Objective: To examine the relationship between low serum parathyroid hormone (PTH) and protein-energy wasting (PEW) in patients who underwent maintenance hemodialysis (MHD) treatment. Methods: 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). Results: 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 (OR=2.12, 95% CI: 1.26-3.54, P=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 (OR=2.09, 95% CI: 1.23-3.52, P=0.006). Further adjustment for diabetes and hypertension, the correlation between low serum PTH group and PEW was still significant (OR=2.02, 95% CI: 1.04-3.90, P=0.037). However, the correlation was not observed in target PTH group and high serum PTH group. Conclusion: 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.
目的： 探讨低甲状旁腺素(PTH)血症与维持性血液透析(MHD)患者蛋白质能量消耗(PEW)的相关性。 方法： 采用多中心横断面研究，收集2015年6月至2017年8月在贵州省11家血透中心行MHD治疗患者的临床资料及血生化指标，并进行人体成分测量及物理测量。根据患者血PTH水平将其分为低PTH组(<150 ng/L)、PTH达标组(150～300 ng/L)、高PTH组(>300 ng/L)，根据国际肾脏营养与代谢学会(ISRNM)制定的PEW诊断标准，采用logistic回归分析低PTH血症与MHD患者PEW发生风险的关系。 结果： 研究最终纳入873例患者，其中男488例，女385例，年龄55.0(44.0，67.0)岁，透析龄31.0(17.0，54.0)个月。多因素logistic回归分析结果显示，在未调整模型中，低PTH与PEW的发生风险密切相关，低PTH组发生PEW的风险是高PTH组的2.12倍(95% CI：1.26～3.54，P＝0.004)；调整性别、年龄后，低PTH组PEW的发生风险是高PTH组的2.09倍(95% CI：1.23～3.52，P＝0.006)；进一步调整高血压、糖尿病后，低PTH组仍与PEW发生风险相关，且低PTH组PEW发生风险是高PTH组的2.02倍(95% CI：1.04～3.90，P＝0.037)；PTH达标组与高PTH组相比，PEW发生风险差异无统计学意义。 结论： 低PTH血症与MHD患者PEW发生风险相关，低PTH血症在评估MHD患者PEW发生风险中具有一定价值。.
Keywords: Hemodialysis; Parathyroid hormone; Protein-energy wasting.