中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (09): 596-600.doi: 10.3969/j.issn.1671-4091.2017.09.005

• 临床研究 • 上一篇    下一篇

维持性血液透析患者蛋白质能量消耗的调查及对生活质量的影响

张艳1,邢利2,程艳3,张靖华4,梁献慧1,王沛1,刘章锁1   

  1. 1 郑州大学第一附属医院血液净化中心
    2 郑州人民医院血液透析室
    3 郑州市第三人民医院肾脏内科
    4 郑州市第七人民医院肾脏内科
  • 收稿日期:2017-06-09 修回日期:2017-07-04 出版日期:2017-09-12 发布日期:2017-09-12
  • 通讯作者: 刘章锁 zhangsuoliu@sina.com E-mail:zhangsuoliu@sina.com.cn

Investigation of protein-energy wasting and its effect on quality of life in maintenance hemodialysis patients

  • Received:2017-06-09 Revised:2017-07-04 Online:2017-09-12 Published:2017-09-12

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摘要： 目的调查维持性血液透析(maintenance hemodialysis,MHD)患者蛋白质能量消耗(protein-energy wasting,PEW)状况及PEW 对生活质量的影响。方法选取多个中心MHD 患者205 例随访，通过实验室检查、人体测量、人体成分分析、标准化蛋白代谢率(nomalized protein catabolic rate, nPCR)评价PEW 状态，应用肾病及生活质量问卷(kidney disease and quality of lifeTM, KDQOLTM-36)评估患者生活质量，分为PEW 组和非PEW 组进行统计分析。结果194 例MHD 患者，40 例诊断为PEW；PEW组患者肌肉组织指数、人体细胞质量、上臂肌肉围径、握力均低于非PEW 组；Logistic 回归分析示C 反应蛋白(C-reactive protein,CRP)为PEW 的危险因素[OR=1.064，95% CI(1.023，1.109)，P=0.001]，spKt/V＞1.2、nPCR＞0.8g/(kg·d)为PEW 的保护因素[OR =0.638,95% CI(0.430，0.954)，P=0.029；OR=0.017, 95% CI (0.005，0.059), P＜0.001]；PEW 组KDQOLTM-36 11 个维度得分均低于非PEW 组，其中总体健康(t= 2.432, P= 0.018)、社会情感 (t= 2.510, P=0.012)、精力体力(t=2.361,P=0.020)、症状影响(t=3.337,P=0.001)4 个维度得分显著低于非PEW 组。结论郑州市MHD 患者PEW 患病率为20.6%，PEW 的特征可能是肌肉组织的消耗，饮食摄入、透析充分性、炎症状态是PEW 的影响因素，PEW影响患者的生活质量。

关键词: 维持性血液透析, 蛋白质能量消耗, 人体成分分析, 生活质量

Abstract: Objective To investigate the protein-energy wasting (PEW) and its impact on quality of life in maintenance hemodialysis (MHD) patients. Methods A total of 205 MHD patients treated in our hospitals were enrolled in this study. They were followed up. Laboratory examinations, body measurements, body composition monitor, and normalized protein catabolic rate (nPCR) to evaluate PEW, and kidney disease and quality of life (KDQOLTM-36) were conducted. They were then divided into PEW group and non-PEW group for statistical analyses. Results In the 194 MHD patients 40 cases were diagnosed as PEW. Lean tissue index, body cell mass, mid-arm circumference and hand-grips were lower in PEW group than in non-PEW group. Logistic regression showed that C- reactive protein was the risk factor for PEW (OR=1.064, 95% CI 1.023～1.109, P=0.001), while spKt/V＞1.2 and nPCR＞0.8g/(kg·d) were the protect factors for PEW (OR=0.638, 95% CI 0.430-0.954, P=0.029 for spKt/V; OR=0.017, 95% CI 0.005～0.059, P＜0.001 for nPCR). The scores of all dimensions in the KDQOLTM- 36 were lower in PEW group than in non-PEW group, especially the scores of general health (t=2.432, P=0.018), social emotions (t=2.510, P=0.012), energy/fatigue (t=2.361, P=0.020) and symptoms/problems (t=3.337, P=0.001). Conclusion The incidence of PEW in MHD patients was 20.6% in Zhengzhou city. Wasting of muscle tissue was the characteristic of PEW. Dietary intake, dialysis adequacy and inflammatory state were the influence factors for PEW. PEW affected the quality of life in MHD patients.

Key words: Protein-energy wasting, Maintenance hemodialysis, Body composition monitor, Quality of life