>0.05).In study group,no significant difference in hemoglobin level between two groups serum PCT was(r=0.580,P<0.05),negatively correlated with albumin,hemoglobin and Kt/V(r=-0.528,positivelycorrelated with hs-CRP all P<0.05).ROC curve analysis showed that at a serum PCT cutoff value of 0.243 ng/ml,the sensitivity and0.462 and-0.554,specificity for identifying the dialysis adequacy in MHD patients dialysis,were and 0.85 and 0.50,respectively.Conclusion and The increase of serum PCT level in MHD patients suggests inadequate aggravation of microinflammation malnutrition.

关 键 词：血液透析 降钙素原 透析充分性 微炎症状态 低蛋白血症 

分 类 号：R692.5[医药卫生—泌尿科学]