| 摘要: |
| 目的分析维持性血液透析患者血清降钙素原（PCT）水平与透析充分性、微炎症状态及营养不良的关系。方法选取行维持性血液透析治疗的慢性肾脏病患者120例为观察组，另择同期行健康体检者120例为对照组。观察组患者行透析前后检测血清尿素氮水平，计算尿素清除率(Kt/V)以评估透析充分性，并根据Kt/V将观察组患者分为透析充分组（Kt/V≥1.2，69例）和透析不充分组（Kt/V＜1.2，51例）。比较观察组与对照组及透析充分组与透析不充分组PCT、hs-CRP、Hb、血清白蛋白水平；分析观察组患者PCT水平与超敏C反应蛋白（hs-CRP）、Hb、血清白蛋白水平及Kt/V的相关性；分析PCT水平对血液透析充分性的评估价值。结果观察组患者PCT、hs-CRP水平均高于对照组（均P＜0.05），Hb、血清白蛋白水平均低于对照组（均P＜0.05）。与透析充分组相比，透析不充分组患者PCT、hs-CRP水平均增高（均P＜0.05），血清白蛋白水平降低（P＜0.05），两组患者Hb水平比较无统计学差异（P＞0.05）。相关性分析显示，观察组患者PCT水平与hs-CRP呈正相关（r=0.580，P＜0.05），与Hb（r=-0.462）、血清白蛋白（r=-0.528）、Kt/V（r=-0.554）均呈负相关（均P＜0.05）。ROC曲线分析得出，当PCT水平为0.243ng/ml时，判断透析是否充分的灵敏度为0.85，特异度为0.51，是最理想的透析充分性判断点。结论维持性血液透析患者血清PCT水平升高提示透析不充分，微炎症状态、营养不良加重。 |
| 关键词: 血液透析 降钙素原 透析充分性 微炎症状态 低蛋白血症 |
| DOI：10.12056/j.issn.1006-2785.2017.39.24.2017-852 |
| 分类号: |
| 基金项目:浙江省科技计划项目（2014C33237）；杭州市科技发展计划项目（20140733Q10） |
|
| Relationship of procalcitonin levels with dialysis adequacy, microinflammation and malnutrition in maintenance hemodialysis patients |
|
|
|
Hangzhou First People's Hospital
|
| Abstract: |
| Objective To analyze the relationship of serum procalcitonin(PCT) level with dialysis adequacy, microinflam- mation and malnutrition in patients with maintenance hemodialysis (MHD). Methods One hundred and twenty MHD patients (study group) and 120 healthy subjects (control group) were included in the study. Blood urea nitrogen (BUN) level before and after dialysis was examined to calculate Kt/V. According to Kt/V value, MHD patients were divided into adequacy group (Kt/V≥ 1.2, n=69) and non-adequacy group (Kt/V ＜1.2, n=51). The levels of PCT, hs-CRP, hemoglobin and albumin were compared between study group and control group, and between adequacy group and non-adequacy group. The correlation of PCT with hs-CRP, hemoglobin, albumin and Kt/V in study group was analyzed. The value of PCT for identifying the dialysis adequacy in MHD patients was assessed by ROC curve analysis. Results Serum PCT and hs-CRP levels in study group were higher, while serum hemoglobin and albumin levels were lower than those in control group (all P＜0.05). Compared to the adequacy group, serum PCT and hs-CRP levels were higher, and hemoglobin level was lower in non-adequacy group (all P＜0.05), however there was no significant difference in serum hemoglobin level between two groups (P ＞0.05). In study group, serum PCT was
positively correlated with hs-CRP (r=0.580, P＜0.05), negatively correlated with albumin, hemoglobin and Kt/V(r=-0.528,
-0.462 and -0.554, all P＜0.05). ROC curve analysis showed that at a serum PCT cutoff value of 0.243 ng/ml, the sensitivity and specificity for identifying the dialysis adequacy in MHD patients were 0.85 and 0.50, respectively. Conclusion The increase of serum PCT level in MHD patients suggests inadequate dialysis, and aggravation of microinflammation and malnutrition. |
| Key words: Hemodialysis Procalcitonin Adequacy of hemodialysis Microinflammation Hypoproteinemia |
