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目的:通过观察超敏C反应蛋白(hsCRP),并采用多种营养评价方法,以评价hsCRP在反映腹膜透析(PD)患者机体营养状态中的意义。方法:选取2015年5月至9月在南京军区南京总医院肾脏科行PD治疗的103例患者,测定其血清炎症因子hsCRP,根据hsCRP水平将PD患者分为hsCRP升高组(hsCRP>3 mg/L)和hsCRP正常组(hsCRP≤3 mg/L)。收集患者一般资料,采用生化指标、人体测量、生物电阻抗(BIA)及改良定量主观整体营养评估(MQ-SGA)评估患者营养状态,并根据MQ-SGA评分分为MQ-SGA>10分组和MQ-SGA≤10分组。结果:共纳入103例患者,其中MQ-SGA>10分组患者33例(32%),MQ-SGA>10分组hsCRP较MQ-SGA≤10分组明显升高,白蛋白、前白蛋白、标准蛋白分解率(nPCR)、上臂中部周径(MAC)、上臂中部肌肉周径(MAMC)、肱三头肌皮褶厚度(TSF)、瘦体重百分比(LBM%)及相位角(PA)均较MQ-SGA≤10组明显降低。26例(25.2%)患者血清hsCRP升高,相比hsCRP正常组,hsCRP升高组患者多种营养参数均下降,白蛋白、前白蛋白、nPCR、体质量指数(BMI)明显降低,MQ-SGA评分明显升高,BIA显示LBM%、PA均明显降低。多因素分析显示MQ-SGA评分、无脂肪的体质量指数(FFMI)、LBM%是hsCRP的独立影响因素。结论:hsCRP升高在PD患者中较为常见,并与人体测量、血生化检查、主观营养评价及人体成分分析测得营养参数均密切相关,提示检测血清hsCRP水平有助于判定PD患者营养状态。
OBJECTIVE: To evaluate the significance of hsCRP in reflecting the nutritional status of patients with peritoneal dialysis (PD) by observing hsCRP and using various nutritional evaluation methods. METHODS: 103 patients with PD treated by Department of Nephrology, Nanjing General Hospital of Nanjing Military Region from May 2015 to September were enrolled in this study. Serum inflammatory factor hsCRP was assayed for hsCRP. According to the level of hsCRP, PD patients were divided into three groups: hsCRP> 3 mg / L) and hsCRP normal group (hsCRP≤3 mg / L). The general data of patients were collected and the nutritional status of the patients was evaluated by biochemical indicators, body measurements, bioelectrical impedance (BIA) and modified quantitative subjective global nutritional assessment (MQ-SGA), and divided into MQ-SGA> 10 groups according to MQ- MQ-SGA≤10 grouping. Results: A total of 103 patients were enrolled. Among them, 33 cases (32%) in MQ-SGA> 10 group and hsCRP in MQ-SGA> 10 group were significantly higher than MQ-SGA≤10 group, albumin, prealbumin, The nPCR, MAC, MAMC, TSF, LBM%, and phase angle (PA) were significantly lower than those of MQ -SGA ≤ 10 group was significantly reduced. Serum hsCRP levels were increased in 26 patients (25.2%). Compared with the normal hsCRP group, the nutritional parameters of patients with elevated hsCRP were decreased, and albumin, prealbumin, nPCR and body mass index (BMI) SGA score was significantly higher, BIA showed LBM%, PA were significantly lower. Multivariate analysis showed that the MQ-SGA score, fat-free body mass index (FFMI), and LBM% were independent predictors of hsCRP. CONCLUSIONS: Elevated hsCRP is more common in PD patients and closely correlated with the nutritional parameters measured by human body measurements, blood biochemical tests, subjective nutritional assessment and body composition analysis. It is suggested that the detection of serum hsCRP levels can help determine the nutritional status of PD patients.