血液透析患者血清SF、TSAT水平与营养状况的相关性分析
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摘要
目的分析维持性血液透析(MHD)患者血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)水平与营养状况的关系。方法选取MHD患者92例(MHD组)和健康体检者50例(对照组),所有受试对象均完成营养状况评估[改良主观综合营养评估法(MQSGA)]、营养生化指标检测[血清白蛋白(Alb)、血红蛋白(Hb)],并行血清SF、TSAT测定。根据MQSGA评分将MHD组进一步分为重度营养不良亚组、轻中度营养不良亚组、营养正常亚组。结果相较于对照组,MHD组BMI、TSF、MAC、HGS及血清A1b、血清Hb均明显降低(P <0.05),MQSGA评分明显增高(P <0.05)。MHD组血清SF明显高于对照组(P <0.05), TSAT明显低于对照组(P <0.05)。MHD患者不同营养状况亚组血清SF、TSAT水平比较差异有统计学意义(P <0. 05),随着营养不良状况越严重,患者血清SF逐渐增高(P <0. 05),TSAT逐渐降低(P <0.05)。相关性分析显示,MHD患者MQSGA评分与血清SF水平呈正相关(r=0.468,P<0.05),与TSAT水平呈负相关(r=-0.394,P<0. 05)。结论 MHD患者血清SF明显增高,TSAT明显降低,血清SF、TSAT水平可能与MHD患者营养不良相关。
Objective To analyze the relationship between serum ferritin(SF) and transferrin saturation(TSAT) levels and nutritional status in patients undergoing maintenance hemodialysis(MHD). Methods 92 patients undergoing MHD(the MHD group) and 50 healthy controls(the control group) were selected for the study. Their nutritional status was assessed [ modified quantitative subjective global assessment(MQSGA) ],also their nutritional biochemical indicators [serum albumin(Alb), hemoglobin(Hb) ], serum SF and TSAT were determined. According to the MQSGA score,patients in MHD group were further divided into three subgroups: the severe malnutrition group,mild to moderate malnutrition group and normal nutrition group. Results Compared with the control group,the BMI,TSF,MAC,HGS,serum Alb and serum Hb were significantly lower,and MQSGA score was significantly higher in the MHD group(P <0. 05). Serum SF was significantly higher in the MHD group than in the control group(P <0. 05),and TSAT was significantly lower than that of the control group(P <0. 05). There were significant differences in serum SF and TSAT levels among the MHD subgroups(P <0.05). The more severe the malnutrition was,the higher the SF was,and the lower the TSAT was(P < 0. 05). Correlation analysis showed that the MQSGA score of patients undergoing MHD was positively correlated with the serum SF level(r = 0. 468, P < 0. 05), and negatively correlated with the TSAT level(r=-0. 394,P <0.05). Conclusion Serum SF is significantly increased and TSAT is significantly decreased in patients undergoing MHD. Serum SF and TSAT levels could be associated with malnutrition in patients undergoing MHD.
Objective To analyze the relationship between serum ferritin(SF) and transferrin saturation(TSAT) levels and nutritional status in patients undergoing maintenance hemodialysis(MHD). Methods 92 patients undergoing MHD(the MHD group) and 50 healthy controls(the control group) were selected for the study. Their nutritional status was assessed [ modified quantitative subjective global assessment(MQSGA) ],also their nutritional biochemical indicators [serum albumin(Alb), hemoglobin(Hb) ], serum SF and TSAT were determined. According to the MQSGA score,patients in MHD group were further divided into three subgroups: the severe malnutrition group,mild to moderate malnutrition group and normal nutrition group. Results Compared with the control group,the BMI,TSF,MAC,HGS,serum Alb and serum Hb were significantly lower,and MQSGA score was significantly higher in the MHD group(P <0. 05). Serum SF was significantly higher in the MHD group than in the control group(P <0. 05),and TSAT was significantly lower than that of the control group(P <0. 05). There were significant differences in serum SF and TSAT levels among the MHD subgroups(P <0.05). The more severe the malnutrition was,the higher the SF was,and the lower the TSAT was(P < 0. 05). Correlation analysis showed that the MQSGA score of patients undergoing MHD was positively correlated with the serum SF level(r = 0. 468, P < 0. 05), and negatively correlated with the TSAT level(r=-0. 394,P <0.05). Conclusion Serum SF is significantly increased and TSAT is significantly decreased in patients undergoing MHD. Serum SF and TSAT levels could be associated with malnutrition in patients undergoing MHD.
