天津医药

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血液透析患者外周血NF-κBp65与超敏C反应蛋白及营养不良的相关性

王景福   

  1. 承德医学院附属医院
  • 收稿日期:2011-07-14 修回日期:2011-10-20 出版日期:2012-01-15 发布日期:2012-01-15
  • 通讯作者: 王景福

Correlations between NF-κBp65 in Peripheral Blood Mononuclear Cells and High Sensitive C-reactive Protein and Malnutrition in Hemodialysis Patients

Jing-Fu WANG   

  • Received:2011-07-14 Revised:2011-10-20 Published:2012-01-15 Online:2012-01-15
  • Contact: Jing-Fu WANG

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摘要： 目的：探讨维持性血液透析（MHD）患者外周血单个核细胞（PBMC）核因子-κBp65（NF-κBp65）活性、超敏C反应蛋白(hs-CRP)水平与营养不良的相关性。方法：选择2010年6月—2011年5月间在我院行MHD治疗3个月以上、尿素清除指数（Kt/V）>1.2的患者71例。营养良好者27例，营养不良者（44例）。测量其营养指标包括主观综合营养评估（SGA）、血生化、人体学等参数。采用ELISA法检测PBMC核蛋白提取物中NF-κBp65的活性。采用免疫透射比浊法检测血清hs-CRP水平。双变量相关性采用Spearman等级相关或Pearson直线相关，控制年龄、性别、身高、体质量影响，采用偏相关分析作多因素分析。结果:71例MHD患者发生营养不良者44例，占61.97％。营养不良组患者NF-κBp65、hs-CRP水平高于营养良好组（均P＜0.01）。营养不良组患者的标准化蛋白分解率（nPCR）、血红蛋白（HB）、血清白蛋白（ALB）、血清前白蛋白（PA）、血清肌酐（Scr）、血清尿素氮（BUN）、肱三头肌皮褶厚度（TSF）、中臂肌围（MAMC）、中臂围（MAC）、体质量指数（BMI）、握力（GS）均低于营养良好组（P＜0.05或P＜0.01）。SGA与NF-κBp65活性、hs-CRP水平均呈正相关（均P＜0.01）。NF-κBp65活性与hs-CRP水平、年龄呈正相关（P＜0.05 或P＜0.01），与HB、ALB、PA呈负相关（P＜0.01）。hs-CRP水平与HB、ALB、PA、TSF、MAMC、MAC呈负相关(P＜0.05或P＜0.01）。将年龄、性别、身高、体质量作为控制因素，将NF-κBp65、hs-CRP与营养相关指标进行偏相关分析，结果显示：SGA与NF-κBp65、hs-CRP均呈正相关（均P＜0.01）。NF-κBp65活性与hs-CRP水平呈正相关（r=0.777，P＜0.01），NF-κBp65、hs-CRP与HB、ALB、MAMC、MAC均呈负相关（P＜0.05或P＜0.01），NF-κBp65与PA呈负相关（P＜0.01），hs-CRP与PA无相关性。结论：MHD患者营养不良发生率较高。NF-κBp65活性可能较血清hs-CRP水平更早发现营养不良。

关键词: 肾疾病, 肾透析, NF –κB, C反应蛋白, 炎症, 营养不良

Abstract: Objective: To investigate the correlations of NF-κBp65 activity in peripheral blood mononuclear cells(PBMC) with high sensitive C-reactive protein(hs-CRP) levels and malnutrition in patients with maintenance hemodialysis.Method: 71 MHD patients were treated in our hospital from June in 2010 to May in 2011, whose treatment period was longer than 3 months and the Urea remove index(Kt/V) was greater than 1.2. MHD patients with malnutrition were 44 cases and who with good nutrition were 27 cases.The Subjective Global Assessment of nutrition(SGA),anthropometric indicators, blood biochemistry of 71 patients with MHD were detected. ELISA method was used to test the activity of NF-κBp65 in PBMC. Immune turbidimetric method was used to test the serum levels of hs-CRP. Bivariate correlation analysis was measured with Pearson linear correlation or Spearman rank correlation analysis. After controlling age, gender, height, weight, Partial correlation analysis was used for multiple factors analysis.Results:The patients with malnutrition were 44 cases in 71 MHD patients, accounting for 61.97%. The NF-κBp65 absorbance value and the hs-CRP levels in malnutrition group were higher than that of good nutrition group(P<0.01). The normalized protein catabolic rate (nPCR), hemoglobin (HB), serum albumin(ALB), serum prealbumin(PA), serum creatinine (Scr), blood urea nitrogen(BUN), triceps skinfold(TSF), mid-arm muscle circumference (MAMC), mid-arm circumference (MAC), Body mass index (BMI), gripping strength (GS) in malnutrition group were lower than that of the good nutrition group(P<0.05 or P<0.01).SGA value was positively correlated with NF-κBp65 activity and hs-CRP levels (P<0.01). NF-κBp65 activity was positively correlated with hs-CRP levels and age(P<0.01 or P＜0.05), and was negative correlated with HB,ALB,PA（P＜0.01).The hs-CRP levels was significantly negatively correlated with the HB, ALB, PA, TSF,MAMC, MAC（P＜0.05 or P＜0.01). Controlling the variables of age, gender, height and weight, the correlation of NF-κBp65 and hs-CRP with some other parameters associated with nutrition was under partial correlation analysis. The results showed that SGA value was positively correlated with NF-κBp65 activity and hs-CRP levels (P<0.01).NF-κBp65 activity was positively correlated with hs-CRP levels (r=0.777，P<0.01),NF-κBp65 activity and hs-CRP levels were negative correlated with HB,ALB,MAMC,MAC（P＜0.05 or P＜0.01).NF-κBp65 activity was negatively correlated with the PA（P＜0.01),The hs-CRP levels was not correlated with the PA.Conclusions: The incidence rate of malnutrition was higher in MHD patients.The malnutrition could be found earlier by NF-κBp65 activity than hs-CRP levels.

Key words: Kidney diseases, renal dialysis, NF-kappa B, C-reactive protein, inflammation, Malnutrition