黄静静, 张金平, 王佳, 王欣, 王伟伟, 杨晓萍. 不同血液透析方式对患者抵抗素水平变化及营养状况的影响[J]. 临床肾脏病杂志, 2018, 18(2): 77-81. DOI: 10.3969/j.issn.1671-2390.2018.02.003
    引用本文: 黄静静, 张金平, 王佳, 王欣, 王伟伟, 杨晓萍. 不同血液透析方式对患者抵抗素水平变化及营养状况的影响[J]. 临床肾脏病杂志, 2018, 18(2): 77-81. DOI: 10.3969/j.issn.1671-2390.2018.02.003
    HUANG Jing-jing, ZHANG Jin-ping, WANG Jia, WANG Xin, WANG Wei-wei, YANG Xiao-ping. Effect of different hemodialysis modalities on resistin and nutritional status[J]. Journal of Clinical Nephrology, 2018, 18(2): 77-81. DOI: 10.3969/j.issn.1671-2390.2018.02.003
    Citation: HUANG Jing-jing, ZHANG Jin-ping, WANG Jia, WANG Xin, WANG Wei-wei, YANG Xiao-ping. Effect of different hemodialysis modalities on resistin and nutritional status[J]. Journal of Clinical Nephrology, 2018, 18(2): 77-81. DOI: 10.3969/j.issn.1671-2390.2018.02.003

    不同血液透析方式对患者抵抗素水平变化及营养状况的影响

    Effect of different hemodialysis modalities on resistin and nutritional status

    • 摘要: 目的 研究不同血液透析方式对患者抵抗素水平及其营养状况的影响。方法 选择石河子大学医学院第一附属医院常规低通量透析(LFHD)患者27例、高通量透析(HFHD)患者28例及健康志愿者30例(正常对照组)为研究对象。采用酶联免疫吸附法测定各组患者透析前后血清抵抗素水平,并检测生化指标营养指标:总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb);炎症指标:C反应蛋白(CRP)、铁蛋白(Fer);血脂:总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL);肾功能及电解质:尿素氮(BUN)、血肌酐(SCr)、尿酸(UA)、钾(K)、钙(Ca)、磷(P)、镁(Mg),比较各组患者透析前后抵抗素水平及其生化指标的差异。由专人进行患者主观综合营养评估(SGA),并收集各研究对象的临床资料,分析各组抵抗素水平变化及其与上述各生化指标的关系。结果 ①与正常对照组相比,LFHD组、HFHD组抵抗素水平明显增高;LFHD组、HFHD组透析前抵抗素水平及透析后抵抗素水平差异无统计学意义;LFHD组、HFHD组透析前后抵抗素水平差异无统计学意义;HFHD组透析前后抵抗素水平差异具有统计学意义。②不同方式血液透析患者Alb、PA、SGA差异具有统计学意义;与LFHD组相比,HFHD组的Alb与PA较高、SGA评分较低。③单因素分析:血清抵抗素与SCr、CRP呈正相关(r=0.768,r=0.473,P<0.05),与估算肾小球滤过率(eGFR)呈负相关(r=-0.813,P<0.05);血清抵抗素与TC、TG、LDL、SGA呈正相关(r=0.408,r=0.294,r=0.397,r=0.286,P<0.05)。④多元线性回归分析:eGFR及CRP对抵抗素水平均有影响。结论 高通量血液透析可能清除部分抵抗素。血液透析患者抵抗素与其营养状况存在密切关系。

       

      Abstract: Objective To investigate the level of resistin in the patients with different hemodialysis modalities and its influence on nutritional status. Methods A total of 55 hemodialysis patients were randomly divided into low flux hemodialysis group (LFHD, n=27) and high flux hemodialysis group (HFHD, n=28), and compared with 30 healthy volunteers (normal control group). All of them were selected as the study objects in the First Affiliated Hospital of Shihezi University. The levels of serum resistin before and after dialysis were determined by enzyme-linked immunosorbent assay(ELISA). Fasting samples of venous blood were obtained in 55 hemodialysis patients before dialysis and the following biochemical indexes were measured:for nutrition index, total protein(TP), albumin (Alb), prealbumin (PA), hemoglobin(Hb); for inflammation indicators, C reactive protein (CRP), ferritin (Fer); for blood lipids, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL); for renal function and electrolyte, renal urea nitrogen(BUN), serum creatinine (SCr), uric acid (UA), kalium (K), calcium (Ca), phosphorus (P), magnesium (Mg). The differences in resistin levels and biochemical indexes were compared between the two groups. All of the patients underwent subjective comprehensive nutritional assessment by specially-assigned person and according to the guidelines, at the same time the clinical data of the subjects were collected. The changes of resistin levels in each dialysis group were analyzed and their relationships with the above biochemical indexes were analyzed.Results (1)As compared with the normal control group, the resistin level in LFHD group and HFHD group was significantly increased. There was no statistically significant difference between LFHD group and HFHD group in the level of pre-dialysis resistance and the level of resistin. There was no significant difference in resistin level between LFHD group and HFHD group before and after dialysis. There were statistically significant differences in the level of resistin before and after dialysis in HFHD group. (2) The differences in Alb, PA and SGA in patients undergoing different hemodialysis methods were statistically significant. As compared with LFHD group, HFHD group had higher Alb and PA but lower SGA scores; (3)Single factor analysis revealed that serum resistin was positively correlated with SCr and CRP (r=0.768, and r=0.473, P<0.05), and negatively correlated with glomerular filtration rate (eGFR) (r=-0.813, P<0.05). Serum resistin was positively correlated with TC, TG, LDL and SGA (r=0.408, r=0.294, r=0.397, and r=0.286 respectively, P<0.05). (4) Multiple linear regression analysis demonstrated that eGFR and CRP had influence on the level of resistin, and the dialysis mode had no significant effect on it.Conclusions High flux dialysis may eliminate some of the resistin. Resistin in hemodialysis patients is closely related to their nutritional status.

       

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