腹膜透析患者蛋白质-能量消耗对腹膜炎的影响

摘要

目的：探讨腹膜透析患者蛋白质-能量消耗（PEW）与腹膜炎发生率的相关性。方法对行维持性腹膜透析（PD）的患者运用改良 SGA 法评分系统（MQSGA）、营养不良-炎症评分（MIS）和血清总蛋白、白蛋白等进行营养评估，采用酶联免疫方法（ELISA）检测血清超敏 C 反应蛋白（Hs - CRP）、白细胞介素-6（IL -6）浓度进行微炎症状态评估，同时检测患者人体学指标、生化指标以及24 h 腹透液蛋白丢失量、瘦素等指标。随后将所有患者依据 PEW 不同分为合并 PEW 组和非 PEW 组，比较两组间腹膜炎的发生率。结果 MQSGA 和 MIS 与 Hs - CRP、IL -6显著正相关。MQSGA 和 MIS 与身体质量指数（BMI）、中臂围（MAC）、肱三头肌皮褶厚度（TSF）、中臂肌围（MAMC）、白蛋白（ALB）、血肌酐（Scr）、血红蛋白（Hb）、尿素氮（BUN）、转铁蛋白（TF）、总铁结合力（TIBC）显著负相关。60例 PD 患者中，PEW 者30例，非 PEW 者30例。与非 PEW 组相比，PEW 组的 MQSGA 分值更高，MIS 分值更高，PEW 组患者 BMI、ALB、Scr 显著降低，hs - CRP、IL -6、24 h 腹透液蛋白丢失量及瘦素显著升高，两组比较差异具有统计学意义（ P <0.05）。PEW 组与非 PEW 组腹膜炎发生率分别为44.7％和10.0％，PEW 组腹膜炎发生率显著高于非 PEW 组（ P <0.01）。结论①MQSGA 和 MIS 可较好评价慢性肾脏病 PD 患者的 PEW，合并 PEW 的 PD 患者，其腹膜炎发生率也较高，PEW 可预测 PD患者发生腹膜炎的风险。②PEW 与瘦素水平、24 h 腹透液蛋白丢失量、微炎症状态等相关。%Objective To evaluate the correlation of the peritonitis incidence with protein - energy consumption(PEW)in peritoneal di-alysis patients. Methods In the patients with continuous ambulatory peritoneal dialysis,nutritional assessment was applied by the method of im-proved SGA score system(MQSGA),malnutrition - inflammation score(MIS)and serum total protein and albumin. The enzyme - linked immune method(ELISA)was used to detect the concentration of serum hypersensitive c - reactive protein(Hs - CRP)and interleukin - 6(IL - 6)for assessment micro inflammatory condition. At the same time,the somatology,biochemical indicators and 24 hours protein lost of drain fluid a-mount,leptin were detected. Then all of the patients by the protein - based on energy consumption(PEW)divided into merger PEW group and non - PEW group. The incidence of peritonitis of the two groups was compared. Results MQSGA and MIS with Hs CRP,IL - 6 were signifi-cantly positive correlation. MQSGA and MIS and body mass index(BMI),the arm circumference(MAC),triceps skinfold(TSF)and arm mus-cle circumference(MAMC),albumin(ALB),and serum creatinine(Scr),hemoglobin(Hb),urea nitrogen(BUN),transferrin(TF)and total iron binding force(TIBC)were significant negative correlation. In all 60 cases of PD patients,30 cases were the PEW group,other 30 cases of the non - PEW group. Compared with the non - PEW group,the MQSGA score and MIS score of PEW group were higher. Compared with the non- PEW group,the BMI,ALB,Scr of PEW group significantly decreased. The leptin,IL - 6,hs - CRP and protein loss quantity of the PEW group significantly increased. The increasing of these indexes showed significant differences between the two groups( P < 0. 05). The peritonitis rates in PEW group and non - PEW respectively were 44. 7% and 10. 0% ,the peritonitis rates of PEW group was significantly higher than those in non - PEW group( P < 0. 01). Conclusion ①Higher incidence of peritonitis existed at the patient of PD with PEW. PEW increased the risk of peritonitis. ②The PEW and leptin levels,24 hours protein lost of drain fluid amount,micro inflammation may be relevant.