维持性血液透析患者血清正五聚蛋白3、铁调素水平与营养状况的关系

doi:10.3969/j.issn.1006-5725.2025.21.006

Abstract

Abstract:

Objective To investigate the association between nutritional status and serum hepcidin and pentraxin 3 （PTX3） levels in patients undergoing maintenance hemodialysis （MHD）. Methods A total of 76 patients with MHD who met the inclusion criteria were recruited from the hemodialysis center at the Affiliated Hospital of Chengde Medical University. Nutritional status was assessed using the Subjective Global Assessment （SGA）， which categorizes patients into three grades： SGA?A， SGA?B， and SGA?C. Serum levels of PTX3 and hepcidin were measured by enzyme?linked immunosorbent assay （ELISA）. Statistical analyses were conducted using SPSS software. One?way analysis of variance （ANOVA） was applied to compare differences across the three SGA groups. Logistic regression analysis was performed to identify influencing factors， and receiver operating characteristic （ROC） curve analysis was used to evaluate diagnostic value. Among the participants， 45 patients were classified as malnourished based on SGA?B and SGA?C scores， while those with SGA?A constituted the well?nourished control group. Results Among the 76 MHD patients， 59.2% were malnourished. We then compared clinical characteristics across the three groups. The results showed that the malnourished group was older and exhibited significantly higher levels of hs?CRP， PTX3， and hepcidin （P < 0.05）， while serum albumin， creatinine， and phosphorus levels were significantly lower （P < 0.05）. Pearson correlation analysis revealed positive correlations between SGA grades and hs?CRP， PTX3， and hepcidin levels （all P < 0.05）. Logistic regression analysis with “malnutrition” as the dependent variable indicated that elevated hs?CRP， PTX3， and hepcidin levels， along with age and male gender， were associated with increased risk of malnutrition in MHD patients， whereas higher serum phosphorus and creatinine levels were protective factors. Further multivariate logistic regression analysis demonstrated that serum PTX3 level was an independent risk factor for malnutrition （P = 0.032）， while higher creatinine level was an independent protective factor （P = 0.047）. ROC curve analysis showed that the combination of serum PTX3 and creatinine levels had a high diagnostic value for identifying malnutrition in MHD patients， yielding an AUC of 0.789 （P < 0.001）， a Youden index of 0.448， sensitivity of 77.8%， and specificity of 71.0%. Conclusions Elevated levels of PTX3 and hepcidin， along with reduced serum creatinine levels， are associated with an increased risk of malnutrition in patients undergoing MHD. Notably， elevated serum PTX3 and decreased serum creatinine independently predict malnutrition in this population and demonstrate high predictive value.

Key words: maintenance hemodialysis, malnutrition, serum ferrimodulin, pentametin 3

CLC Number:

R446

Yan HUANG,Shuzhong DUAN,Jing WANG,Jieqiong LIU,Liangyan MA,Shuo LI,Yanqing WU,Xinyang WANG,Lanfang JIA,Jingfu. WANG. Correlation analysis of serum pentraxin 3 and hepcidin with nutritional status in maintenance hemodialysis patients[J]. The Journal of Practical Medicine, 2025, 41(21): 3338-3344.

