摘要目的 研究长期维持性血液透析(MHD)患者血清犬尿氨酸的变化及其与患者营养状态和血管硬化的关系.方法 纳入年龄性别相匹配的健康对照、长期服用α酮酸的MHD患者、未服用α酮酸的MHD患者各20例.用高效液相色谱法测定3组的血清犬尿氨酸水平.测定两组MHD患者C反应蛋白(CRP)水平.用主观综合性营养评估(SGA)及炎性营养不良评分(MIS)对两组MHD患者进行营养评估.用脉搏波传导速度(PWV)评估动脉硬化情况.结果 MHD患者血清犬尿氨酸水平显著高于健康人[(3.20±1.12)μmol/L比(1.74±0.27)μmol/L,P<0.011.服用α酮酸组与未服用α酮酸组血清犬尿氨酸水平差异无统计学意义[(3.20±0.88)μmol/L比(3.29±1.34)μmol/L,P>0.05].MHD患者血白细胞介素6(IL-6)水平显著高于健康对照组[(6.45±3.78)ng/L比(1.38±1.59)ng/L,P<0.01].α酮酸组IL-6水平显著低于非α酮酸组[(3.37±0.82)ng/L比(9.62±2.48)ng/L,P<0.05];2组间CRP水平差异无统计学意义.与非α酮酸组比较,α酮酸组SGA评分较高(26.00±1.75比22.67±2.61,P=0.001),MIS评分较低(5.82±2.27比10.00±2.62,P=0.002),左、右侧PWV均较低[(21.11±8.21)m/s比(24.57±5.45)m/s,P=0.244;(19.27±3.22)m/s比(24.19±5.41)m/s,P=0.015].相关分析显示,血清犬尿氨酸与血IL-6呈正相关(r=0.352,P=0.011);与透析前Scr呈负相关(r=-0.412,P=0.019).结论 MHD患者普遍存在炎性反应状态,色氨酸代谢产物犬尿氨酸水平可反映这种炎性反应状态.α酮酸可能通过减轻其炎性反应程度从而改善MHD患者的营养、贫血及血管硬化.

abstractsObjective To study the association of serum L-kynurenine changes with nutritional status and vascular stiffness in maintenance hemodialysis (MHD) patients. Methods Twenty gender- and age-matched healthy volunteers (healthy group) and 40 MHD patients,including 20 cases with α-keto aicd(α-keto acid group)and 20 cases without α-keto aicd(non-α-keto acid group)were enrolled in the study.Serum L-kynurenine was measured by high performance liquid chromatography.C-reactive protein (CRP)and interleukin 6 (IL-6)were detected.Subjective global assessment(SGA)and malnutrition inflammation score(MIS)were applied to evaluate the nutritional status.Pulse wave velocity(PWV)was used to evaluate arterial stiffness for both groups of MHD patients. Results Serum L-kynurenine was significantly higher in MHD patients than that in healthy subjects[(3.20±1.12)μmol/L vs (1.74±0.27)μmol/L,P<0.01],while such difference was not found between α-keto aicd group and non-α-keto-aicd group [(3.20±0.88)μmol/L vs (3.29±1.34)μmol/L,P>0.05].IL-6 was significantly higher in MHD patients as compared to healthy subjects[(6.45±3.78)ng/L vs(1.38±1.59)ng/L,P<0.01],while such difference was found between α-keto aicd group and non-α-keto aicd group[(3.37±0.82)ng/L vs (9.62±2.48)ng/L,P<0.051.There was no difference of CRP concentration between two MHD groups.As compared to non-α-keto acid group,higher SGA score(26.00±1.75 vs 22.67±2.61,P=0.001),lower MIS score(5.82±2.27 vs 10.00±2.62,P=0.002),lower left side PWV[(21.11±8.21)m/s vs(24.57±5.45)m/s,P=0.244]and lower right side PWV[(19.27±3.22)m/s vs (24.19±5.41)m/s,P=0.015]were observed in α-keto aicd group.Pearson analysis showed positive correlation between serum L-kynurenine and IL-6(r=0.352,P=0.011)and negative correlation between L-kynurenine and pre-dialysis Scr(r=-0.412,P=0.019). Conclusions Inflammation is common in MHD patients.Tryptophan degeneration product L-kynurenine may indicate inflammation status.α-keto acid improves nutritional status,anemia and arterial stiffness maybe through the alleviation of inflammation in MHD patients.