腹膜透析营养不良–微炎症综合征中西医研究进展
Research Progress in Traditional Chinese and Western Medicine for Peritoneal Dialysis Malnutrition Inflammation Complex Syndrome
DOI: 10.12677/acm.2024.1482198, PDF,    科研立项经费支持
作者: 王锐杰:青海大学医学院中医系,青海 西宁;张永刚*:青海省人民医院中医科,青海 西宁
关键词: 腹膜透析营养不良–微炎症综合征中西医Peritoneal Dialysis Malnutrition-Microinflammatory Syndrome Traditional Chinese and Western Medicine
摘要: 随着我国腹膜透析(peritoneal dialysis, PD)患者的日益增多,透析远期并发症也日趋突出。营养不良–微炎症综合征(Malnutrition inflammation complex syndrome, MICS)是PD患者重要的远期并发症之一,它对腹膜透析患者的生活质量及生存率产生了严重影响。为此本文对腹膜透析患者引起的营养不良–炎症综合征的现代医学病因病机及治疗进行概述,使现代医学及传统中医药充分结合,为治疗腹膜透析营养不良–微炎症综合征提供新的思路和方法。
Abstract: Along with the increasing number of peritoneal dialysis (PD) patients in our country, dialysis long-term complications are becoming more and more prominent. Malnutrition inflammation complex syndrome (MICS) is one of the most important long-term complications in patients with PD, which seriously affects the quality of life and survival rate of patients with peritoneal dialysis. Therefore, this paper summarizes the etiology, pathogenesis and treatment of dystrophies-inflammatory syndrome caused by peritoneal dialysis patients, and fully combines modern medicine with traditional Chinese medicine to provide new ideas and methods for the treatment of peritoneal dialysis dystrophies-microinflammatory syndrome.
文章引用:王锐杰, 张永刚. 腹膜透析营养不良–微炎症综合征中西医研究进展[J]. 临床医学进展, 2024, 14(8): 178-187. https://doi.org/10.12677/acm.2024.1482198

参考文献

[1] Bello, A.K., Okpechi, I.G., Osman, M.A., Cho, Y., Cullis, B., Htay, H., et al. (2022) Epidemiology of Peritoneal Dialysis Outcomes. Nature Reviews Nephrology, 18, 779-793. [Google Scholar] [CrossRef] [PubMed]
[2] 倪兆慧, 金海姣. 中国腹膜透析发展70年[J]. 中国血液净化, 2019, 18(10): 661-663.
[3] Leinig, C.E., Moraes, T., Ribeiro, S., Riella, M.C., Olandoski, M., Martins, C., et al. (2011) Predictive Value of Malnutrition Markers for Mortality in Peritoneal Dialysis Patients. Journal of Renal Nutrition, 21, 176-183. [Google Scholar] [CrossRef] [PubMed]
[4] Harvinder, G.S., Swee, W.C.S., Karupaiah, T., et al. (2016) Dialysis Malnutrition and Malnutrition Inflammation Scores: Screening Tools for Prediction of Dialysis-Related Protein-Energy Wasting in Malaysia. Asia Pacific Journal of Clinical Nutrition, 25, 26-33.
