血液透析患者血镁与营养不良-炎症-动脉粥样硬化综合征的相关性

摘要

目的 探讨维持性血液透析患者血镁与营养不良-炎症-动脉粥样硬化(MIA)综合征的关系.方法 选取2013年3至8月在北京朝阳医院血液净化科行维持性血液透析的120例患者,收集患者人体测量学指标、实验室数据等情况,分析血镁与营养不良、慢性炎症、动脉粥样硬化各指标的相关性,并分析MIA综合征的相关因素.结果 120例患者血清总镁水平为(1.11 ±0.14)mmol/L.营养不良者44例(36.7％),血清镁水平显著低于营养正常患者[(1.00±0.12) mmol/L比(1.14±0.15) mmol/L,t=3.576,P=0.001];慢性炎症者43例(35.8％),血清镁水平显著低于无慢性炎症的患者[(1.07±0.13) mmol/L比(1.13 ±0.15) mmol/L,t=2.138,P=0.035];动脉粥样硬化者79例(65.8％),血清镁水平显著低于无动脉粥样硬化的患者[(1.08 ±0.12) mmol/L比(1.15±0.08) mmol/L,t=0.385,P=0.019];合并MIA综合征者26例(21.7％),血清镁水平显著低于无MIA综合征的患者[(1.02 ±0.10) mmol/L比(1.13 ±0.14) mmol/L,江3.534,P=0.001].血清镁与超敏C反应蛋白(hs-CRP)、颈动脉内膜中层厚度(IMT)呈负相关(r=-0.237,P=0.010;r=-0.331,P=0.000),与血清白蛋白、尿素氮、血肌酐、血尿酸、血钾、肱三头肌皮褶厚度、上臂围、上臂肌围和血红蛋白呈正相关(r =0.191,P=0.037; r=0.345,P=0.000; r=0.242,P=0.008;r=0.282,P=0.002;r=0.254,P=0.005;r=0.265,P=0.011;r=0.233,P=0.018;r =0.282,P=0.007; r=0.374,P=0.000).多因素Logistic回归分析显示年龄(OR=1.142,95％CI=1.026～1.271,P=0.009)、hs-CRP (OR=1.415,95％ CI=1.152～1.740,P=0.001)、IMT(OR=1.386,95％ CI=1.009～1.904,P=0.044)、血清白蛋白(OR=0.944,95％ CI=0.910～0.978,P=0.002)和血清镁水平(OR=0.886,95％ CI=0.788～0.996,P=0.042)是MIA综合征发生的相关因素.结论 血清镁水平与维持性血液透析患者是否合并营养不良、炎症状态、动脉粥样硬化及MIA综合征相关.%Objective To investigate the potential correlation between serum magnesium and malnutrition-inflammation-atherosclerosis (MIA) syndrome in maintenance hemodialysis (MHD) patients.Methods A total of 120 patients who received MHD in Department of Blood Purification of Beijing Chaoyang Hospital from March to August 2013 were enrolled.Anthropometric and laboratory data were collected for the analysis of correlation between serum magnesium and indicators relating to malnutrition,chronic inflammation,and atherosclerosis,and the analysis of relevant factors of MIA syndrome.Results In the 120 MHD patients,the mean serum magnesium level was (1.11 ±0.14) mmol/L.44 patients had malnutrition (36.7％),whose serum magnesium level was significantly lower than that of patients in normal nutritious status [(1.04 ±0.12) mmol/L vs.(1.14 ±0.15) mmol/L,t =3.576,P =0.001] ; 43 patients had chronic inflammation (35.8％),with serum magnesium level significantly lower than that of patients without inflammation [(1.07 ±0.13) mmol/L vs.(1.13 ±0.15) mmol/L,t =2.138,P =0.035]; 79 patients had atherosclerosis (65.8％),whose serum magnesium level was significantly lower than that of patients without atherosclerosis [(1.08 ±0.12) mmol/L vs.(1.15 ±0.08) mmol/L,t =0.385,P =0.019] ; and 26 patients had MIA syndrome (21.7％),whose serum magnesium level was significantly lower than that of non-MIA patients [(1.02 ± 0.10) mmol/L vs.(1.13 ± 0.14) mmol/L,t =3.534,P =0.001].Serum magnesium level was found negatively correlated with high-sensitivity C-reactive protein (hs-CRP,r =-0.237,P =0.010) and carotid intima-media thickness (IMT,r =-0.331,P =0.000),and positively correlated with serum albumin,blood urea nitrogen,serum creatinine,uric acid,serum potassium,triceps skin-fold thickness,mid-arm circumference,mid-arm muscle circumference and hemoglobin (r =0.191,P =0.037; r =0.345,P =0.000; r =0.242,P=0.008; r =0.282,P=0.002; r=0.254,P=0.005; r=0.265,P=0.011; r=0.233,P=0.018; r=0.282,P=0.007; r=0.374,P =0.000).Multivariate logistic regression analysis showed that age (OR =1.142,95％ CI =1.026-1.271,P=0.049),hs-CRP (OR=1.415,95％ CI=1.152-1.740,P=0.001),IMT (OR =1.386,95％ CI=1.009-1.904,P=0.044),serum albumin (OR =0.944,95％ CI=0.910-0.978,P=0.002) and serum magnesium (OR =0.886,95％ CI =0.788-0.996,P =0.042) were related factors of MIA syndrome.Conclusions Serum magnesium level is correlated to malnutrition,inflammation,atherosclerosis,and MIA syndrome in MHD patients.