引文
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[10]王文素,周建伟,张倩,等.血液灌流对维持性血液透析患者肾性贫血和微炎症状态的影响[J].河北医科大学学报,2016,37(5):585-588.
[11] PARK K S,RYU G W, JHEE J H, et al. Serum ferritin predicts mortality regardless of inflammatory and nutritional status in patients starting dialysis:a prospective cohort study[J]. Blood Purif,2015,40(3):209-217.
[12]庞欣欣,张丽洁,张枫,等.合适的转铁蛋白饱和度有助于血液透析患者血红蛋白持续达标[J].中国血液净化,2015,14(3):141-144.
[13] KARABOYAS A,ZEE J,MORGENSTERN H,et al. Understanding the recent increase in ferritin levels in united states dialysis patients:potential impact of changes in intravenous iron and erythropoiesis-stimulating agent dosing[J]. Clin J Am Soc Nephrol,2015,10(10):1814-1821.
[14]刘日光,陈林,傅君舟,等.单中心初始血液透析患者透前贫血治疗状况的回顾性调查[J].中国中西医结合肾病杂志,2014,15(9):791-793.
[15]卞爱琳,卢惠茹,梁刚,等.老年人贫血及营养状况分析[J].中华老年医学杂志,2011,30(4):313-315.
[2] HECKING M,KARABOYAS A,SARAN R,et al. Predialysis serumsodium level, dialysate sodium, and mortality in maintenance hemodialysis patients:the Dialysis Outcomes and Practice Patterns Study(DOPPS)[J]. Am J Kidney Dis,2012,59(2):238-248.
[3] CAMPBELL K L,BAUER J D,IKEHIRO A,et al. Role of nutrition impact symptoms in predicting nutritional status and clinical outcome in hemodialysis patients:a potential screening tool[J]. J Ren Nutr,2013,23(4):302-307.
[4]缪妙,王成军,王昱,等.维持性血液透析患者营养不良情况及其影响因素分析[J].中国中西医结合肾病杂志,2018,19(4):301-304.
[5] KALANTAR-ZADEH K,KLEINER M,DUNNE E,et al. A modified quantitative subjective global assessment of nutrition for dialysis patients[J]. Nephrol Dial Transplant, 1999,14(7):1732-1738.
[6]漆映辉,倪兆慧,曲晓璐,等.不同血液净化技术的联合应用对维持性血液透析患者矿物质和骨异常的影响[J].中国血液净化,2016,15(2):72-76.
[7]翁丽娜,崔益鸿,徐玮.维持性血液透析患者营养状况及其影响因素分析[J].海南医学,2018,29(6):773-777.
[8]何琴,蔡宏,张伟明,等.维持性血液透析患者贫血状况与预后的关系[J].中华肾脏病杂志,2016,32(2):110-117.
[9]刘延.促红素联合多糖铁复合物及左卡尼汀治疗维持性血液透析患者肾性贫血临床研究[J].河北医学,2016,22(4):529-532.
[10]王文素,周建伟,张倩,等.血液灌流对维持性血液透析患者肾性贫血和微炎症状态的影响[J].河北医科大学学报,2016,37(5):585-588.
[11] PARK K S,RYU G W, JHEE J H, et al. Serum ferritin predicts mortality regardless of inflammatory and nutritional status in patients starting dialysis:a prospective cohort study[J]. Blood Purif,2015,40(3):209-217.
[12]庞欣欣,张丽洁,张枫,等.合适的转铁蛋白饱和度有助于血液透析患者血红蛋白持续达标[J].中国血液净化,2015,14(3):141-144.
[13] KARABOYAS A,ZEE J,MORGENSTERN H,et al. Understanding the recent increase in ferritin levels in united states dialysis patients:potential impact of changes in intravenous iron and erythropoiesis-stimulating agent dosing[J]. Clin J Am Soc Nephrol,2015,10(10):1814-1821.
[14]刘日光,陈林,傅君舟,等.单中心初始血液透析患者透前贫血治疗状况的回顾性调查[J].中国中西医结合肾病杂志,2014,15(9):791-793.
[15]卞爱琳,卢惠茹,梁刚,等.老年人贫血及营养状况分析[J].中华老年医学杂志,2011,30(4):313-315.