中国血液净化

›› 2004, Vol. 3 ›› Issue (8): 416-419.

• 论著 • 上一篇    下一篇

血液透析患者营养评估与静息能量代谢

张汝忠 宗 敏 李士杰 薛惠君 王亚岚 丁俊文   

  1. 200040 上海，华东医院肾病科(张汝忠)，营养科(宗敏，李士杰)； 检验科(薛惠君，王亚风，丁俊文)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-08-12 发布日期:2004-08-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-08-12 Published:2004-08-12

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摘要： 目的 探讨蛋白质能量营养不良症（PEM）程度不同的血液透析（HD）患者的静息能量代谢 率（REE）与营养参数、透析效能及炎性因子间联系。方法 用MIS综合性营养炎症评分法对15名HD患者进行PEM评分，根据评分分组，并应用代谢车对其透析前能量代谢进行检测，用TANITA 410型人体成分分析仪测量瘦体（FFM），与营养相关的人体、生化参数及炎性因子也同时被测量。用ANOVA分析出，不同PEM组间的差别。结果 ①MIS评分：(9.02±3.76)分，其中0～10分10例（10/15），10～20分5例(5/15)，20～30分0例(0/15)，表明HD患者处于轻、中度PEM；②轻、中度PEM（MIS分组）比较结果：轻度组与中度组仅在Kt/V上存在差异（ P=0.031）;其他指标：年龄、 Hb、Hct 、EF、REE、体重指数、总蛋白、白蛋白、胆固醇、甘油三酯、右上臂围、三头肌皮褶厚度、MAMC、瘦体、血液透析间期增加体重、淋巴细胞绝对数、nPCR、URR、残余GFR、血清白蛋白、血清总蛋白、血Ph、PTH、CRP、IL-6、血清Scr、BUN等无差异(P>0.05)。结论 轻、中度 PEM血液透析患者静息能量间无差异，但Kt/V存在差异，表明透析充分性对于血液透析患者PEM程度具有影响。

关键词: MIS, 血液透析, 充分性, 静息能量代谢

Abstract:

Objective To evaluate malnutrition inflammation score (MIS) and its relation-ship with resting energy expenditure (REE) and various parameters in maintenance hemodialysis patients. Methods Degree of protein -energy malnutrition(PEM) was evaluated by MIS in 15 patients undergoing maintenance hemodialysis, the patients were divided into mild,moderate groups according to MIS. Energy expenditure was measured by indirect calorimetry using a Sensor Medics Metabolic Cart and a face mask in the resting state. Skinfold thicknesses, mid-arm muscle circumference were measured by a Harpenden caliper and a rule, lean body mass was measured by Tanita Body Composition Analyzer, body mass index was calculated by equation, and several laboratory values, including serum albumin, urea, creatinine, serum C-reactive protein,interleukin-6(IL-6), parathyroid hormone(PTH), total cholesterol(TC), triglycerides(TG), hemoglobin, lymphocyte count, et al, were recorded. Kt/V and nPCR were evaluated by urea kinetic modeling. Results Ten patients(66.7%) had a mildly PEM, five patients(33.3%)had a moderately PEM, there was no difference between two groups in REE, Kt/V was higher in mildly PEM group than in PEM group. The levels of other biochemical and anthropometric parameters were similar of the two groups. Conclusion There was no difference between mildly and moderately nutritional status patients undergoing maintenance hemodialysis in REE. Kt/V levels seem to be associated with the degree of PEM.

Key words: Hemodialysis, Adequacy, Resting energy expenditure

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