摘要
目的探讨经维持性血液透析治疗的终末期肾脏病(end-stage renal disease,ESRD)患者蛋白质能量消耗(protein-energy wasting,PEW)与胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平的关系。方法120例经维持性血液透析治疗的ESRD患者,根据是否并发PEW分为PEW组63例和非PEW组57例,选取50例体检健康者为对照组;比较3组血清IGF-1水平。收集ESRD患者一般资料和实验室指标,并进行2组间比较;采用Pearson相关性分析法分析PEW组血清IGF-1水平与临床参数的相关性;采用多因素logistic回归分析ESRD患者发生PEW的影响因素;绘制ROC曲线,评估血清IGF-1水平对经维持性血液透析治疗的ESRD患者发生PEW的预测效能。结果PEW组血清IGF-1水平[(113.19±17.45)μg/L]低于非PEW组[(162.09±19.67)μg/L]和对照组[(187.42±24.53)μg/L](P<0.05),非PEW组低于对照组(P<0.05)。PEW组患者体质量指数、上臂肌围和血清三酰甘油、HCO3-、血红蛋白、前白蛋白、白蛋白水平低于非PEW组(P<0.05),胰岛素抵抗指数、血清白细胞介素-6、血肌酐水平高于非PEW组(P<0.05);PEW组血清IGF-1水平与体质量指数(r=0.628,P<0.001)、上臂肌围(r=0.632,P<0.001)、血红蛋白(r=0.554,P<0.001)、HCO3-(r=0.536,P<0.001)、前白蛋白(r=0.653,P<0.001)、白蛋白水平(r=0.635,P<0.001)、三酰甘油(r=0.534,P<0.001)呈正相关,与胰岛素抵抗指数(r=—0.563,P<0.001)、白细胞介素-6(r=—0.692,P<0.001)、血肌酐水平(r=—0.614,P<0.001)呈负相关;IGF-1(OR=5.818,95%CI:0.726~16.923,P=0.001)、上臂肌围(OR=0.047,95%CI:0.008~0.283,P=0.001)、胰岛素抵抗指数(OR=0.964,95%CI:0.836~0.126,P=0.026)、HCO3-(OR=1.062,95%CI:0.847~0.138,P=0.036)、前白蛋白(OR=0.969,95%CI:0.949~0.989,P=0.003)、白蛋白(OR=0.170,95%CI:0.065~0.441,P<0.001)、白细胞介素-6(OR=1.293,95%CI:1.175~1.424,P<0.001)、血肌酐(OR=1.018,95%CI:1.010~1.026,P<0.001)是经维持性血液透析治疗的ESRD患者发生PEW的影响因素;血清IGF-1最佳截断值为140.
Objective To investigate the relationship between serum insulin-like growth factor-1(IGF-1)level and protein-energy wasting(PEW)in patients undergoing maintenance hemodialysis(MHD)for end-stage renal disease(ESRD).Methods Totally 120 ESRD patients undergoing MHD were divided into PEW group(n=63)and non-PEW group(n=57),and another 50 healthy volunteers were as controls(control group).The serum IGF-1 levels were measured and compared among three groups.The general data and laboratory parameters of ESRD patients were collected and compared between PEW group and non-PEW group.Pearson correlation analysis was used to assess the correlation between serum IGF-1 levels and clinical parameters in PEW group.Multivariate logistic regression was used to analyze the influencing factors of PEW in ESRD patients.ROC curve was drawn to evaluate the predictive efficiency of serum IGF-1 level on PEW in ESRD patients.Results The serum IGF-1 level was significantly lower in PEW group((113.19±17.45)μg/L)than that in non-PEW group((162.09±19.67)μg/L)and control group((187.42±24.53)μg/L)(P<0.05),and lower in non-PEW group than that in control group(P<0.05).The body mass index,upper arm muscle circumference,serum triacylglycerol,HCO3-,hemoglobin,prealbumin and albumin levels were significantly lower in PEW group than those in non-PEW group(P<0.05),while homeostasis model assessment of insulin resistance,serum interleukin-6 and serum creatinine levels were significantly higher in PEW group than those in non-PEW group(P<0.05).The serum IGF-1 level was positively correlated with body mass index(r=0.628,P<0.001),upper arm muscle circumference(r=0.632,P<0.001),serum hemoglobin(r=0.554,P<0.001),HCO-3(r=0.536,P<0.001),prealbumin(r=0.653,P<0.001),albumin(r=0.635,P<0.001)and serum triacylglycerol(r=0.534,P<0.001),and negatively correlated with homeostasis model assessment of insulin resistance(r=—0.563,P<0.001),interleukin-6(r=—0.692,P<0.001)and serum creatinine(r=—0.614,P<0.001)in PEW group.IGF-1(OR=5.818,95%CI:0.726-16.923,P=0.001),
作者
边小勇
祁佳梅
于小芸
BIAN Xiao-yong;QI Jia-mei;YU Xiao-yun(Department of Nephrology,Qingyang People's Hospital,Qingyang,Gansu 745000,China)
出处
《中华实用诊断与治疗杂志》
2021年第6期592-595,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
甘肃省卫生行业科研计划项目(GSWSKY2018-053)。
