Relationships of Malnutrition, Inflammation and Cardiovascular Disease in Chronic Peritoneal Dialysis Patients

慢性腹膜透析患者的營養不良、發炎和心血管疾病之關連性

吳安邦(An-Bang Wu) ； 吳紅蓮(Hung-Lien Wu) ； 程盟夫(Meng-Fu Cheng) ； 曾進忠(Chin-Chung Tseng) ； 黃延君(Yan-Jiun Huang) ； 黃建鐘(Jeng-Jong Huang)

《Acta Nephrologica》 21卷1期 (2007/03) Pp. 40-47

摘要

背景：營養不良、慢性發炎以及心血管疾病（MIA症候群）三者常同時存在，它們是影響血液透析患者預後的重要因素。本研究目的是要檢驗此三者在南台灣腹膜透析患者問的相關性。
方法：本研究登錄92位成大醫院慢性腹膜透析成人患者（36位男性、56位女性），並根據有無心血管疾病或有無慢性發炎作分組，我們比較他們的人體測量、生化數值、發炎指數（發炎指數≧8mg/dL，視為慢性發炎）以及營養狀況（SGA score≦5視為營養不良）。
結果：九十二位患者的平均年齡為42.0±13.7歲，接受腹膜透析的平均時間為3.7±3.1年，其中41位病人(55%)有營養不良，12位病人(13%)有心血管疾病，23位病人屬慢性發炎。心血管疾病組與非心血管疾病組相比，有較高之發炎指數，和貧血，但其營養狀況則無差異。而慢性發炎組也有較高比例之心血管疾病。
結論：我們的研究顯示慢性發炎和心血管疾病有明顯相關，但和營養不良的關聯性則不明顯。

關鍵字

營養不良 ； 發炎 ； 心血管疾病 ； 腹膜透析

並列摘要

Background: The combination of malnutrition, chronic inflammation and atherosclerotic cardiovascular disease (CVD) is called the MIA complex (syndrome) which often exists in hemodialysis patients. And they are the most important predictors of clinical outcome. Our study aims were to investigate the prevalence and relationships of malnutrition, inflammation, and CVD in patients on chronic peritoneal dialysis (PD) in Southern Taiwan.
Methods: Our cross-sectional study enrolled 92 chronic PD patients (36 males and 56 females) from the PD unit of National Cheng Kung University Hospital, Tainan. We compared the anthropometry, biochemical parameters, serum C-reactive protein (CRP), and nutritional status assessed by modified subjective global assessment (SGA) with 7-point scale between CVD and non-CVD patients, or between inflammation (CRP ≥8mg/L) and non-inflammation patients. SGA score ≤5 was considered as malnutrition.
Results: Forty-one patients (55%) had malnutrition, 12 patients (13%) had CVD, and 23 patients (25%) had high serum CRP levels (≥8mg/L). The CVD group had significantly higher serum CRP levels than that of non-CVD group. The nutritional status was similar between two groups except for a significantly poorer SGA score in the CVD group. The inflammation group had significantly higher proportion of CVD, anthropometric parameters, and lower hemoglobin level than that of low CRP (＜8mg/L) group.
Conclusions: Our findings indicated that there was a strong link between inflammation and CVD in chronic PD patients, but malnutrition (defined by SGA score ≤5) was not so evident compared with the other two components of MIA complex in our PD group.

並列關鍵字

malnutrition ； inflammation ； cardiovascular disease ； peritoneal dialysis