维持性血液透析患者蛋白质能量消耗与甲状旁腺激素水平的关系  

Relationship between protein-energy wasting and parathyroid hormone levels in patients undergoing maintenance hemodialysis

作　　者：李晴 申世华 王韦乐 刘静静 王怡雅 朱威 杨静[1] Li Qing;Shen Shihua;Wang Weile;Liu Jingjing;Wang Yiya;Zhu Wei;Yang Jing(Department of Nephrology,The Third Affiliated Hospital of Anhui Medical University,Hefei 230061,Anhui Province,China)

机构地区：[1]安徽医科大学第三附属医院肾内科,合肥230061

出　　处：《中国基层医药》2024年第4期553-559,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：安徽省合肥市卫生健康应用医学研究(Hwk2019yb003);安徽省合肥市卫生健康应用医学研究(Hwk2021yb002)。

摘　　要：目的探讨维持性血液透析患者(maintenance hemodialysis,MHD)蛋白质能量消耗(protein-energy wasting,PEW)与甲状旁腺激素(parathyroid hormone,PTH)水平的关系。方法采用横断面研究,选取2022年1月至2023年5月在安徽医科大学第三附属医院行维持性血液透析治疗的成年患者150例为研究对象,依据PTH水平将患者分为低PTH组(<150 ng/L)、PTH达标组(150~300 ng/L)、较高PTH组(>300~600 ng/L)及高PTH组(PTH>600 ng/L),PEW的诊断采用国际肾脏营养与代谢学会(international society of renal nutrition and metabolism,ISRNM)提出的PEW诊断标准,采用logistic回归分析探究PEW与PTH水平的关系。结果150例MHD患者中蛋白质能量消耗组52例(34.7%),低PTH组患者蛋白质能量消耗患病率高于PTH达标组、较高PTH组及高PTH组(χ^(2)=20.64,P<0.05),单因素logistic回归分析结果显示,低PTH(OR=13.810,95%CI:2.907~65.603,P=0.001)与PEW风险增加相关,低PTH组发生PEW的风险是高PTH组的13.810倍;多因素logistic回归分析结果显示,低PTH(OR=19.891,95%CI:1.810~218.620,P=0.014)、C反应蛋白(OR=1.056,95%CI:1.015~1.099,P=0.007)与PEW风险增加独立相关,血红蛋白(OR=0.959,95%CI:0.931~0.988,P=0.005)、上臂中部周径(OR=0.544,95%CI:0.338~0.875,P=0.012)与PEW风险降低独立相关,低PTH组发生PEW的风险是高PTH组的19.891倍;PTH达标组、较高PTH组与高PTH组相比,PEW发生风险差异均无统计学意义(均P>0.05)。结论低PTH的患者发生PEW的风险显著增加,临床工作中应重视对低PTH血症的防治,对降低PEW发生风险具有重要的意义。Objective To investigate the relationship between protein-energy wasting(PEW)and parathyroid hormone(PTH)levels in patients undergoing maintenance hemodialysis.Methods A cross-sectional study was conducted to enroll 150 adult patients undergoing maintenance hemodialysis at The Third Affiliated Hospital of Anhui Medical University from January 2022 to May 2023.These patients were categorized into four groups based on their PTH levels:low PTH group(<150 ng/L),standard PTH group(150-300 ng/L),very high PTH group(300-600 ng/L),and extreme high PTH group(>600 ng/L).The diagnosis of PEW was determined using the diagnostic criteria proposed by the International Society of Renal Nutrition and Metabolism(ISRNM).Logistic regression analysis was performed to investigate the association between PEW and PTH levels.Results Among the 150 patients undergoing maintenance dialysis,52(34.7%)were diagnosed with PEW.The prevalence of PEW was significantly higher in the low PTH group compared with the standard,very high,and extreme high PTH groups(χ^(2)=20.64,all P<0.05).Univariate logistic regression analysis revealed a strong association between low PTH levels(OR=13.810,95%CI:2.907-65.603,P=0.001)and an increased risk of PEW.The risk of PEW in the low PTH group was 13.810 times higher than that in the extreme high PTH group.Multivariate logistic regression analysis further confirmed that low PTH levels(OR=19.891,95%CI:1.810-218.620,P=0.014)and low C-reactive protein levels(OR=1.056,95%CI:1.015-1.099,P=0.007)were independently associated with an increased risk of PEW.Higher hemoglobin levels(OR=0.959,95%CI:0.931-0.988,P=0.005)and a larger middle upper arm circumference(OR=0.544,95%CI:0.338-0.875,P=0.012)were independently associated with a reduced risk of PEW.The risk of PEW in the low PTH group was 19.891 times higher than that in the extreme high PTH group.However,there was no significant difference in the risk of PEW in the standard and very high PTH groups compared with the extreme high PTH group(both P>0.05).Conclusion The risk

关 键 词：肾透析 甲状旁腺激素相关蛋白质 患病率 C反应蛋白质 血红蛋白类 横断面研究 

分 类 号：R692.5[医药卫生—泌尿科学]