维持性血液透析患者维生素D浓度与营养状况的相关研究

发布时间：2018-05-21 01:31

本文选题：血液透析 + 维生素D　；参考：《承德医学院》2015年硕士论文

【摘要】：目的:了解维持性血液透析(Maintenance Hemodialysis,MHD)患者血清中25-羟维生素D3[25-OH-D3]浓度与营养指标的相关性,为提高维持性血液透析患者生活质量,降低营养不良的发生率提供研究依据。方法:选取2014年6月至2014年12月于河北省承德医学院附属医院血液净化中心行维持性血液透析的120例患者作为研究对象,其中男性71例,女性49例,年龄22~86岁,平均年龄(57.83±14.76)岁,透析龄为0.25~9.08年,平均透析龄(1.85±1.77)年。收集一般资料:包括性别、年龄、身高、体重、身体质量指数(BMI)、透析时间、残余尿量、收缩压、舒张压、上臂围、肱二头肌皮褶厚度、肱三头肌皮褶厚度、改良主观营养评估(MQSGA)、检查血清25-OH-D3及其它生化指标。以25-OH-D3水平大于30ng/ml为正常标准,在30~15ng/ml为不足标准,小于15ng/ml为缺乏标准,其中64例MHD患者25-OH-D3不足、56例MHD患者25-OH-D3缺乏,无25-OH-D3水平正常者。将25-OH-D3分为不足组与缺乏组,并对两组中的各项生化指标、一般资料等进行统计学分析;将MHD合并糖尿病患者58例与MHD非糖尿病患者62例分为糖尿病组与非糖尿病组,并对两组中的生化指标、一般资料等进行统计学分析。纳入本研究中的MHD患者均知情自愿,并签署同意书。透析方法:所有透析患者均采用德国Fresenius4008S型血液透析机,采用德国费森尤斯聚砜膜透析器,其有效膜面积为1.5~1.7m2,均为碳酸氢盐透析液,K+2mmol/L、Na+140mmol/L、Cl-109.5mmol/L、Mg2+0.5mmol/L、Ca2+1.5mmol/L、HCO3-32mmol/L,血流的速度为180~250ml/min,透析液的流量为500ml/min,透析温度为36.5℃,维持性血液透析2~3次/周,透析时间4h/次,抗凝药物均采用低分子肝素钠或普通肝素,血液透析通路为前臂动静脉内瘘或右颈内静脉半永久导管。将所有入组MHD患者采取清晨空腹(禁食10~12h)静脉血2ml,将血标本静置后放入离心机3000r/min离心10min并收集血清标本置于-20℃环境冷冻保存,用酶联免疫法定量测定人血清或血浆中25-羟基维生素D3[25-OH-D3]的含量,试剂盒购自北京博晖创新光电技术股份有限公司;另外取透析前静脉血2ml,送入承德医学院附属医院检验科,采用免疫化学发光法检测患者透前甲状旁腺激素(Parathyroid hormone,PTH)、铁蛋白(Ferritin,FERR),全自动生化仪检测患者透前血钙(Calciums--hot Nmmdia,Ca)、磷(Phosphorus,P)、白蛋白(Serumalbumin,ALB)、血红蛋白(Hemoglobin,HGB)、中性粒细胞计数(Neutrophilicgranulocyte,NEUT#)、血β2微球蛋白(β2-microglobulin,β2-MG)、血尿酸(Uric acid,UA)、血肌酐(Serum Creatinine,Scr),尿素氮(Bloodureanitrogen,BUN)等生化指标。统计学方法应用SPSS17.0软件进行统计学分析。正态分布的计量资料用均数±标准差表示。两组计量资料的比较采用两独立样本t检验;率的比较采用卡方检验,P0.05为差异有统计学意义。探索25-OH-D3的独立危险因素采用Logistics回归分析。以患者25-OH-D3(不足、缺乏)水平为因变量,以年龄、是否患糖尿病、身体质量指数BMI、上臂围、白蛋白ALB及血肌酐Scr为自变量。P0.1为差异有统计学意义。结果:1 MHD患者糖尿病组与非糖尿病组进行比较,MHD患者25-OH-D3(15.43±6.11ng/ml vs17.96±5.33ng/ml,p0.01)、ALB(36.68±4.00g/L vs38.90±3.85g/L,p0.01)、β2-MG(18.72±5.45mg/L vs20.67±5.64mg/L,p0.05)、BUN(19.97±6.55mmol/L vs 23.16±8.21mmol/L,p0.05)、Scr(713.70±232.82umol/L vs 909.89±279.57umol/L,p0.01)水平降低,有统计学意义;MHD患者的年龄(61.48±12.61岁vs54.42±15.87岁,p0.01)、肱二头肌皮褶厚度(6.36±3.00cm vs5.14±2.70cm,p0.05)、肱三头肌皮褶厚度(13.16±5.64cm vs10.95±5.37cm,p0.05)水平升高,有统计学意义。(基本情况见表4)2 MHD患者25-OH-D3不足与缺乏组比较,MHD患者的年龄(23.27±4.67岁vs59.68±14.19岁,p0.01)、糖尿病(37.5%vs60.7%,p0.05)比例降低,有统计学意义;MHD患者的上臂围(25.50±2.95cm vs24.65±2.37cm,p0.05)、BMI(23.37±4.58kg/m2 vs21.46±4.23kg/m2,p0.01)、ALB(38.43±4.28g/L vs 37.09±3.68 g/L,p0.05)、Scr(854.78±289.71umol/L vs768.69±252.26umol/L,p0.05)水平升高,有统计学意义。(基本情况见表5)3 Logistics回归分析结果显示BMI(p0.05)、ALB(p0.05)、糖尿病(p0.05)为25-OH-D3的独立危险因素。(基本情况见表6、7)结论:1对MHD患者25-OH-D3水平检测发现,MHD患者中25-OH-D3缺乏普遍存在。2 MHD患者糖尿病组中ALB、25-OH-D3水平明显低于非糖尿病组,提示糖尿病加重营养不良及25-OH-D3缺乏。3 MHD患者的ALB、BMI、糖尿病为25-OH-D3水平的独立危险因素,提示25-OH-D3缺乏与营养不良存在相关性。