Figures/Tables 5

Tab.1

Tab.2

Tab.3

Tab.4

Fig.1

References 33

[1]	ZHANG L， ZHAO M H， ZUO L， et al. China Kidney Disease Network （CK-NET） 2016 Annual Data Report ［J］. Kidney Int Suppl， 2020， 10（2）： e97-e185. doi:10.1016/j.kisu.2020.09.001 doi: 10.1016/j.kisu.2020.09.001
[2]	COHEN-HAGAI K， NACASCH N， STERNSCHUSS A， et al. Malnutrition and inflammation in hemodialysis patients： Comparative evaluation of neutrophil reactive oxygen formation ［J］. Nutrition， 2020， 78： 110793. doi:10.1016/j.nut.2020.110793 doi: 10.1016/j.nut.2020.110793
[3]	RAHMAN T， KHOR B H， SAHATHEVAN S， et al. Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka， Bangladesh ［J］. Nutrients， 2022， 14（7）1408. doi:10.3390/nu14071469 doi: 10.3390/nu14071469
[4]	KALANTAR-ZADEH K， KOPPLE J D， BLOCK G， et al. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients ［J］. Am J Kidney Dis， 2001， 38（6）： 1251-1263. doi:10.1053/ajkd.2001.29222 doi: 10.1053/ajkd.2001.29222
[5]	陈璐琳，杨廷杰，孙猛，等. 营养不良与冠状动脉炎症对冠心病患者预后的影响［J］. 实用医学杂志， 2025， 41（7）： 1010-1017.
[6]	母元梅，赵佳圆，张莹. C反应蛋白/白蛋白比值与维持性血液透析患者心血管事件风险的关系［J］. 实用医学杂志， 2024， 40（1）： 72-78.
[7]	VALENTE M J， ROCHA S， COIMBRA S， et al. Long Pentraxin 3 as a Broader Biomarker for Multiple Risk Factors in End-Stage Renal Disease： Association with All-Cause Mortality ［J］. Mediators Inflamm， 2019， 2019： 3295725. doi:10.1155/2019/3295725 doi: 10.1155/2019/3295725
[8]	DONI A， MANTOVANI A， BOTTAZZI B， et al. PTX3 Regulation of Inflammation， Hemostatic Response， Tissue Repair， and Resolution of Fibrosis Favors a Role in Limiting Idiopathic Pulmonary Fibrosis ［J］. Front Immunol， 2021， 12： 676702. doi:10.3389/fimmu.2021.676702 doi: 10.3389/fimmu.2021.676702
[9]	SUH S H， OH T R， CHOI H S， et al. Predictive Value of Serum Hepcidin Levels for the Risk of Incident End-Stage Kidney Disease in Patients with Chronic Kidney Disease： The KNOW-CKD ［J］. Kidney Dis （Basel）， 2024， 10（6）： 492-503.
[10]	ZOU L X， SUN L， HUA R X， et al. Serum Hepcidin-25 and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis ［J］. Int J Gen Med， 2021， 14： 3153-3162. doi:10.2147/ijgm.s313777 doi: 10.2147/ijgm.s313777
[11]	XU Y， WANG Y， HU H， et al. Relationship between serum hepcidin levels and cardiovascular disease in patients with maintenance hemodialysis ［J］. Physiol Int， 2020， 107（4）： 491-500. doi:10.1556/2060.2020.00040 doi: 10.1556/2060.2020.00040
[12]	FENG T， XU Y， ZHENG J， et al. Prevalence of and risk factors for chronic kidney disease in ten metropolitan areas of China： A cross-sectional study using three kidney damage markers ［J］. Ren Fail， 2023， 45（1）： 2170243. doi:10.1080/0886022x.2023.2170243 doi: 10.1080/0886022x.2023.2170243
[13]	董朝坤，翁敏. 生物电阻抗相位角在维持性血液透析患者营养状况中的研究进展［J］. 实用医学杂志， 2022， 38（9）： 1157-1160.
[14]	CARRERO J J， THOMAS F， NAGY K， et al. Global Prevalence of Protein-Energy Wasting in Kidney Disease： A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism ［J］. J Ren Nutr， 2018， 28（6）： 380-392. doi:10.1053/j.jrn.2018.08.006 doi: 10.1053/j.jrn.2018.08.006
[15]	MORAIS D M， TROMBIM I C， DE G ES C R， et al. The adductor pollicis muscle thickness is not associated with physical function， lean mass， and nutritional status in patients on maintenance hemodialysis ［J］. Front Nutr， 2024， 11： 1502309. doi:10.3389/fnut.2024.1502309 doi: 10.3389/fnut.2024.1502309
[16]	TUR K， G L A. Independent Association Between Malnutrition Inflammation Score and C Reactive Protein/Albumin Ratio in Hemodialysis Patients ［J］. J Inflamm Res， 2024， 17： 9325-9333. doi:10.2147/jir.s477307 doi: 10.2147/jir.s477307
