持续不卧床腹膜透析患者相位角的影响因素及预估营养不良的研究

doi:10.3969/j.issn.1671-4091.2021.09.005

摘要/Abstract

摘要： 【摘要】目的生物电阻抗分析法(bioelectrical impedance analysis，BIA)可用来评估营养状况[相位角(phase angle，PA)]及容量状态[人体多余水分(over-hydration，OH)]，本研究通过BIA 评估持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)患者的营养状况与容量状态，探讨CAPD 患者PA 的影响因素及预估营养不良。方法纳入2017 年10 月～2020 年10 月于吉林大学第二医院腹膜透析中心行CAPD 的门诊患者200 例，入选患者开始腹膜透析(peritoneal dialysis，PD)3 个月后行BIA 检测，根据PA 的参考值，分为营养不良组(PA＜4.5°)和营养正常组(PA≥4.5°),回顾性分析患者的临床和实验室资料，探讨影响CAPD 患者PA 的相关因素，并预测营养不良的最佳临界值。结果200 例患者中营养不良的患病率为55.50%，营养不良组的患者较营养正常组OH 升高(Z= -5.984，P＜0.001)，而白蛋白、肌肉组织指数(lean tissue index，LTI)均下降(t 为3.823 和6.719, P 均＜0.001)，相关分析结果显示PA 与白蛋白(r=0.232,P=0.003)和LTI(r=0.556,P＜0.001)呈正相关,与OH 呈负相关(r=- 0.583,P＜0.001)。根据ROC 曲线结果，当OH 大于2.85L 或LTI 小于12.85kg/m2 或白蛋白低于35.05g/L 时，CAPD 患者出现营养不良的可能性大，此时的特异性(分别为67.50%、74.70%、40.30%)及敏感性(分别为71.40%、67.10%、86.30%)都相对较高。结论在CAPD 患者中营养不良的现象普遍存在，可结
合OH、LTI 及白蛋白水平预估患者的营养状况。纠正CAPD 患者的营养不良，不仅要对患者予以营养支持，同时要积极纠正患者的容量超负荷状态。

关键词: 持续不卧床腹膜透析, 生物电阻抗分析法, 相位角, 营养不良, 人体多余水分, 白蛋白

Abstract: 【Abstract】Objective Bioelectrical impedance analysis (BIA) can be used to evaluate the nutrition status by phase angle (PA) and the volume status of overhydration (OH). This study investigated the nutrition status and the volume status by BIA in patients with continuous ambulatory peritoneal dialysis (CAPD), to explore the influencing factors of PA and the prediction of malnutrition by PA. Methods 200 CAPD patients in the Peritoneal Dialysis Center of the Second Hospital, Jilin University during October 2017 to October 2020 were enrolled. Patients subjected to BIA 3 months after peritoneal dialysis. Patients were then divided into
malnutrition group (PA＜4.5° ) and normal nutrition group (PA≥4.5° ) based on the reference PA value. Their clinical and laboratory data were collected and compared. The factors affecting PA in CAPD patients and the optimal value for the prediction of malnutrition were explored. Results The prevalence of malnutrition was 55.50% in the 200 CAPD patients. Compared with normal nutrition group, the prevalence of OH was higher (Z=-5.984, P<0.001), while the levels of albumin and lean tissue index (LTI) were lower (t=3.823 and 6.719, P<0.001) in malnutrition group. Univariate correlation analyses showed that PA was positively correlated with albumin (r=0.232, P=0.003) and LTI (r=0.556, P <0.001), and was negatively correlated with OH (r=- 0.583, P<0.001). ROC curve shows that when the values are set at >2.85L for OH, <12.85kg/m2 for LTI and <35.05g/L for albumin for the prediction of malnutrition in CAPD patients, the specificities are 67.50%, 74.70% and 40.30% respectively, and the sensitivities are 71.40%, 67.10% and 86.30% respectively. Conclusion Malnutrition is relatively prevalent in CAPD patients. Clinically, the values of OH, LTI and albumin are useful to estimate nutrition status in CAPD patients. In addition to nutritional support, correction of OH is also important to treat malnutrition in CAPD patients.

