Nasri Hamid
Shahrekord University of Medical Sciences, Hajar Medical, Educational and Therapeutic Center, Department of Internal Medicine, Shahrekord, Iran.
Bratisl Lek Listy. 2005;106(12):390-5.
Malnutrition and inflammation are common in hemodialysis (HD) patients, and are usually closely associated. Serum C-reactive protein (CRP) concentrations have been found to be significantly elevated in hemodialysis patients and reflects chronic inflammation, and as an acute-phase reactant, is a sensitive and independent marker of malnutrition. To investigate the association of serum CRP level with some nutritional variables in diabetic and non diabetic end-stage renal failure patients undergoing regular hemodialysis, we designed a study on 36 maintenance hemodialysis patients (f = 15, m = 21), consisting of 25 non-diabetic HD patients and 11 diabetic HD patients. In this study a near significant difference of CRP between diabetic and non-diabetics of all patients with more values of CRP in diabetics and a significant difference of CRP between diabetic and non-diabetics of female HD patients with more values in diabetics were seen. A significant difference of CRP between males and females of non-diabetic population with more values of CRP in males was found too. An inverse correlation of serum CRP with serum cholesterol and triglyceride levels and a near significant positive correlations of CRP with serum ALP and with serum intact parathormone (iPTH) were found too. An inverse correlation of serum CRP with dialysis efficacy was also seen. No significant association between serum CRP and serum albumin was seen. Compatible with some studies and in contrast to some other studies, the association of serum albumin with serum CRP levels in this study was insignificant. The positive correlation of high serum iPTH with inflammation implies further need to control hyperphosphatemia and secondary hyperparathyroidism in HD patients, also inverse correlation of serum CRP with cholesterol and triglyceride further support the malnutrition-inflammation complex syndrome (MICS) which frequently seen in hemodialysis patients (Tab. 3, Fig. 3, Ref. 42).
营养不良和炎症在血液透析（HD）患者中很常见，且通常密切相关。已发现血液透析患者血清C反应蛋白（CRP）浓度显著升高，其反映慢性炎症，作为一种急性期反应物，是营养不良的敏感且独立的标志物。为研究血清CRP水平与接受定期血液透析的糖尿病和非糖尿病终末期肾衰竭患者某些营养变量之间的关联，我们对36例维持性血液透析患者（女性15例，男性21例）进行了一项研究，其中包括25例非糖尿病HD患者和11例糖尿病HD患者。在本研究中，所有患者中糖尿病患者与非糖尿病患者的CRP存在近乎显著差异，糖尿病患者的CRP值更高；女性HD患者中糖尿病患者与非糖尿病患者的CRP也存在显著差异，糖尿病患者的值更高。还发现非糖尿病人群中男性与女性的CRP存在显著差异，男性的CRP值更高。血清CRP与血清胆固醇和甘油三酯水平呈负相关，与血清碱性磷酸酶（ALP）和血清完整甲状旁腺激素（iPTH）呈近乎显著的正相关。血清CRP与透析疗效也呈负相关。未发现血清CRP与血清白蛋白之间存在显著关联。与一些研究一致且与其他一些研究相反，本研究中血清白蛋白与血清CRP水平的关联不显著。血清iPTH升高与炎症的正相关意味着进一步需要控制HD患者的高磷血症和继发性甲状旁腺功能亢进，血清CRP与胆固醇和甘油三酯的负相关也进一步支持了血液透析患者中常见的营养不良-炎症复合综合征（MICS）（表3，图3，参考文献42）。