[Abstract]:Objective: to understand the correlation between the serum concentration of 25- hydroxyvitamin D3[25-OH-D3] and the nutritional indexes in the serum of Maintenance Hemodialysis (MHD) patients, so as to provide the basis for improving the quality of life of maintenance hemodialysis patients and reducing the incidence of malnutrition. Method: from June 2014 to December 2014 in Hebei Province, Chengde medicine was selected. 120 cases of maintenance hemodialysis were performed in the blood purification center of the Affiliated Hospital of the college. There were 71 males and 49 females, age 22~86 years, the average age (57.83 + 14.76) years, 0.25~9.08 years of dialysis age and average age of dialysis (1.85 + 1.77) years. The data included sex, age, height, weight, body mass index (BM). I), dialytic time, residual urine volume, systolic pressure, diastolic pressure, upper arm circumference, skin fold thickness of biceps brachii, skin fold thickness of triceps brachii, modified subjective nutrition assessment (MQSGA), serum 25-OH-D3 and other biochemical indexes. 25-OH-D3 level was higher than 30ng/ml as normal standard, 30~15ng/ml was less than 15ng/ml as a lack standard, 64 cases M HD patients were deficient in 25-OH-D3, 56 cases of MHD patients with 25-OH-D3 deficiency and no 25-OH-D3 level. The 25-OH-D3 was divided into insufficient group and lack group, and the biochemical indexes in the two groups were statistically analyzed. 58 cases of diabetic patients and 62 non diabetic patients with MHD were divided into diabetes group and non diabetic group, and two of non diabetic patients were divided into two. The biochemical indexes and general data in the group were statistically analyzed. The MHD patients in this study were informed voluntarily and signed the agreement. All dialysis patients were treated with German Fresenius polysulfone membrane dialyzer with a German Fresenius polysulfone membrane dialyzer with an effective membrane area of 1.5~1.7m2, which were both bicarbonate. Analysis of fluid, K+2mmol/L, Na+140mmol/L, Cl-109.5mmol/L, Mg2+0.5mmol/L, Ca2+1.5mmol/L, HCO3-32mmol/L, the velocity of blood flow was 180~250ml/min, the flow rate of dialysate was 500ml/min, the dialysis temperature was 36.5 C, the maintenance hemodialysis was 2~3 / week, the dialysis time was 4h/ times, and the anticoagulant used low molecular weight heparin sodium or ordinary heparin, hemodialysis pathway. For the forearm arteriovenous fistula or the right internal jugular vein of the internal jugular vein, all the MHD patients were treated with the early morning fasting (fasting 10~12h) venous blood 2ml. The blood specimens were placed in the centrifuge 3000r/min centrifuge 10min and the serum samples were collected at -20 centigrade for cryopreservation, and the quantitative determination of 25- hydroxyvitamins in human serum or plasma by enzyme immunoassay was used to determine the 25- hydroxyl dimension in human serum and plasma. The content of D3[25-OH-D3] was purchased from Beijing Bo Hui innovation Optoelectronic Technology (Limited by Share Ltd), and the pre dialysis venous blood 2ml was taken