维持性血液透析患者代谢综合征发病情况及危险因素分析

目的 探讨维持性血液透析患者代谢综合征（metabolic syndrome,MS）发病情况及影响因素.方法 于2010年6月至12月将北京朝阳医院血液净化中心规律透析的162例尿毒症患者分为MS组（66例）和非代谢综合征（NMS）组（96例）,比较两组人体测量学指标、生化指标的差异,应用二项logistic回归分析探求MS发生的危险因素.结果 MS发生率为40.7%（66/162）.MS组与NMS组体重指数（24.2±3.1）比（21.6±2.7）kg/m2]、腰围（93±8）比（79±7）cm]、白细胞（6.8±1.5）×10^9/L比（5.6±1.4）×10^9/L]、超敏C反应蛋白（7±5）比（4±3）mg/L]、高密度脂蛋白胆固醇（0.99±0.26）比（1.39±0.39）mmol/L]、低密度脂蛋白胆固醇（2.5±0.8）比（2.1±0.7）mmol/L]、甘油三酯（2.1±1.1）比（1.3±0.8）mmol/L]、血糖（5.9±2.7）比（4.8±1.3）mmol/L]、血清铁（16±7）比（13±5）μmol/L]、尿酸（429±114）比（388±88）μmol/L]、二氧化碳结合力（22±4）比（23±4）mmol/L]比较,差异均有统计学意义（均P〈0.05）.但两组非血管通路侧肱三头肌皮下脂肪厚度、主观综合性营养评估法评分比较差异无统计学意义（均P〉0.05）.二项logistic回归分析显示血清铁（OR=1.058,95%CI=1.001～1.119）、白细胞（OR=1.786,95%CI=1.346～2.371）、超敏C反应蛋白（OR=1.101,95%CI=1.010～1.201）是MS发生的独立危险因素.结论 维持性血液透析患者伴发MS发生率高,微炎症可能参与了MS发生,血清铁、白细胞、超敏C反应蛋白是MS发生的独立危险因素;维持性血液透析患者营养状况与MS无必然联系.

Analysis on risk factors for metabolic syndrome in patients with maintaining hemodialysis

Objective To investigate prevalence of metabolic syndrome (MS) and its related factors in patients with maintaining hemodialysis (MHD). Methods A total of 162 cases on MHD in Beijing Chaoyang Hospital during June to December 2010, were enrolled in this study and divided into MS group and non-MS group according to the diagnostic criteria for MS set by the International Diabetes Federation. Anthropometric and blood biochemical characteristics of the two groups were compared with t-test and x2 test Risk factors for MS were explored with binary logistic regression analysis. Results Prevalence of MS was 40. 7% (66/162) . There was significant difference found in body mass index (24. 2 ±3. 1) vs. (21. 6 ±2. 7) kg/m2], waistline circumference(93 ±8) vs. (79 ±7)cm] , white blood cell count (6. 8 ± 1. 5) × 109/L vs. (5. 6 ± 1. 4) × 109/L] , hypersensitive serum C-reactive protein (7 ± 5)vs. (4 ±3) mg/L], high-density lipoprotein-cholesterol (0. 99 ±0. 26)vs. (1.39 ±0.39) mmol/L], low-density lipoprotein-cholesterol (2. 5 ± 0. 8) vs. ( 2. 1 ± 0. 7) mmol/L], triglyceride ( TG) ( 2. 1 ±1.1 )vs. (1.3±0.8) mmol/L], fasting blood glucose (5.9±2. 7)vs. (4.8±1.3) mmol/L], serum level of iron (16±7)vs. (13 ±5) μmol/L], uric acid (429±114) vs. (388±88) (μmol/L], and carbon dioxide combining power (CO2CP) (22 ±4)vs. (23 ±4) mmol/L]between MS group and non-MS group (All P < 0.05 ) . But there was no significant difference found in subjective global assessment of nutritional status (SGA) , thickness of skin fold of the triceps muscle (TSF) between the two groups (Both P > 0.05). Binary logistic regressive analysis revealed that serum level of iron (OR = 1.058,95% CI = 1.001 -1. 119), white blood cell count ( OR = 1. 786,95% CI = 1. 346 - 2.371) and hypersensitive serum C-reactive protein (OR = 1. 101,95% CI = 1.010 - 1.201 ) were independent risk factors for MS in MHD patients. Conclusions Morbidity of MS is high in patients with MHD, involved with inflammation process. Serum level of iron, white blood cell count and hypersensitive serum C-reactive protein are independent risk factors for MS in patients with MHD and no inevitable connection between MS and nutritional status in them is found.