[17]	TAKAHASHI H， INOUE K， SHIMIZU K， et al. Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients ［J］. J Ren Nutr， 2017， 27（3）： 201-206. doi:10.1053/j.jrn.2016.12.005 doi: 10.1053/j.jrn.2016.12.005
[18]	TOLEDO F R， ANTUNES A A， VANNINI F C D， et al. Validity of malnutrition scores for predicting mortality in chronic hemodialysis patients ［J］. Int Urol Nephrol， 2013， 45（6）： 1747-1752. doi:10.1007/s11255-013-0482-3 doi: 10.1007/s11255-013-0482-3
[19]	刘洁琼，王景福. 老年维持性血液透析患者穿透素3与超敏C反应蛋白和营养不良的关系［J］. 河北医科大学学报， 2019， 40（6）： 654-657.
[20]	ROCHA S， VALENTE M J， COIMBRA S， et al. Interleukin 6 （rs1800795） and pentraxin 3 （rs2305619） polymorphisms-association with inflammation and all-cause mortality in end-stage-renal disease patients on dialysis ［J］. Sci Rep， 2021， 11（1）： 14768. doi:10.1038/s41598-021-94075-x doi: 10.1038/s41598-021-94075-x
[21]	YILMAZ M I， SONMEZ A， ORTIZ A， et al. Soluble TWEAK and PTX3 in nondialysis CKD patients： Impact on endothelial dysfunction and cardiovascular outcomes ［J］. Clin J Am Soc Nephrol， 2011， 6（4）： 785-792. doi:10.2215/cjn.09231010 doi: 10.2215/cjn.09231010
[22]	TSAI H C， OU S M， WU C C， et al. Pentraxin 3 Predicts Arteriovenous Fistula Functional Patency Loss and Mortality in Chronic Hemodialysis Patients ［J］. Am J Nephrol， 2022， 53（2/3）： 148-156. doi:10.1159/000522049 doi: 10.1159/000522049
[23]	LI H， MALHOTRA S， KUMAR A. Nuclear factor-kappa B signaling in skeletal muscle atrophy ［J］. J Mol Med （Berl）， 2008， 86（10）： 1113-1126. doi:10.1007/s00109-008-0373-8 doi: 10.1007/s00109-008-0373-8
[24]	MIYAMOTO T， RASHID QURESHI A， HEIMB RGER O， et al. Inverse relationship between the inflammatory marker pentraxin-3， fat body mass， and abdominal obesity in end-stage renal disease ［J］. Clin J Am Soc Nephrol， 2011， 6（12）： 2785-2791. doi:10.2215/cjn.02320311 doi: 10.2215/cjn.02320311
[25]	FOUQUE D， KALANTAR-ZADEH K， KOPPLE J， et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease ［J］. Kidney Int， 2008， 73（4）： 391-398. doi:10.1038/sj.ki.5002585 doi: 10.1038/sj.ki.5002585
[26]	ISOYAMA N， QURESHI A R， AVESANI C M， et al. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients ［J］. Clin J Am Soc Nephrol， 2014， 9（10）： 1720-1728. doi:10.2215/cjn.10261013 doi: 10.2215/cjn.10261013
[27]	GANZ T. Systemic iron homeostasis ［J］. Physiol Rev， 2013， 93（4）： 1721-1741. doi:10.1152/physrev.00008.2013 doi: 10.1152/physrev.00008.2013
[28]	MALTANERI R E， CHAMORRO M E， GIONCO S E， et al. Erythropoietin enhances iron bioavailability in HepG2 cells by downregulating hepcidin through mTOR， C/EBPα and HIF-1α ［J］. Biochim Biophys Acta Mol Cell Res， 2024， 1871（7）： 119800. doi:10.1016/j.bbamcr.2024.119800 doi: 10.1016/j.bbamcr.2024.119800
[29]	张妍，周晓玲，陈孟华. 终末期肾脏病患者血清中铁调素的水平变化及其与铁代谢的关系［J］. 中国血液净化， 2011， 10（7）： 371-375.
[30]	MATSUOKA T， ABE M， KOBAYASHI H. Iron Metabolism and Inflammatory Mediators in Patients with Renal Dysfunction ［J］. Int J Mol Sci， 2024， 25（7）：3745. doi:10.3390/ijms25073745 doi: 10.3390/ijms25073745
[31]	GANGAT N， WOLANSKYJ A P. Anemia of chronic disease ［J］. Semin Hematol， 2013， 50（3）： 232-238. doi:10.1053/j.seminhematol.2013.06.006 doi: 10.1053/j.seminhematol.2013.06.006
[32]	CARRERO J J， STENVINKEL P， CUPPARI L， et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease： A consensus statement from the International Society of Renal Nutrition and Metabolism （ISRNM）［J］. J Ren Nutr， 2013， 23（2）： 77-90. doi:10.1053/j.jrn.2013.01.001 doi: 10.1053/j.jrn.2013.01.001
[33]	LI Y， YANG Y， WANG J. Skeletal muscle mass and kidney function among Chinese older adults： A cross-sectional study ［J］. Ren Fail， 2024， 46（2）： 2377776. doi:10.1080/0886022x.2024.2377776 doi: 10.1080/0886022x.2024.2377776