into the Affiliated Hospital of Chengde Medical College laboratory department, and the immunochemiluminescence method was used to detect Parathyroid hormone (PTH), Ferritin, FERR, and automatic biochemical analyzer. Calciums--hot Nmmdia (Ca), phosphorus (Phosphorus, P), albumin (Serumalbumin, ALB), hemoglobin (Hemoglobin, HGB), neutrophilic granulocyte count (Neutrophilicgranulocyte, NEUT#), beta 2 microglobulin (beta 2-microglobulin, beta), blood uric acid, urea nitrogen, urea nitrogen, were detected. Itrogen, BUN) and other biochemical indexes. Statistical method was used to make statistical analysis with SPSS17.0 software. The measurement data of normal distribution were expressed with mean standard deviation. Two independent sample t tests were used for the comparison of the two groups of measurement data; the comparison of the rate adopted the chi square test, and P0.05 was the difference of the overall planning significance. To explore the independent risk factors for 25-OH-D3. Logistics regression analysis. With the patient's 25-OH-D3 (deficiency, lack) level as the dependent variable, age, diabetes, body mass index BMI, upper arm circumference, albumin ALB and serum creatinine Scr as independent variables,.P0.1 were statistically significant. Results: 1 MHD patients were compared with non diabetic group, MHD patients 25-OH-D3 (15.43 + 6.11). Ng/ml vs17.96 + 5.33ng/ml, P0.01), ALB (36.68 + 4.00g/L vs38.90 + 3.85g/L, P0.01), and beta 2-MG (18.72 + 5.45mg/L vs20.67 23.16). 42 + 15.87 years old, P0.01), the thickness of the biceps brachii skin fold (6.36 + 3.00cm vs5.14 + 2.70cm, P0.05), the thickness of the triceps brachii (13.16 + 5.64cm vs10.95 + 5.37cm, P0.05), was statistically significant. (the basic situation is table 4) 2 MHD patients were compared with the deficiency group, the age of the MHD patients (23.27 + 4.67 years old, 14.19 years old, sugar), sugar The ratio of 37.5%vs60.7% (P0.05) was reduced, and there was statistical significance. The upper arm circumference of MHD patients (25.50 + 2.95cm vs24.65 + 2.37cm, P0.05), BMI (23.37 + 4.58kg/m2 vs21.46 + 4.23kg/m2, P0.01), (38.43 + 37.09 + 3.68), had statistical significance. In this case, table 5) 3 Logistics regression analysis results show that BMI (P0.05), ALB (P0.05), and diabetes (P0.05) are independent risk factors for 25-OH-D3. (basically, table 6,7) conclusion: 1 for MHD patients 25-OH-D3 level detection, 25-OH-D3 deficiency generally exists in the diabetic group in MHD patients, significantly lower than non diabetes. The disease group suggests that diabetes aggravated dystrophy and 25-OH-D3 deficiency of.3 MHD patients with ALB, BMI, and diabetes are independent risk factors for 25-OH-D3 levels, suggesting a correlation between the lack of 25-OH-D3 and malnutrition.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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