Key words: Continuous ambulatory peritoneal dialysis, Bioelectrical impedance analysis, Phase angle, Malnutrition, Overhydration, Albumin

中图分类号:

R459.5

李继翠, 庄小花, 田向辉, 卢雪红. 持续不卧床腹膜透析患者相位角的影响因素及预估营养不良的研究[J]. 中国血液净化, 2021, 20(09): 595-598.

参考文献

1. Lee, J.Y., et al., Serum leptin level is associated with phase angle in CKD5 patients not undergoing dialysis[J]. PLoS One, 2018. 13(8): p. e0202055.
2. Han, B.G., et al., Clinical Significance of Phase Angle in Non-Dialysis CKD Stage 5 and Peritoneal Dialysis Patients[J]. Nutrients, 2018. 10(9).
3. 周巍, 腹膜透析患者的转归及其危险因素分析[J].中国血液净化. 2012. 11(11): p. 600-605.
4. Jang, M., et al., Numerical expression of volume status using the bioimpedance ratio in continuous ambulatory peritoneal dialysis patients: A pilot study. Kidney Res Clin Pract, 2017. 36(3): p. 290-295.
5. Lee, J.Y., et al., Serum leptin level is associated with phase angle in CKD5 patients not undergoing dialysis. PLoS One, 2018. 13(8): p. e0202055.
6. Alves, F.D., et al., Prognostic role of phase angle in hospitalized patients with acute decompensated heart failure. Clin Nutr, 2016. 35(6): p. 1530-1534.
7. Lee, J.E., et al., Comparison of hydration and nutritional status between young and elderly hemodialysis patients through bioimpedance analysis. Clin Interv Aging, 2015. 10: p. 1327-34.
8. Abbas, S.R., F. Zhu, and N.W. Levin, Bioimpedance can solve problems of fluid overload. [J ].Ren Nutr, 2015. 25(2): p. 234-7.
9. 王艳莉, 食管癌手术病人相位角与营养状况的相关性研究. 肠外与肠内营养, 2019. 26(02): p. 65-69.
10. Ruiz-Margáin, A., et al., Malnutrition assessed through phase angle and its relation to prognosis in patients with compensated liver cirrhosis: a prospective cohort study. Dig Liver Dis, 2015. 47(4): p. 309-14.
11. Grundmann, O., S.L. Yoon, and J.J. Williams, The value of bioelectrical impedance analysis and phase angle in the evaluation of malnutrition and quality of life in cancer patients--a comprehensive review. Eur J Clin Nutr, 2015. 69(12): p. 1290-7.
12. Han, B.G., et al., Clinical Significance of Phase Angle in Non-Dialysis CKD Stage 5 and Peritoneal Dialysis Patients. Nutrients, 2018. 10(9).
13. Park, J.H., Y.I. Jo, and J.H. Lee, Clinical usefulness of bioimpedance analysis for assessing volume status in patients receiving maintenance dialysis. Korean J Intern Med, 2018. 33(4): p. 660-669.
14. Van Biesen, W., et al., Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort[J]. PLoS One, 2011. 6(2): p. e17148.
15. Chen, J.B., et al., Relationship between Kt/V urea-based dialysis adequacy and nutritional status and their effect on the components of the quality of life in incident peritoneal dialysis patients. BMC Nephrol, 2012. 13: p. 39.
16. Guest, S., Hypoalbuminemia in peritoneal dialysis patients. Adv Perit Dial, 2013. 29: p. 55-60.
17. Oliveira, C.M., et al., The phase angle and mass body cell as markers of nutritional status in hemodialysis patients. J Ren Nutr, 2010. 20(5): p. 314-20.
18. Stobaus, N., et al., Determinants of bioelectrical phase angle in disease. Br J Nutr, 2012. 107(8): p. 1217-20.
19. Kim, J.K., et al., Prevalence of and factors associated with sarcopenia in elderly patients with end-stage renal disease. Clin Nutr, 2014. 33(1): p. 64-8.
20. Domanski, M. and K. Ciechanowski, Sarcopenia: a major challenge in elderly patients with end-stage renal disease. J Aging Res, 2012. 2012: p. 754739.
21. Huang, R., et al., Lower Phase Angle Measured by Bioelectrical Impedance Analysis Is a Marker for Increased Mortality in Incident Continuous Ambulatory Peritoneal Dialysis Patients. J Ren Nutr, 2019.
22. Kim, J.S., et al., Association between E/e′ ratio and fluid overload in patients with predialysis chronic kidney disease. PLoS One, 2017. 12(9): p. e0184764.
23. Van Biesen, W., et al., Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort. PLoS One, 2011. 6(2): p. e17148.

