营养不良、微炎症状态对腹膜透析患者心血管钙化的影响

胡绍兰; 杨敏; 白彝华; 郑帅; 肖明鲜

营养不良、微炎症状态对腹膜透析患者心血管钙化的影响

昆明医科大学第二附属医院肾内科

基金项目:

基金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2015FB054);

计量
- 文章访问数: 2104
- HTML全文浏览量: 748
- PDF下载量: 156
- 被引次数: 0
出版历程
- 收稿日期: 2018-03-14

Effect of Malnutrition and Micro-inflammatory State on Cardiovascular Calcification in Patients with Peritoneal Dialysis

Funds:

基金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2015FB054);

摘要

摘要: 目的分析维持性腹膜透析患者营养不良、微炎症状态与心血管钙化的相关性, 并探讨心血管钙化的相关危险因素.方法选择2016年1月至2017年12月昆明医科大学第二附属医院行持续性非卧床腹膜透析 (CAPD) 患者81例, 完善该81例患者相关实验室检查、人体测量, 行超声心动图评估其心脏瓣膜钙化 (CVC) 、腹部侧位片了解其腹主动脉钙化 (AAC) 情况, 采用改良定量主观整体评估表 (MQSGA) ) 评估患者营养状况, 根据评分分为营养正常 (<10分) 、轻中度营养不良 (1120分) 、重度营养不良 (2135分) 组.结果营养正常组24例 (29.6%) , 轻中度营养不良组41例 (50.6%) , 重度营养不良组16例 (19.8%) , 瓣膜钙化发生率为45.7%, 腹主动脉钙化发生率为24.7%, 心血管钙化发生率为55.6%.营养不良、微炎症状态在有无瓣膜钙化2组间差异有统计意义意义 (P<0.05) , 年龄 (P=0.006) 、透析龄 (P=0.048) 、前白蛋白 (P=0.015) 、磷 (P=0.007) 、钙磷乘积 (P=0.013) 、hs-CRP (P=0.004) 在瓣膜钙化组和非瓣膜钙化组之间差异有统计学意义.结论腹膜透析患者普遍存在营养不良、微炎症状态, 营养不良、微炎症状态越重心血管钙化发生率越高, 高龄、长透析龄、低前白蛋白、高磷、高钙磷乘积、hs-CRP升高是心脏瓣膜钙化的独立危险因素.
- 营养不良 /
- 微炎症 /
- 心血管钙化 /
- 腹膜透析
Abstract: Objective To analyze the correlation between cardiovascular calcification and malnutrition and micro-inflammatory state, and to explore the related risk factors of cardiovascular calcification in patients with maintenance peritoneal dialysis.Methods From January 2016 to December 2017, 81 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) at the Second Affiliated Hospital of Kunming Medical University were enrolled in the study. The related laboratory tests and body measurements were performed in the81 patients. Cardiac Valve Calcification (CVC) was estimated by transthoracic echocardiography and abdomen lateral radiographs to understand the status of abdominal aortic calcification (AAC) . Nutritional status was assessed by modified quantitative subjective global assessment table (MQSGA) , which was divided into normal nutrition (<10 points) , mild to moderate malnutrition (11-20 points) , and severe malnutrition (21-35 points) group. Results Twenty-four patients (29.6%) in the normal group, forty-one patients (50.6%) in the mild to moderate group, and sixteen patients (19.8%) in the severe group were found.The incidence of valve calcification, abdominal aorta calcification and cardiovascular calcification were 45.7%, 24.7%, and 55.6% respectively. Significant difference was found in malnutrition and micro-inflammatory state between the two groups with and without valve calcification. Age (P = 0.006) , dialysis age (P = 0.048) , prealbumin (P = 0.015) , phosphorus (P = 0.007) , calcium-phosphorus product (P = 0.013) and hs-CRP (P = 0.004) were significantly different between valvular and non-valvular calcification group. Conclusion Malnutrition and micro-inflammatory states can be found in most peritoneal dialysis patients.The more severe the malnutrition and micro-inflammatory state are, the higher the incidence of cardiovascular calcification is.Advanced age, years of dialysis, low prealbumin, high phosphorus, high calcium-phosphorus product, and elevated hs-CRP can be the independent risk factor of cardiovascular calcification.
- Malnutrition /
- Micro-inflammation /
- Cardiovascular calcification /
- Peritoneal dialysis

