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目的:探讨炎症对腹膜透析(PD)患者6分钟步行试验(6MWT)的影响。方法:选取2010-05-01至2011-04-30在上海交通大学医学院附属仁济医院PD中心规律随访的、稳定的、能耐受6MWT的患者。入选患者均行6MWT,记录6分钟步行距离(6MWD),测定临床生化指标,采用ELISA法测定患者血浆白细胞介素6(IL-6)、五聚素3(PTX3)的浓度。采用多元逐步回归分析炎症指标与PD患者6MWD的关系。结果:共入选100例患者,其中男性52例、女性48例,平均年龄56.0±12.7岁,17例(17%)患者合并糖尿病,8例(8%)合并心血管并发症。相关分析结果显示,6MWD与年龄(r=-0.475,P<0.001),血清氨基末端B型利钠肽前体(NT-pro BNP)ln NTpro BNP(r=-0.217,P=0.031),lnhs-CRP(r=-0.231,P=0.025),ln PTX3(r=-0.271,P=0.009),ln IL-6(r=-0.270,P=0.008)成负相关,与收缩压(r=0.256,P=0.011)、舒张压(r=0.370,P<0.001)、左室射血分数(LVEF)(r=0.261,P=0.013)、前白蛋白(r=0.297,P=0.003)及蛋白质分解率(n PCR)(r=0.362,P<0.001)呈正相关。多元逐步回归显示ln PTX3与6MWD独立相关(β=-0.161,P=0.045),患者年龄(β=-0.403,P<0.001)、女性(β=-0.176,P=0.043)、舒张压(β=0.335,P<0.001)、ln NT-pro BNP(β=-0.161,P=0.026)也是6MWD的独立影响因素。结论:PD患者6MWD受到PTX3的影响,炎症与PD患者运动能力的关系值得进一步深入研究。
Objective: To investigate the effect of inflammation on 6-minute walking test (6MWT) in peritoneal dialysis (PD) patients. Methods: Patients who were stable and able to tolerate 6MWT at the PD center of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2010-05-01 to 2011-04-30 were selected. All patients were enrolled in 6MWT, 6MWD walking distance was recorded, clinical and biochemical indexes were measured, and the concentration of plasma interleukin 6 (IL-6) and pentamer 3 (PTX3) in patients were measured by ELISA. The relationship between inflammatory markers and 6MWD in patients with PD was analyzed by multivariate stepwise regression analysis. RESULTS: A total of 100 patients were enrolled, including 52 males and 48 females, with an average age of 56.0 ± 12.7 years. 17 (17%) had diabetes and 8 (8%) had cardiovascular complications. The results of correlation analysis showed that there was significant difference between 6MWD and age (r = -0.475, P <0.001), serum NT-proBNP ln NTpro BNP (r = -0.217, P = 0.031) -CRP (r = -0.231, P = 0.025), ln PTX3 (r = -0.271, P = 0.009) and IL-6 (r = -0.270, P = 0.008) 0.256, P = 0.011), diastolic blood pressure (r = 0.370, P <0.001), left ventricular ejection fraction (LVEF) Protein degradation rate (nPCR) (r = 0.362, P <0.001) was positively correlated. Multiple stepwise regression showed that ln PTX3 was independently associated with 6MWD (β = -0.161, P = 0.045), age of patients (β = -0.403, P <0.001) = 0.335, P <0.001), and ln NT-pro BNP (β = -0.161, P = 0.026) was also an independent influencing factor for 6MWD. CONCLUSION: The 6MWD of PD patients is affected by PTX3. The relationship between inflammation and exercise ability of PD patients deserves further study.