中国血液净化

›› 2003, Vol. 2 ›› Issue (5): 253-256.

• 论著 • 上一篇    下一篇

血液透析患者代谢性酸中毒对机体营养状况的影响

余 毅 袁伟杰 张国兆 于 光   

  1. 350025 福州，南京军区福州总医院血液透析中心（余毅) 200433 上海，第二军医大学第一附属医院肾内科（袁伟杰 张国兆 于光）
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-05-19 发布日期:2003-05-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-05-19 Published:2003-05-19

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摘要： 目的 了解维持性血液透析（ MHD）患者代谢性酸中毒（MA）的发生情况，探讨MA对机体营养 状况的影响。方法 89例MHD患者，透析前抽血查HCO-3和尿素氮、肌酐、血白蛋白、前白蛋白、钙、磷和PTH等指标，并计算Kt／V、总淋巴细胞计数（TLC）和nPCR等营养相关的指标。将89例患者分为MA组（HCO3-≤21mmol/L，61例）和非MA组（HCO3－＞21 mmol/L，28例），进行分析比较。结果 89例患者透析前HCO3－为(19.26±3.51)mmol/L，MA发生率68.5%，透析前血HCO3-与血钙正相关（P＜0.05），与血磷、血尿素氮、肌酐、尿酸、白蛋白、前白蛋白和 nPCR呈负相关 （P＜0.05），而与 体重指数(BMI)、TLC、Kt／V和PTH无明显相关（P＞0.05）。 MA组和非MA组比较，血尿素氮、肌酐、白蛋白、前白蛋白和nPCR差异显著（P＜0.05） ；而二组 BMI、TLC、Kt／V、钙、磷和PTH水平均无显著差异（ P＞0.05）。 结论 轻度的 MA，即使在透析充分的 MHD患者也是很常见的，这种轻度的MA可能主要是由于机体蛋白质摄入增加引起，短期内对机体的营养指标似无明显影响。有关长期MA对机体营养状况的影响，尚待临床进一步观察。

关键词: 维持性血液透析, 代谢性酸中毒, 营养, 标准蛋白分解率

Abstract: Objective To get the information of occurrence rate of metabolic acidosis（MA）in maintenance hemodialysis（MHD）and to investigate the impact of MA on nutritional status. Methods Eighty-nine MHD patients were enrolled in the study. Predialysis laboratory values including HCO3-, urea nitrogen, creatinine, albumin, prealbumin, calcium, phosphorus and intact parathyroid hormone (PTH) were checked. Kt／V,total lymphocyte counts（TLC）and normalized protein catabolic rate (nPCR) were calculated. The correlations between predialysis serum HCO3- level and parameters related to dietary intake and nutritional status were analyzed. MA was defined as a predialysis serum HCO3- concentration of ≤21mmol/L. The subjects were divided into 2 groups: one (MA group) consisted of 61 cases who had a mean serum HCO3- levels equal to or less than 21mmol/L, the other (non-MA group) consisted of 28 cases whose mean serum HCO3- concentrations were more than 21mmol/L. Results The predialysis serum HCO3- concentrations were 19.26±3.51 mmol/L in 89 cases, of which the occurrence rate of MA was 68.5%. The predialysis serum HCO3- level correlated positively with serum calcium，negatively with serum phosphorus, urea nitrogen, creatinine, uric acid, albumin, prealbumin and nPCR (P＜0.05), while there were no significant correlations between predialysis serum HCO3- level and BMI, TLC, Kt／V and PTH（ P＞0.05）. Urea nitrogen, creatinine, albumin, prealbumin and nPCR were significantly different between the MA group and the non-MA group（ P＜0.05）, whereas BMI,TLC, Kt／V, calcium, phosphorus and PTH levels showed no statistically significant differences （P＞0.05）. Conclusion Mild predialysis MA is very common even in well-dialyzed MHD patients，which may be the result of increased protein intake rather than the cause of the high protein catabolic rate. Moreover, the degree of MA may not influence nutritional parameters in a short time, but the further investigation as to long-term effect of MA on the nutritional status should be made.

Key words: Metabolic acidosis, Nutrition, Normalized protein catabolic rate(nPCR) 