[5] Wang, A.Y. (2011) Consequences of Chronic Inflammation in Peritoneal Dialysis. Seminars in Nephrology, 31, 159-171. [Google Scholar] [CrossRef] [PubMed]
[6] Krishnamoorthy, V., Sunder, S., Mahapatra, H.S., Verma, H., Sharma, N., Jayaraman, R., et al. (2015) Evaluation of Protein-Energy Wasting and Inflammation on Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Its Correlations. Nephro-Urology Monthly, 7, e33143. [Google Scholar] [CrossRef] [PubMed]
[7] Stenvinkel, P., Heimbürger, O., Paultre, F., Diczfalusy, U., Wang, T., Berglund, L., et al. (1999) Strong Association between Malnutrition, Inflammation, and Atherosclerosis in Chronic Renal Failure. Kidney International, 55, 1899-1911. [Google Scholar] [CrossRef] [PubMed]
[8] Deger, S.M., Hung, A.M., Gamboa, J.L., Siew, E.D., Ellis, C.D., Booker, C., et al. (2017) Systemic Inflammation Is Associated with Exaggerated Skeletal Muscle Protein Catabolism in Maintenance Hemodialysis Patients. JCI Insight, 2, e95185. [Google Scholar] [CrossRef] [PubMed]
[9] Jankowska, M., Cobo, G., Lindholm, B. and Stenvinkel, P. (2017) Inflammation and Protein-Energy Wasting in the Uremic Milieu. In: Ronco, C. and Karger, A.G., Eds., Expanded Hemodialysis: Innovative Clinical Approach in Dialysis, S. Karger AG, 58-71. [Google Scholar] [CrossRef] [PubMed]
[10] 王友云, 杜浩昌. 持续非卧床腹膜透析患者营养综合评估及相关分析[J]. 南京医科大学学报(自然科学版), 2017, 37(5): 639-641, 652.
[11] Salame, C., Eaton, S., Grimble, G. and Davenport, A. (2018) Protein Losses and Urea Nitrogen Underestimate Total Nitrogen Losses in Peritoneal Dialysis and Hemodialysis Patients. Journal of Renal Nutrition, 28, 317-323. [Google Scholar] [CrossRef] [PubMed]
[12] Katalinic, L., Premuzic, V., Basic-Jukic, N., Barisic, I. and Jelakovic, B. (2019) Hypoproteinemia as a Factor in Assessing Malnutrition and Predicting Survival on Hemodialysis. Journal of Artificial Organs, 22, 230-236. [Google Scholar] [CrossRef] [PubMed]
[13] Nediani, C. and Dinu, M. (2022) Oxidative Stress and Inflammation as Targets for Novel Preventive and Therapeutic Approaches in Non-Communicable Diseases Ii. Antioxidants, 11, Article 824. [Google Scholar] [CrossRef] [PubMed]
[14] Wang, W., Liang, S., Zhu, F., Liu, J., Chen, X. and Cai, G. (2019) Association of the Malnutrition-Inflammation Score with Anthropometry and Body Composition Measurements in Patients with Chronic Kidney Disease. Annals of Palliative Medicine, 8, 596-603. [Google Scholar] [CrossRef] [PubMed]
[15] Cohen-Hagai, K., Nacasch, N., Sternschuss, A., Ohana, M., Wolach, B., Benchetrit, S., et al. (2020) Malnutrition and Inflammation in Hemodialysis Patients: Comparative Evaluation of Neutrophil Reactive Oxygen Formation. Nutrition, 78, Article ID: 110793. [Google Scholar] [CrossRef] [PubMed]
[16] 刘荣雪, 李大山, 吴永贵. 血清碳酸氢盐水平与腹膜透析患者心血管事件关联性研究[J]. 安徽医科大学学报, 2024, 59(2): 351-356.
