【摘要】目的检测维持性血液透析(maintenance hemodialysis，MHD)患者血清内脏脂肪组织来源的丝氨酸蛋白酶抑制剂(Vaspin)、脂肪因子(Apelin)、视黄酸受体反应蛋白2(chemerin)水平，并分析其与患者营养代谢的相关性。方法选取MHD 患者100 例为研究组，同期健康体检者120 例为对照组，检测血清Vaspin、Apelin、chemerin 水平及营养代谢相关指标。结果与对照组比较，MHD 患者透析前血清钙、Vaspin、Apelin、高密度脂蛋白胆固醇(high density lipoprotein cholesterol，HDL)水平降低(t 值分别为12.783，10.271，10.989，13.592；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001)，C 反应蛋白(C-reactive protein，CRP)、肌酐、尿素氮、Chemerin、三酰甘油(triglyceride，TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol，LDL) 水平升高(t 值分别为26.372，29.789，32.423，22.455，7.891，3.616；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，＜0.001，＜0.001)，透析6 个月后血清钙、Vaspin、Apelin、HDL、LDL 水平降低(t 值分别为4.270、18.343、19.478、6.662、2.408，P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，0.017)，血清磷、空腹血糖、CRP、肌酐、尿素氮、Chemerin、TG 水平升高(t 值分别为12.251，4.184，18.729，37.385，41.026，26.809，8.137；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，＜0.001)；与透析前比较，MHD 组透析6 个月患者血清肌酐、尿素氮、Vaspin、Apelin、TG、LDL 水平降低(t 值分别为4.814，7.223，6.423，7.936，2.455，5.214；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，0.015，＜0.001)，钙、磷、空腹血糖、Chemerin、HDL 水平升高(t 值分别为7.692，9.972，3.463，12.129，7.250；P 值分别为＜0.001，＜0.001，0.001，＜0.001，＜0.001)；与对照组、MHD 组透析前比较，MHD 组透析6 个月后血清总蛋白(total protein，TP)水平、白蛋白水平降低(t 值分别为8.831、8.447、7.714、8.269，P 值分别为＜0.001，＜0.001，＜0.001，＜0.001)；MHD 组透析6 个月后血清Vaspin、

Apelin 水平均与血清TG 水平负相关(r 值分别为-0.402，-0.487；P 值分别为0.025，0.017)，与血清HDL、LDL、TP、白蛋白水平正相关(r 值分别为0.419，0.460，0.506，0.499，0.423，0.438，0.517，0.513；P 值分别为0.009，0.023，0.034，0.021，0.026，0.011，0.018，0.031)；血清chemerin 水平与血清TG 水平正相关(r=0.461，P=0.015)，与血清HDL、LDL、TP、Alb 水平负相关(r 值分别为-0.512，-0.473，-0.519，-0.458；P值分别为0.021，0.015，0.041，0.015)，与总胆固醇水平无相关性(r=0.162，P=0.109)。结论血清Vaspin、Apelin、chemerin水平均与MHD 组患者营养代谢有关，可能作为机体营养代谢的监测指标。

【Abstract】Objective To measure the serum levels of visceral adipose tissue derived serine protease inhibitor (Vaspin), adipokine (Apelin) and Chemerin in uremia patients undergoing maintenance hemodialysis (MHD), and to correlate the serum levels with the nutritional metabolism status in these patients. Methods A total of 100 uremia patients undergoing MHD were selected as the study group, and 120 healthy people were recruited as the control group. Serum levels of Vaspin, Apelin and Chemerin and the indicators relating to nutritional metabolism status were measured. Results Serum levels of calcium (Ca), Vaspin, Apelin and high density lipoprotein cholesterol (HDL) were lower (t=12.783, 10.271, 10.989 and 13.592 respectively; P＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively), while serum levels of C-reactive protein (CRP), creatinine (CRE), blood urea nitrogen (BUN), Chemerin, triglyceride (TG) and low density lipoprotein cholesterol (LDL) were higher in study group before dialysis than in control group (t=26.372, 29.789, 32.423, 22.455, 7.891 and 3.616 respectively; P＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively). After MHD for 6 months, serum levels of Ca, Vaspin, Apelin, HDL and LDL decreased (t =4.270, 18.343, 19.478, 6.662 and 2.408 respectively; P＜0.001, ＜0.001, ＜0.001, ＜0.001 and 0.017 respectively), while serum phosphorus (P), fasting blood sugar, CRP, CRE, BUN, Chemerin and TG increased (t= 12.251, 4.184, 18.729, 37.385, 41.026, 26.809 and 8.137 respectively; P＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively). Serum levels of CRE, BUN, Vaspin, Apelin, TG, LDL were lower (t=4.814, 7.223, 6.423, 7.936, 2.455 and 5.214 respectively; P＜0.001, ＜0.001, ＜0.001, ＜0.001, 0.015 and ＜0.001 respectively), while serum levels of Ca, P, fasting blood sugar, Chemerin and HDL were higher in study group after MHD for 6 months than in the group before MHD (t =7.692, 9.972, 3.463, 12.129 and 7.250 respectively; P＜0.001, ＜0.001, 0.001, ＜0.001 and ＜0.001 respectively). Serum levels of total protein (TP) and albumin (Alb) were lower in study group after MHD for 6 months than in those before MHD and in control group (t=8.831, 8.447, 7.714 and 8.269 respectively; P＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively). Pearson test showed that serum levels of Vaspin and Apelin were negatively correlated with serum TG levels (t =-0.402 and -0.487; P=0.025 and 0.017), and positively correlated with serum levels of HDL, LDL, TP and Alb in study group after MHD for 6 months (r=0.419, 0.460, 0.506, 0.499; 0.423, 0.438, 0.517 and 0.513 respectively; P=0.009, 0.023, 0.034, 0.021; 0.026, 0.011, 0.018 and 0.031 respectively); serum Chemerin levels were positively correlated with serum TG level (r=0.461, P=0.015), and negatively correlated with serum levels of HDL, LDL, TP and Alb (r=-0.512, -0.473, -0.519 and -0.458 respectively; P=0.021, 0.015, 0.041 and 0.015 respectively), but not correlated with serum TC level in study group after MHD for 6 months (r=0.162, P=0.109). Conclusion Serum levels of Vaspin, Apelin, and Chemerin were correlated to the nutritional metabolism status. hey may be used as monitoring indices for nutrition metabolism status in MHD patients.