目的：探讨尿毒症患者肠黏膜免疫屏障功能与容量负荷、营养状况的关系。方法选择尿毒症非透析患者（非透析组）和透析患者（透析组）各60例，另选择30例健康志愿者作为对照组，采用ELISA法检测粪便分泌型免疫球蛋白A（sIgA）水平，超声测量下腔静脉内径（IVCD）和塌陷指数（CI），采用改良的主观整体综合评价法评分量表（ MQSGA）评价患者的营养状况，将sIgA表达量与IVCD、CI、MQSGA分别行直线回归和相关分析。结果与对照组比较，透析组和非透析组粪便sIgA表达量均明显降低（P均＜0．01），IVCD均明显升高（P均＜0．01），透析组与非透析组相比，IVCD无统计学差异；回归分析显示，sIgA表达量与IVCD呈直线回归关系（b＝-0．264，P＜0．01）。直线相关分析显示，sIgA与MQSGA有明显负相关关系（r＝-0．591，P＜0．01）。结论无论透析还是非透析尿毒症患者均存在肠黏膜免疫屏障功能障碍和容量超负荷，肠黏膜免疫屏障功能障碍程度与容量负荷和营养状况有关。%Objective To evaluate intestinal immunologic barrier function in uremic patients and its relationship with volume and malnutrition status.Methods Sixty uremic patients without hemodialysis, sixty uremic patients undergoing hemodialysis, and thirty healthy people in control group were recruited for this study.Enzyme-linked immunosorben assay ( ELISA) was used to analyze feces secretory immunoglobulin A ( sIgA) to evaluate intestinal immunologic barrier function, fluid status [ evaluated by the inferior vena cava diameter ( IVCD) and the collapsibility index ( CI) ] was measured by B-mode ultrasonic diagnostic equipment.Modified quantitative subjective global assessment ( MQSGA) was used to evaluate nutritional status.The relationship among sIgA, CI, IVCD and MQSGA was assessed.Results The amounts of feces sIgA were significantly lower in hemodialysis group and no-hemodialysis group than those of control group (all P<0.01).The measurements of IVCD were significantly higher in hemodialysis group and no-hemodialysis group than those of control group (all P<0.01).No significant difference of the measurements of IVCD between no-hemodialysis and dialysis group was found.Linear regression was found between sIgA and IVCD, b=-0.264,P<0.01.Negative correlation was found between sIgA and MQSGA, r=-0.591, P<0.01.Conclusions In uremic patients, whether hemodialysis or without hemodialysis, intestinal immunologil barrier is damaged, blood volume is overloaded.The injury degree of intestinal immu-nologic barrier is associated with volume status and nutritional status.
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