[17] Mafra, D., Lobo, J.C., Barros, A.F., Koppe, L., Vaziri, N.D. and Fouque, D. (2014) Role of Altered Intestinal Microbiota in Systemic Inflammation and Cardiovascular Disease in Chronic Kidney Disease. Future Microbiology, 9, 399-410. [Google Scholar] [CrossRef] [PubMed]
[18] Marzocco, S., Fazeli, G., Di Micco, L., Autore, G., Adesso, S., Dal Piaz, F., et al. (2018) Supplementation of Short-Chain Fatty Acid, Sodium Propionate, in Patients on Maintenance Hemodialysis: Beneficial Effects on Inflammatory Parameters and Gut-Derived Uremic Toxins, a Pilot Study (PLAN Study). Journal of Clinical Medicine, 7, Article 315. [Google Scholar] [CrossRef] [PubMed]
[19] Ramezani, A., Massy, Z.A., Meijers, B., Evenepoel, P., Vanholder, R. and Raj, D.S. (2016) Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target. American Journal of Kidney Diseases, 67, 483-498. [Google Scholar] [CrossRef] [PubMed]
[20] Vaziri, N.D., Wong, J., Pahl, M., Piceno, Y.M., Yuan, J., DeSantis, T.Z., et al. (2013) Chronic Kidney Disease Alters Intestinal Microbial Flora. Kidney International, 83, 308-315. [Google Scholar] [CrossRef] [PubMed]
[21] Vaziri, N.D., Yuan, J., Rahimi, A., Ni, Z., Said, H. and Subramanian, V.S. (2011) Disintegration of Colonic Epithelial Tight Junction in Uremia: A Likely Cause of CKD-Associated Inflammation. Nephrology Dialysis Transplantation, 27, 2686-2693. [Google Scholar] [CrossRef] [PubMed]
[22] Tian, N., Yan, Y., Chen, N., Xu, S., Chu, R., Wang, M., et al. (2023) Relationship between Gut Microbiota and Nutritional Status in Patients on Peritoneal Dialysis. Scientific Reports, 13, Article No. 1572. [Google Scholar] [CrossRef] [PubMed]
[23] Alcalde-Estévez, E., Sosa, P., Asenjo-Bueno, A., Plaza, P., Olmos, G., Naves-Díaz, M., et al. (2021) Uraemic Toxins Impair Skeletal Muscle Regeneration by Inhibiting Myoblast Proliferation, Reducing Myogenic Differentiation, and Promoting Muscular Fibrosis. Scientific Reports, 11, Article No. 512. [Google Scholar] [CrossRef] [PubMed]
[24] Caldiroli, L., Molinari, P., Dozio, E., Rigolini, R., Giubbilini, P., Romanelli, M.M.C., et al. (2022) In Patients with Chronic Kidney Disease Advanced Glycation End-Products Receptors Isoforms (Srage and Esrage) Are Associated with Malnutrition. Antioxidants, 11, Article 1253. [Google Scholar] [CrossRef] [PubMed]
[25] Yabuuchi, J., Ueda, S., Yamagishi, S., Nohara, N., Nagasawa, H., Wakabayashi, K., et al. (2020) Association of Advanced Glycation End Products with Sarcopenia and Frailty in Chronic Kidney Disease. Scientific Reports, 10, Article No. 17647. [Google Scholar] [CrossRef] [PubMed]
[26] 柴桂芬, 周明皓, 汪宏, 等. 腹膜透析患者营养不良的影响因素及风险预测模型的构建及验证[J]. 现代生物医学进展, 2022, 22(16): 3182-3187.
[27] Yilmaz, S. and Rakicioglu, N. (2021) Effect of Dialysis Time on Dietary Intake, Body Composition, Muscle Strength, and Nutritional Status of Hemodialysis Patients. Saudi Journal of Kidney Diseases and Transplantation, 32, 729-734. [Google Scholar] [CrossRef] [PubMed]
[28] Schömig, M., Eisenhardt, A. and Ritz, E. (2000) The Microinflammatory State of Uremia. Blood Purification, 18, 327-332. [Google Scholar] [CrossRef] [PubMed]
[29] Amdur, R.L., Feldman, H.I., Gupta, J., Yang, W., Kanetsky, P., Shlipak, M., et al. (2016) Inflammation and Progression of CKD: The CRIC Study. Clinical Journal of the American Society of Nephrology, 11, 1546-1556. [Google Scholar] [CrossRef] [PubMed]
[30] Zhang, H. and Sun, S. (2015) NF-κB in Inflammation and Renal Diseases. Cell & Bioscience, 5, Article No. 63. [Google Scholar] [CrossRef] [PubMed]
[31] Lin, L. and Hu, K. (2014) Tissue Plasminogen Activator and Inflammation: From Phenotype to Signaling Mechanisms. American Journal of Clinical and Experimental Immunology, 3, 30-36.