HTML全文

参考文献(19)

[1]	[1]HARVINDER G S, SWEE W C, KARUPAIAH T, et al.Dialysis malnutrition and malnutrition inflammation scores:screening tools for prediction of dialysis-related protein-energy wasting in Malaysia[J].Asia Pacific Journal of Clinical Nutrition, 2016, 25 (1) :26-33.
[2]	[2]EKRAMZADEH M, SOHRABI Z, SALEHI M, et al.Adiponectin as a novel indicator of malnutrition and inflammation in hemodialysis patients[J].Iranian Journal of Kidney Diseases, 2013, 7 (4) :304-308.
[3]	[3]SZYMON B, TOMASZ H, MARIUSZ K, et al.Validation of mini nutritional assessment scale in peritoneal dialysis patients[J].Archives of Medical Science Ams, 2013, 9 (4) :669-676.
[4]	[4]YEE W A.Calcium balance and negative impact of calcium load in peritoneal dialysis patients.[J].Perit Dial Int, 2014, 34 (4) :345-352.
[5]	[5]AVILADAZ M, MORAVILLALPANDO C, PRADOURIBE M C, et al.De novo development of heart valve calcification in incident peritoneal dialysis patients[J].Archives of Medical Research, 2014, 45 (7) :638-644.
[6]侯金花, 蒋琦, 刘志红.2017 KDIGO临床实践指南更新:慢性肾脏病矿物质与骨异常诊断、评估、预防和治疗[J].肾脏病与透析肾移植杂志, 2017, 26 (5) :462-466.
[7]	[7]SEDHAIN A, HADA R, AGRAWAL R K, et al.Assessment of nutritional status of nepalese hemodialysis patients by anthropometric examinations and modified quantitative subjective global assessment[J].Nutrition&Metabolic Insights, 2015, 8 (8) :21-27.
[8]	[8]KOTUR-STEVULJEVIC J, SIMIC-OGRIZOVIC S, DOPSAJ V, et al.A hazardous link between malnutrition, inflammation and oxidative stress in renal patients[J].Clinical Biochemistry, 2012, 45 (15) :1202-1205.
[9]	[9]CHEN J, PENG H, ZHANG K, et al.The insufficiency intake of dietary micronutrients sssociated with malnutrition-inflammation dcore in hemodialysis population[J].Plos One, 2013, 8 (6) :e66841.
[10]	[10]SEZER S, OZDEMIR F N, ARAT Z, et al.Triad of malnutrition, inflammation, and atherosclerosis in hemodialysis patients[J].Nephron, 2002, 91 (3) :456-462.
[11]	[11]WANG AY, WOO J, WANG M, et al.Association of inflammation and malnutrition with cardiac valve calcification in continuous ambulatory peritoneal dialysis patients[J].J Am Soc Nephrol, 2001, 12 (9) :1927-1936.
[12]	[12]PENCAK P, CZERWIENSKA B, FICEK R, et al.Calcification of coronary arteries and abdominal aorta in relation to traditional and novel risk factors of atherosclerosis in hemodialysis patients[J].Bmc Nephrology, 2013, 14 (1) :2-10
[13]姜山, 王春元, 沈华英, 等.老年腹膜透析患者心脏瓣膜钙化的危险因素[J].中国老年学, 2015, 35 (22) :6387-6389.
[14]	[14]STENVINKEL P, HEIMBRGER O, LINDHOLM B, et al.Are there two types of malnutrition in chronic renal failure evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome) [J].Review of Middle East Studies, 2000, 15 (7) :953-960.
[15]	[15]REBI D, RAI S, HAMZI MEHMEDBAI A, et al.Valvular calcification and left ventricular modifying in peritoneal dialysis patients[J].Ren Fail, 2015, 37 (8) :1316-1322.
[16]	[16] GYUNG K H, SONG S W, YUN K T, et al.Risk factors for progression of aortic arch calcification in patients on maintenance hemodialysis and peritoneal dialysis[J].Hemodialysis International International Symposium on Home Hemodialysis, 2011, 15 (4) :460-467.
[17]	[17]WANG C, JIANG L, FENG S, et al.Risk factor analysis of calcification in aortic and mitral valves in maintenance peritoneal dialysis patients[J].Kidney&Blood Pressure Research, 2013, 37 (4-5) :488-495.
[18]	[18]SHANAHAN C M, CROUTHAMEL M H, KAPUSTIN A, et al.Arterial calcification in chronic kidney disease:key roles for calcium and phosphate[J].Circulation Research, 2011, 109 (6) :697-711.
[19]	[19]OHTAKE T, KOBAYASHI S.Impact of vascular calcification on cardiovascular mortality in hemodialysis patients:clinical significance, mechanisms and possible strategies for treatment[J].Renal Replacement Therapy, 2017, 3 (1) :13.

