目的 通过K-means聚类分析把血液透析过程中患者进食的食物分类，观察不同种类食物对透析中血糖波动的影响，寻找有助于维持血糖稳定的食物类型。 方法 根据食物的克重和营养成分(热量、碳水化合物、蛋白质、脂肪)计算单位能量密度指标，使用K-means聚类进行分组。探索食物聚类与血糖波动之间的关系。 结果 本研究共入组34例患者，将患者进食的每一种食物作为一个样本，共144例。通过聚类分析得出4组食物：第1组(高糖高脂肪)、第2组(高碳水化合物)、第3组(低密度)、第4组(高蛋白)。4组食物对透析中血糖波动影响关系：整体比较H=61.593，P=0.001；两两比较：高蛋白组和高糖高脂肪组对进食1 h后血糖差值有统计学意义(H值=0.000，P＜0.001)；高糖高脂肪组和高碳水化合物组对进食1 h后血糖差值有统计学意义(H=0.000，P＜0.001)。高糖、高脂肪组的升糖效应最显著[1.20(0.70,1.52)mmol/L]；高碳水化合物组[-1.2(-2.08，-0.40)mmol/L]和高蛋白组[-1.31(-2.08,0.35)mmol/L]对血糖变化总体呈下降趋势；低密度组对血糖变化有小幅度上升趋势[0.30(-1.50,0.95)mmol/L]。 结论 推荐患者在透析 1 h优先选择蛋白质类食物，次选碳水化合物类食物；透析最后 1 h，选择进食少量高糖高脂肪类食物。不建议进食过量的低密度食物。

Objectives  This study classified food consumed by patients during hemodialysis using K-means clustering analysis, observed the effect of different food type on blood glucose fluctuations during dialysis, and identified the food type beneficial to stabilize blood glucose.  Methods  The unit energy density index of every food was calculated based on its weight (in grams) and nutritional components (calories, carbohydrates, protein, and fat). K-means clustering was applied to categorize different food types.  Results  A total of 34 patients were enrolled in this study, with each type of food consumed by the patients regarded as one sample, yielding 144 samples in total. Four food groups were identified via clustering analysis: group 1 (high-sugar and high-fat), group 2 (high-carbohydrate), group 3 (low-density), and group 4 (high-protein). Different food group exerted significant effect on intradialytic blood glucose fluctuation: overall comparison showed H=61.593 and P=0.001; pairwise comparisons revealed significant differences in blood glucose change after food intake for one hour between the high-protein group and the high-sugar high-fat group (H=0.000, P＜0.01) as well as between the high-sugar high-fat group and the high-carbohydrate group (H=0.000, P＜0.01). The high-sugar high-fat group exhibited the most prominent glucose-raising effect [1.20 (0.70, 1.52) mmol/L]; blood glucose level generally decreased in the high-carbohydrate group [-1.20 (-2.08, -0.40) mmol/L] and the high-protein group [-1.31 (-2.08, 0.35) mmol/L]; the low-density group was associated with a slightly upward trend of blood glucose [0.30 (-1.50, 0.95) mmol/L].  Conclusions  High-protein food is recommended to the patients in the first hour of hemodialysis, followed by high-carbohydrate food. A small amount of high-sugar and high-fat food may be consumed in the final hour of dialysis. Large portions of low-energy-density food are not recommended on hemodialysis.