[32] White, S., Lin, L. and Hu, K. (2020) NF-κB and tPA Signaling in Kidney and Other Diseases. Cells, 9, Article 1348. [Google Scholar] [CrossRef] [PubMed]
[33] Roumeliotis, S., Eleftheriadis, T. and Liakopoulos, V. (2019) Is Oxidative Stress an Issue in Peritoneal Dialysis? Seminars in Dialysis, 32, 463-466. [Google Scholar] [CrossRef] [PubMed]
[34] Stinghen, A.E.M., Massy, Z.A., Vlassara, H., Striker, G.E. and Boullier, A. (2016) Uremic Toxicity of Advanced Glycation End Products in CKD. Journal of the American Society of Nephrology, 27, 354-370. [Google Scholar] [CrossRef] [PubMed]
[35] Miricescu, D., Balan, D., Tulin, A., Stiru, O., Vacaroiu, I., Mihai, D., et al. (2021) Impact of Adipose Tissue in Chronic Kidney Disease Development (Review). Experimental and Therapeutic Medicine, 21, Article No. 539. [Google Scholar] [CrossRef] [PubMed]
[36] Noels, H., Lehrke, M., Vanholder, R. and Jankowski, J. (2021) Lipoproteins and Fatty Acids in Chronic Kidney Disease: Molecular and Metabolic Alterations. Nature Reviews Nephrology, 17, 528-542. [Google Scholar] [CrossRef] [PubMed]
[37] Li, F., Wang, M., Wang, J., Li, R. and Zhang, Y. (2019) Alterations to the Gut Microbiota and Their Correlation with Inflammatory Factors in Chronic Kidney Disease. Frontiers in Cellular and Infection Microbiology, 9, Article 206. [Google Scholar] [CrossRef] [PubMed]
[38] Onal, E.M., Afsar, B., Covic, A., Vaziri, N.D. and Kanbay, M. (2018) Gut Microbiota and Inflammation in Chronic Kidney Disease and Their Roles in the Development of Cardiovascular Disease. Hypertension Research, 42, 123-140. [Google Scholar] [CrossRef] [PubMed]
[39] Pan, W. and Kang, Y. (2017) Gut Microbiota and Chronic Kidney Disease: Implications for Novel Mechanistic Insights and Therapeutic Strategies. International Urology and Nephrology, 50, 289-299. [Google Scholar] [CrossRef] [PubMed]
[40] Hobby, G.P., Karaduta, O., Dusio, G.F., Singh, M., Zybailov, B.L. and Arthur, J.M. (2019) Chronic Kidney Disease and the Gut Microbiome. American Journal of Physiology-Renal Physiology, 316, F1211-F1217. [Google Scholar] [CrossRef] [PubMed]
[41] 黎历. 不同腹膜转运特性的腹透患者血清和透出液Hs-CRP、IL-6水平对比及相关因素分析[D]: [硕士学位论文]. 吉首: 吉首大学, 2021.
[42] Choi, E., Yang, J., Ji, G., Park, M.S., Seong, Y., Oh, S.W., et al. (2022) The Effect of Probiotic Supplementation on Systemic Inflammation in Dialysis Patients. Kidney Research and Clinical Practice, 41, 89-101. [Google Scholar] [CrossRef] [PubMed]
[43] 金玫萍, 杨利才, 张栋梁, 等. 益生菌干预腹膜透析患者对内毒素、炎症因子及营养状况的影响[J]. 中国中现代医学结合肾病杂志, 2022, 23(6): 525-527.