相关文章(20)

[1]	关毅标, 黄胜, 李丽波. 杂合型血液净化对腹膜透析不充分ESRD患者透析充分性、免疫、炎症的影响, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240818
[2]	刘玉文, 张丽梅, 王永丽, 徐小梅, 母亚丹, 杨志杰, 杨树婷, 罗凤云. 老年多学科团队服务对共病伴营养不良老年患者的疗效分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20241211
[3]	雷娅婷, 张俊玲, 周竹, 罗婷, 朱小花. 持续非卧床腹膜透析患者心理现状与自我管理能力相关性研究, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20241014
[4]	赵江, 汤钦岚, 闵向东, 张强, 陈留萍, 阮元, 刘志涛. 云南贡山县6～80岁独龙族居民营养不良影响因素分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210226
[5]	杨荆, 王淑娴, 周竹. 有氧运动与营养管理对维持性血透患者营养不良的疗效, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20201123
[6]	胡绍兰, 杨敏, 白彝华, 郑帅, 肖明鲜, 张馨心, 马丽. 复方α-酮酸联合低蛋白饮食对腹膜透析患者营养及微炎症状态的影响, 昆明医科大学学报.
[7]	杨倩蓉, 杨明莹, 黄芩, 于云霞, 王剑松, 王海峰. 延续护理对持续性非卧床腹膜透析患者生活质量的影响, 昆明医科大学学报.
[8]	李梅蕊, 张铁松, 王美芬, 李斌, 侯玉玲, 阎洁. 云南省儿科住院患儿营养风险筛查与营养状况调查, 昆明医科大学学报.
[9]	茶春丽, 李靖娟, 陈国姝, 窦丽娜, 代留玲, 李俊. 透析患者微炎症状态与血脂代谢及钙磷代谢的相关性, 昆明医科大学学报.
[10]	黄朝莉, 谷粒, 宁成. 前列地尔联合左卡尼汀对维持性血液透析患者微炎症及营养状态的影响, 昆明医科大学学报.
[11]	白彝华. 云南地区腹膜透析患者发生心脑血管事件的危险因素, 昆明医科大学学报.
[12]	白彝华. 抑郁状态对维持性腹膜透析患者发生骨质疏松的影响, 昆明医科大学学报.
[13]	孟鸿琼. 不同营养状态对老年慢性肺源性心脏病患者糖代谢异常的影响, 昆明医科大学学报.
[14]	沈丽达. 胃癌患者营养风险筛查和营养支持治疗调查分析, 昆明医科大学学报.
[15]	马娟. 184例心血管疾病患者吸烟及戒烟现状调查分析, 昆明医科大学学报.
[16]	光雪峰. 心血管疾病诊疗进展, 昆明医科大学学报.
[17]	龙晶. 云南省边远农村12~18月龄小儿营养状况及影响因素分析, 昆明医科大学学报.
[18]	. 心血管外科进展, 昆明医科大学学报.
[19]	李俊. 维持性血液透析患者微炎症状态与心血管并发症相关性研究, 昆明医科大学学报.
[20]	翁敏. 腹膜透析患者钙磷代谢紊乱的探讨, 昆明医科大学学报.