Duggan A, Huffman F G
Renal Dietitian, Complete Dialysis Care Inc, Coral Springs, FL, USA.
J Ren Nutr. 1998 Jul;8(3):142-9. doi: 10.1016/s1051-2276(98)90006-1.
To evaluate the use of serum transthyretin (TTR) as a valid indicator of nutritional status in the hemodialysis patient and to validate the correlation of low-serum (TTR) levels with established nutrition assessment parameters.
Prospective, cohort, correlation analysis.
Free-standing outpatient dialysis center.
Fifty-one stable, chronic hemodialysis patients meeting the following selection criteria: (1) received thrice weekly hemodialysis treatments for greater than 3 months, (2) absence of impaired hepatic function, (3) absence of chronic infection, inflammatory syndromes, or infections in the 3 months before the study, (4) not taking corticosteroids, and (5) willing to participate in the study as evidenced by signing of an informed consent.
Serum TTR, albumin, blood urea nitrogen, creatinine, cholesterol, postdialysis weight and body mass index were measured monthly for 6 consecutive months. Normalized protein catabolic rate and KT/V were measured monthly for 3 consecutive months.
Nutrition and biochemical indices.
The overall mean TTR level was 32 mg/dL +/- 7 for the 6-month study period. Thirty-six percent of patients had mean TTR levels less than 30 mg/dL. TTR levels less than 30 mg/dL correlated significantly with urine outputs greater than 240 mL/24 hours, predialysis blood urea nitrogen < 18 mmol/L (<50 mg/dL), and normalized protein catabolic rate less than 0.8 g/kg/d (P < .05). A significant correlation was found between TTR and creatinine, albumin and loss of dry body weight (P < .05). Mean TTR levels less than 30 mg/dL were found in 33% of subjects with mean albumin levels greater than 35 g/L (>3.5 g/dL) and in 19% with mean albumin levels greater than 40 g/L (>4.0 g/dL). TTR levels were consistently lower in diabetics for all 6 months (statistically significant in 2 out of 6 months).
Measuring serial serum TTR levels in hemodialysis patients is a reliable method for identifying patients in need of nutrition intervention.
评估血清转甲状腺素蛋白（TTR）作为血液透析患者营养状况有效指标的用途，并验证低血清TTR水平与既定营养评估参数之间的相关性。
前瞻性队列相关性分析。
独立的门诊透析中心。
51名病情稳定的慢性血液透析患者，符合以下入选标准：（1）每周接受三次血液透析治疗超过3个月；（2）肝功能无损害；（3）在研究前3个月内无慢性感染、炎症综合征或感染；（4）未服用皮质类固醇；（5）签署知情同意书，表明愿意参与研究。
连续6个月每月测量血清TTR、白蛋白、血尿素氮、肌酐、胆固醇、透析后体重和体重指数。连续3个月每月测量标准化蛋白分解代谢率和KT/V。
营养和生化指标。
在为期6个月的研究期间，TTR总体平均水平为32mg/dL±7。36%的患者TTR平均水平低于30mg/dL。TTR水平低于30mg/dL与尿量大于240mL/24小时、透析前血尿素氮<18mmol/L（<50mg/dL）以及标准化蛋白分解代谢率低于0.8g/kg/d显著相关（P<.05）。发现TTR与肌酐、白蛋白和干体重减轻之间存在显著相关性（P<.05）。在白蛋白平均水平大于35g/L（>3.5g/dL）的受试者中，33%的人TTR平均水平低于30mg/dL；在白蛋白平均水平大于40g/L（>4.0g/dL）的受试者中，19%的人TTR平均水平低于30mg/dL。糖尿病患者在所有6个月中的TTR水平始终较低（6个月中有2个月具有统计学意义）。
测量血液透析患者的系列血清TTR水平是识别需要营养干预患者的可靠方法。