[44] Tong, M., Ren, K., Chen, L. and Zhao, G. (2020) Statin Ameliorates Adipose Inflammation via NLRP3 Suppression. International Journal of Cardiology, 301, 154. [Google Scholar] [CrossRef] [PubMed]
[45] Liberale, L., Carbone, F., Montecucco, F. and Sahebkar, A. (2020) Statins Reduce Vascular Inflammation in Atherogenesis: A Review of Underlying Molecular Mechanisms. The International Journal of Biochemistry & Cell Biology, 122, Article ID: 105735. [Google Scholar] [CrossRef] [PubMed]
[46] Zhang, Z., Wu, P., Zhang, J., Wang, S. and Zhang, G. (2016) The Effect of Statins on Microalbuminuria, Proteinuria, Progression of Kidney Function, and All-Cause Mortality in Patients with Non-End Stage Chronic Kidney Disease: A Meta-Analysis. Pharmacological Research, 105, 74-83. [Google Scholar] [CrossRef] [PubMed]
[47] Rapa, S.F., Di Iorio, B.R., Campiglia, P., Heidland, A. and Marzocco, S. (2019) Inflammation and Oxidative Stress in Chronic Kidney Disease—Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites. International Journal of Molecular Sciences, 21, Article 263. [Google Scholar] [CrossRef] [PubMed]
[48] Pedraza-Chaverri, J., Sánchez-Lozada, L.G., Osorio-Alonso, H., Tapia, E. and Scholze, A. (2016) New Pathogenic Concepts and Therapeutic Approaches to Oxidative Stress in Chronic Kidney Disease. Oxidative Medicine and Cellular Longevity, 2016, Article ID: 6043601. [Google Scholar] [CrossRef] [PubMed]
[49] Freundlich, M., Quiroz, Y., Zhang, Z., Zhang, Y., Bravo, Y., Weisinger, J.R., et al. (2008) Suppression of Renin-Angiotensin Gene Expression in the Kidney by Paricalcitol. Kidney International, 74, 1394-1402. [Google Scholar] [CrossRef] [PubMed]
[50] Sanchez-Niño, M., Bozic, M., Córdoba-Lanús, E., Valcheva, P., Gracia, O., Ibarz, M., et al. (2012) Beyond Proteinuria: VDR Activation Reduces Renal Inflammation in Experimental Diabetic Nephropathy. American Journal of Physiology-Renal Physiology, 302, F647-F657. [Google Scholar] [CrossRef] [PubMed]
[51] Deb, D.K., Sun, T., Wong, K.E., Zhang, Z., Ning, G., Zhang, Y., et al. (2010) Combined Vitamin D Analog and AT1 Receptor Antagonist Synergistically Block the Development of Kidney Disease in a Model of Type 2 Diabetes. Kidney International, 77, 1000-1009. [Google Scholar] [CrossRef] [PubMed]
[52] He, W., Kang, Y.S., Dai, C. and Liu, Y. (2011) Blockade of Wnt/β-Catenin Signaling by Paricalcitol Ameliorates Proteinuria and Kidney Injury. Journal of the American Society of Nephrology, 22, 90-103. [Google Scholar] [CrossRef] [PubMed]
[53] 陆振强. 羟基红花黄色素A联合黄芪甲苷对慢性肾脏病的保护作用[J]. 南京中医药大学学报, 2018, 34(6): 589-592.
[54] 郭晓香. 浅析中药当归的炮制及应用与药理初探[J]. 世界最新医学信息文摘, 2017, 17(30): 175-176.
[55] 刘毓, 刘鹏, 韩晶雪, 等. 基于网络药理学大黄治疗慢性肾脏病机制研究[J]. 中华中医药学刊, 2021, 39(2): 32-36, 262-264.
[56] 王钦汶, 戴新新, 项想, 等. 丹酚酸和丹参酮干预糖尿病肾病的分子机制研究进展[J]. 药学学报, 2019, 54(8): 1356-1363.
[57] 蔡红蝶, 宿树兰, 郭建明. 丹参对糖尿病肾损伤大鼠肠道菌群多样性的影响[J]. 中国中药杂志, 2021, 46(2): 426-435.
[58] 王金象, 雷兵, 车卫平. 排毒保肾丸对腹膜透析患者腹膜转运效能影响的研究[J]. 江西中医药大学学报, 2023, 35(5): 42-45.
[59] 吕勇, 谢如意, 陈文娣, 等. 加味参苓白术散对脾虚瘀浊证持续性不卧床腹膜透析患者的临床疗效[J]. 中成药, 2023, 45(8): 2549-2552.
[60] 童孟立, 倪军, 翁宁, 等. 穴位针灸可提高腹透患者的上臂握力和营养水平[J]. 中华中医药学刊, 2015, 33(7): 1638-1640.
[61] 林基伟. 八段锦对腹膜透析患者临床疗效影响的非随机对照研究[D]: [博士学位论文]. 广州: 广州中医药大学, 2017.