Su F X, Wu J, Zhou C M, Li Q, Hu S S, Lin X, Da J J, Zha Y
Department of Nephrology, Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China.
Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China.
Zhonghua Yi Xue Za Zhi. 2018 Nov 13;98(42):3401-3405. doi: 10.3760/cma.j.issn.0376-2491.2018.42.005.
To examine the relationship between low serum parathyroid hormone (PTH) and protein-energy wasting (PEW) in patients who underwent maintenance hemodialysis (MHD) treatment. A cross-sectional study was conducted in MHD patients between June 2015 and August 2017 in 11 MHD centers from Guizhou province. Body composition and physical parameters were measured, clinical data and other related laboratory values were collected according to the medical record system. Participants were assigned to low serum PTH group (PTH<150 ng/L), target PTH group (150 ng/L≤ PTH ≤300 ng/L) and high serum PTH group (PTH>300 ng/L). Multivariate logistic regression analysis was used to analyze the relationship between low serum PTH and risk of PEW, which was diagnosed according to the diagnostic criteria recommened by the International Society of Renal Nutrition and Metabolism (ISRNM). A total of 873 MHD patients (488 males and 385 females) were included in the final analysis, with a mean age of 55.0 (44.0, 67.0) years and a mean hemodialysis duration of 31.0(17.0, 54.0) months. In unadjusted model, low serum PTH group was associated with PEW (=2.12, 95% 1.26-3.54, =0.004), when compared with high serum PTH group. After adjustment for age and sex, low serum PTH group was still significantly associated with PEW (=2.09, 95% : 1.23-3.52, =0.006). Further adjustment for diabetes and hypertension, the correlation between low serum PTH group and PEW was still significant (=2.02, 95% : 1.04-3.90, =0.037). However, the correlation was not observed in target PTH group and high serum PTH group. Low serum PTH was associated with risk of PEW, regardless of age, sex, history of diabetes and hypertension, and thus it might be a promising indicator of PEW in MHD patients.
探讨维持性血液透析（MHD）患者血清甲状旁腺激素（PTH）水平降低与蛋白质能量消耗（PEW）之间的关系。2015年6月至2017年8月，在贵州省11个MHD中心对MHD患者进行了一项横断面研究。测量身体成分和身体参数，根据病历系统收集临床资料及其他相关实验室值。参与者被分为血清PTH水平降低组（PTH<150 ng/L）、目标PTH组（150 ng/L≤PTH≤300 ng/L）和血清PTH水平升高组（PTH>300 ng/L）。采用多因素logistic回归分析血清PTH水平降低与PEW风险的关系，PEW根据国际肾脏营养与代谢学会（ISRNM）推荐的诊断标准进行诊断。最终纳入分析873例MHD患者（男性488例，女性385例），平均年龄55.0（44.0，67.0）岁，平均血液透析时间31.0（17.0，54.0）个月。在未校正模型中，与血清PTH水平升高组相比，血清PTH水平降低组与PEW相关（比值比=2.12，95%可信区间：1.263.54，P=0.004）。校正年龄和性别后，血清PTH水平降低组仍与PEW显著相关（比值比=2.09，95%可信区间：1.233.52，P=0.006）。进一步校正糖尿病和高血压后，血清PTH水平降低组与PEW的相关性仍显著（比值比=2.02，95%可信区间：1.04~3.90，P=0.037）。然而，目标PTH组和血清PTH水平升高组未观察到相关性。血清PTH水平降低与PEW风险相关，不受年龄、性别、糖尿病史和高血压史影响，因此可能是MHD患者PEW的一个有前景的指标。