项目	SGA-A组（n = 31）	SGA-B组（n = 36）	SGA-C组（n = 9）	χ²/F值	P值
性别/例				6.952	0.031
男	22	20	2
女	9	16	7
年龄/岁	56.90 ± 15.94^#△	69.42 ± 12.41^?	76.78 ± 10.27^?	10.488	< 0.001
体质指数/（kg/m²）	22.86 ± 3.30	22.20 ± 3.10	21.35 ± 2.07	0.936	0.397
透析龄/年	42.23 ± 29.44	37.64 ± 30.97	47.33 ± 37.40	0.415	0.662
Kt/V	1.37 ± 0.13	1.40 ± 0.13	1.30 ± 0.08	1.899	0.157
糖尿病病史/［例（%）］	14（45.2）	14（38.9）	5（55.6）	0.879	0.645
脑血管病肢体活动障碍/［例（%）］	4（12.9）	8（22.2）	3（33.3）	2.104	0.349
血清白蛋白/（g/L）	42.25 ± 2.32^#△	37.83 ± 2.91^?△	32.68 ± 2.22^?#	54.092	< 0.001
血肌酐/（μmol/L）	924.83 ± 196.23^#△	766.51 ± 243.45^?△	543.74 ± 299.53^?#	10.29	< 0.001
血红蛋白/（g/L）	112.16 ± 13.99	107.61 ± 16.28	98.67 ± 11.84	2.947	0.059
白细胞计数/（×10⁹）	6.38 ± 2.05	5.67 ± 1.49	5.52 ± 1.28	1.736	0.184
红细胞计数/（×10¹²）	3.72 ± 0.56	3.56 ± 0.56	3.42 ± 0.40	1.393	0.255
血小板计数/（×10⁹）	177.84 ± 58.30	150.00 ± 55.02	172.11 ± 46.95	2.166	0.122
血钾/（mmol/L）	4.63 ± 0.71	4.93 ± 0.97	4.34 ± 0.89	2.011	0.142
血钙/（mmol/L）	2.13 ± 0.21	2.04 ± 0.22	1.99 ± 0.30	2.082	0.132
血磷/（mmol/L）	2.04 ± 0.52^△	1.82 ± 0.56	1.53 ± 0.57^*	3.459	0.037
甲状旁腺激素/（pg/mL）	399.52 ± 296.76	360.58 ± 278.97	336.54 ± 188.95	0.242	0.786
铁蛋白/（ng/mL）	207.75 ± 142.62	195.63 ± 174.03	167.34 ± 145.64	0.227	0.798
hs-CRP/（mg/L）	1.60 ± 0.88^#△	3.31（1.84，7.63）^?△	8.45 ± 3.19^?#	25.7	< 0.001
PTX3/（ng/mL）	2.26 ± 0.92^#△	3.08 ± 1.15^?△	3.86 ± 1.15^?#	9.735	< 0.001
铁调素/（ng/mL）	14.46 ± 3.50^#△	18.55 ± 2.49^?△	21.53 ± 1.60^?#	28.131	< 0.001