[1]	舒亮辉, 王星月, 王云, 朝亚, 高冰. PDCA 循环管理对基层医院维持性血液透析患者矿物质代谢及营养指标改善的疗效观察[J]. 中国血液净化, 2021, 20(05): 351-355.
[2]	周小春, 王晓玲, 马志刚, 李小丽, 王俭勤. 维持性血液透析患者甲状旁腺全切术后营养不良和炎症状态的评价[J]. 中国血液净化, 2020, 19(12): 807-810.
[3]	魏萌, 魏丽敏, 王萌, 何荃, 严森辉, 党喜龙, 蒋红利. 维持性血液透析患者血管钙化的危险因素分析[J]. 中国血液净化, 2020, 19(11): 742-746.
[4]	封蕾, 杨杰, 李萍, 李云姝, 陈客宏. 电子智能辅助工具改善透析患者营养不良及矿物质骨代谢异常的观察研究[J]. 中国血液净化, 2020, 19(05): 301-304.
[5]	陈爱珍, 李静, 孙秀丽, 殷娜, 李慧霞, 闫海霞, 侯国存. 血液透析途中高蛋白饮食对患者营养指标的影响[J]. 中国血液净化, 2019, 18(12): 813-817.
[6]	董晶倩, 高山林. 骨硬化蛋白在肾性骨营养不良中的研究进展[J]. 中国血液净化, 2019, 18(11): 766-768.
[7]	史亚男,周晶晶,连晓英,刘小菁,孙倩美,李忠心. 腹膜透析患者低甲状旁腺素血症相关因素分析[J]. 中国血液净化, 2018, 17(10): 667-671.
[8]	封蕾,李云姝,李萍,陈客宏 . 比较MQSGA 及MIS 对老年维持性血液透析患者营养状况的评估研究[J]. 中国血液净化, 2018, 17(08): 519-522.
[9]	苏春燕,汪涛,王培玉. 维持性腹膜透析患者的饮食蛋白摄入评估[J]. 中国血液净化, 2017, 16(07): 437-441.
[10]	周丽娜,黄文,施珍,朱源,章圣泽,董芍芍,王德选. 血液透析患者低PTH血症与营养不良、炎症及无力性骨病的关系[J]. 中国血液净化, 2017, 16(06): 373-377.
[11]	鲍云非,王红,周楚,王晋伟,张路霞. 慢性肾脏病一体化管理门诊患者的营养状况与饮食调查[J]. 中国血液净化, 2017, 16(03): 154-157.
[12]	陈玮,黄雯,张国娟. 营养、炎症状态与血液透析患者冠状动脉粥样硬化性心脏病的关系[J]. 中国血液净化, 2016, 15(12): 678-681.
[13]	段丽萍,郑朝霞,吕宁,杨立娟,杨志凯,董捷. 腹膜透析患者营养不良-炎症-心血管疾病和认知功能的关系[J]. 中国血液净化, 2016, 15(11): 600-604.
[14]	周长菊,曹娟,章旭,印荻,丁浩,赵彩霞,危志强,赵烨. 维持性透析患者的蛋白能量消耗情况及影响因素分析[J]. 中国血液净化, 2016, 15(09): 483-487.
[15]	王国勤,徐彩棉,李狄,卞维静,程虹. 主观综合评分联合生物电阻抗法评估血液透析患者的营养状况[J]. 中国血液净化, 2016, 15(01): 14-17.