老年营养风险指数联合血清补体C3水平在维持性血液透析患者腹主动脉钙化评估中的价值  

Value of Geriatric Nutritional Risk Index combined with serum complement C3 levels in assessment of abdominal aortic calcification in maintenance hemodialysis patients

作　　者：李佳[1] 王玉[1] 刘怡彤 周路路 孙杰[2] 魏善斋 LI Jia;WANG Yu;LIU Yitong;ZHOU Lulu;SUN Jie;WEI Shanzhai(Department of Nutrition,Shuyang Affiliated Hospital of Nanjing University of Chinese Medicine,Shuyang 223600,China)

机构地区：[1]南京中医药大学沭阳附属医院营养科,江苏沭阳223600 [2]南京中医药大学沭阳附属医院肾内科

出　　处：《山东医药》2022年第10期30-34,共5页Shandong Medical Journal

基　　金：江苏省老年医学临床技术应用研究项目(LR20210059);宿迁市市级指导性科技计划项目(Z20200062)。

摘　　要：目的探讨老年营养风险指数(GNRI)联合血清补体C_(3)水平在维持性血液透析(MHD)患者腹主动脉钙化(AAC)评估中的价值。方法选取232例MHD患者,根据是否合并AAC分为钙化组(n=165)与无钙化组(n=67),根据AAC评分将钙化组分为重度钙化组(n=48)、中度钙化组(n=55)、轻度钙化组(n=62)。收集患者临床资料,计算GNRI,采用放射免疫扩散法检测血清补体C_(3)。Spearman相关系数分析钙化组GNRI和血清补体C_(3)水平与AAC评分的相关性。多因素Logistic回归分析MHD患者发生ACC的影响因素。ROC曲线分析GNRI和血清补体C_(3)水平对MHD患者发生ACC的预测价值。结果与无钙化组比较,钙化组年龄增加,体质量指数、白蛋白、GNRI降低,透析时间延长,低密度脂蛋白胆固醇(LDL-C)、血磷、全段甲状旁腺素(iPTH)、补体C_(3)水平升高(P均<0.05)。轻度、中度、重度钙化组GNRI依次降低,血清补体C_(3)水平依次升高(P均<0.05)。Spearman相关系数显示,钙化组AAC评分与GNRI呈负相关(rs=-0.827,P<0.01),与血清补体C_(3)水平呈正相关(rs=0.779,P<0.01)。多因素Logistic回归分析分析显示,透析时间(OR=1.009,95%CI:1.001~1.018)、血磷(OR=1.034,95%CI:1.003~1.065)、iPTH(OR=1.019,95%CI:1.007~1.032)、补体C_(3)(OR=2.332,95%CI:1.136~4.789)是MHO患者发生ACC的独立危险因素,白蛋白(OR=0.910,95%CI:0.835~0.992)、GNRI(OR=0.782,95%CI:0.708~0.865)是MHD患者发生ACC的独立保护因素(P均<0.05)。ROC曲线分析显示,GNRI、补体C_(3)、GNRI+补体C_(3)预测MHD患者ACC的AUC分别为0.793、0.795、0.868,GNRI+补体C_(3)预测AUC大于GNRI、补体C_(3)单独预测(P<0.05)。结论GNRI降低和血清补体C_(3)水平升高是MHD患者发生ACC的独立危险因素,与MHD患者ACC程度有关,二者可作为MHD患者ACC预测指标。Objective To investigate the value of the Geriatric Nutrition Risk Index(GNRI)combined with serum complement C_(3) levels in the assessment of abdominal aortic calcification(AAC)in maintenance hemodialysis(MHD)pa⁃tients.Methods A total of 232 MHD patients were selected and divided into the calcification group(n=165)and noncalcification group(n=67)according to whether they had AAC,and the calcification group was then divided into the se⁃vere calcification group(n=48),moderate calcification group(n=55),and mild calcification group(n=62)according to the AAC score.Patients'clinical data were collected,GNRI was calculated and the level of serum complement C3 was de⁃tected by radioimmunoassay.Spearman's correlation coefficient was used to analyze the correlations between GNRI and se⁃rum complement C3 levels and AAC scores in the calcification group.Factors influencing ACC in MHD patients were ana⁃lyzed by using multifactorial Logistic regression.ROC curves were used to analyze the predictive value of GNRI and serum complement C3 levels for ACC in MHD patients.Results Compared with the non-calcification group,the calcification group had increased age,decreased body mass index,albumin,GNRI,longer dialysis time,and increased low-density li⁃poprotein cholesterol(LDL-C),blood phosphorus,intact parathyroid hormone(iPTH),and complement C3 levels(all P<0.05).GNRI decreased in the mild,moderate and severe calcification groups in that order,and serum complement C3 lev⁃els increased in turn(all P<0.05).Spearman's correlation coefficient showed that AAC scores were negatively correlated with GNRI and positively correlated with serum complement C3 levels in the calcification group(rs=-0.827,0.779,all P<0.01).Multifactorial Logistic regression analysis showed that time of dialysis(OR=1.009,95%CI:1.001 to 1.018),blood phosphorus(OR=1.034,95%CI:1.003 to 1.065),iPTH(OR=1.019,95%CI:1.007 to 1.032),and comple⁃ment C3(OR=2.332,95%CI:1.136 to 4.789)were independent risk factors,and albumin(OR=0.910,95%CI:0.835 to 0.992)and

关 键 词：终末期肾脏病 维持性血液透析 腹主动脉钙化 老年营养风险指数 补体C_(3) 

分 类 号：R692[医药卫生—泌尿科学]