项目	hs-CRP	PTX3	铁调素
SGA等级
t值	0.641	0.459	0.656
P值	< 0.001	< 0.001	< 0.001

项目	B	SE	Wals	OR	95%CI	P值
男性	0.94	0.50	3.59	2.56	0.968 ~ 6.749	0.058
年龄	0.07	0.02	12.00	1.07	1.032 ~ 1.119	0.001
体质指数	-0.09	0.08	1.32	0.91	0.785 ~ 1.065	0.251
糖尿病病史	0.78	0.64	1.50	2.18	0.625 ~ 7.629	0.221
脑血管病肢体活动障碍	-0.12	0.47	0.07	0.89	0.353 ~ 2.231	0.799
血肌酐	0.00	0.00	9.78	0.99	0.994 ~ 0.999	0.002
血红蛋白	-0.03	0.02	3.05	0.97	0.941 ~ 1.004	0.081
白细胞计数	-0.25	0.14	3.19	0.78	0.586 ~ 1.025	0.074
红细胞计数	-0.67	0.45	2.25	0.51	0.213 ~ 1.229	0.134
血小板计数	-0.01	0.00	2.98	0.99	0.984 ~ 1.001	0.084
血钾	0.24	0.28	0.69	1.27	0.726 ~ 2.202	0.407
血钙	-2.22	1.17	3.58	0.11	0.011 ~ 1.084	0.059
血磷	-0.93	0.45	4.36	0.39	0.164 ~ 0.945	0.037
甲状旁腺激素	0.00	0.00	0.44	1.00	0.998 ~ 1.001	0.508
铁蛋白	0.00	0.00	0.24	1.00	0.996 ~ 1.002	0.626
透析龄	0.00	0.01	0.14	1.00	0.983 ~ 1.012	0.712
Kt/V	0.44	1.84	0.06	1.55	0.042 ~ 57.434	0.813
hs?CRP	0.97	0.28	12.42	2.64	1.540 ~ 4.540	< 0.001
PTX3	0.91	0.28	10.76	2.49	1.444 ~ 4.301	0.001
铁调素	0.59	0.15	15.09	1.80	1.339 ~ 2.425	< 0.001

项目	B	SE	Wals	OR	95%CI	P值
年龄	0.01	0.03	0.04	1.01	0.946 ~ 1.071	0.837
血肌酐	-0.01	0.00	3.95	0.99	0.990 ~ 0.999	0.047
血磷	0.07	0.90	0.01	1.07	0.183 ~ 6.285	0.938
hs-CRP	0.61	0.33	3.45	1.85	0.966 ~ 3.535	0.063
PTX3	0.97	0.45	4.58	2.64	1.085 ~ 6.418	0.032
铁调素	0.28	0.17	2.64	1.33	0.944 ~ 1.861	0.104
常量	-4.72	3.91	1.46	0.01		0.227

Correlation analysis of serum pentraxin 3 and hepcidin with nutritional status in maintenance hemodialysis patients

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 33

Related Articles 13

Recommended Articles

Metrics

Comments

[1]	Lulin CHEN,Tingjie YANG,Meng SUN,Xin LI,Yiming GUO,Yuqing YANG,Yudong CAO,Wenzhe LI,Jiangshu YUAN,Honghui YANG. Association between coronary inflammation and malnutrition on prognosis in patients with coronary artery disease [J]. The Journal of Practical Medicine, 2025, 41(7): 1010-1017.
[2]	Qiaoying MO,Fangyi ZHU,Cunkui ZHU,Shenglong. MA. Nomogram model of malnutrition risk in patients suffering from chronic heart failure grounded on GNRI score [J]. The Journal of Practical Medicine, 2025, 41(5): 691-698.
[3]	Hanzhi DAI,Sheng ZHANG,Ronghai. LIN. The latest developments in nutritional therapy pathways for patients in critical condition [J]. The Journal of Practical Medicine, 2024, 40(4): 585-590.
[4]	Jingfang WAN,Kehong. CHEN. Advances in research on optimal dialysate bicarbonate concentration for maintenance hemodialysis patients [J]. The Journal of Practical Medicine, 2024, 40(18): 2520-2524.
[5]	Hongmei LIU,Huahong ZHOU,Xiangjiu CHEN,Guobao HONG,Xiongbin WU,Yanjuan LIANG,Chunting LI,Meidi ZHENG,Yueqin LAI,Fanna. LIU. Association of frailty with anxiety and depression in patients on maintenance hemodialysis [J]. The Journal of Practical Medicine, 2024, 40(18): 2612-2617.
[6]	Jingjing WANG,Weidong WANG,Mengyu WANG,Qingqin ZHANG,Xiaohong. KANG. Evaluation value of objective nutritional screening tools for esophageal cancer patients undergoing radiotherapy and chemotherapy [J]. The Journal of Practical Medicine, 2024, 40(14): 1957-1962.
[7]	Yuanmei MU,Jiayuan ZHAO,Ying. ZHANG. The association between C⁃reactive protein/albumin ratio and the risk of cardiovascular events in maintenance hemodialysis patients [J]. The Journal of Practical Medicine, 2024, 40(1): 72-78.
[8]	Zhijun XU,Qingping ZHOU,Zhenning LIANG,Yi. QIAN. Influence pathway of self⁃management behavior in maintenance hemodialysis patients based on COM⁃B model [J]. The Journal of Practical Medicine, 2023, 39(23): 3120-3126.
[9]	LU Xiaomei, HUO Ben⁃ gang, HUANG Nan, TANG Yueqiu, ZHU Dan. . Impact of blood flow rate on outcome in elderly maintenance hemodialysis patients [J]. The Journal of Practical Medicine, 2023, 39(10): 1269-1273.
[10]	DONG Chaokun, WENG Min.. Research progress of bioelectrical impedance phase angle as a nutritional indicator of maintenance hemodi⁃alysis patients [J]. The Journal of Practical Medicine, 2022, 38(9): 1157-1160.
[11]	LIU Ying, TAN Yinfeng, WANG Lei, WANG Yujiao, CHEN Xiying, ZHAO Yanjin, QI Wei, ZHANG Ying, HE Shuyang.. Correlation between nutritional risk screening combined with scored patient ⁃generated subjective global assessment and malignant cancer⁃related sarcopenia [J]. The Journal of Practical Medicine, 2022, 38(2): 173-178.
[12]	XU Jun, WANG Xiaowei, LIU Min, QI Xiangming.. Curative effect of lanthanum carbonate combined with cinacalcet and calcitriol on SHPT patients undergo⁃ing hemodialysis [J]. The Journal of Practical Medicine, 2021, 37(1): 82-86.
[13]	HE Wen⁃ wen, SU Mo, CAI Zhimin, YANG Liu, FAN Xiaoxia.. Body function investigation and influencing factors analysis of maintenance hemodialysis patients [J]. The Journal of Practical Medicine, 2020, 36(20): 2852-2855.