維持性血液透析患者營(yíng)養(yǎng)狀態(tài)的分析研究

張淑華　夏群

【摘要】 目的：用營(yíng)養(yǎng)不良-炎癥評(píng)估（MIS）方法全面評(píng)估維持性血液透析（MHD）患者的營(yíng)養(yǎng)狀況，并找出導(dǎo)致?tīng)I(yíng)養(yǎng)不良的主要原因；分析患者營(yíng)養(yǎng)不良發(fā)生的相關(guān)危險(xiǎn)因素。方法：選取南京市浦口區(qū)中心醫(yī)院101例維持性血液透析患者，根據(jù)MIS評(píng)分分為輕度營(yíng)養(yǎng)不良組和中重度營(yíng)養(yǎng)不良組，觀察兩組在生化指標(biāo)及人體測(cè)量指標(biāo)之間的差異。結(jié)果：輕度營(yíng)養(yǎng)不良組與中重度營(yíng)養(yǎng)不良組年齡、肌酐、鐵蛋白、上臂圍（MAC）、肱三頭肌皮皺厚度（TSF）、上臂中部肌圍（MAMC）、體重指數(shù)（BMI）、尿素清除率（KT/V）、改良主觀綜合性評(píng)估（MQSGA）等方面，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。按照年齡分為老齡組和非老齡組，非老齡組尿素、肌酐、尿酸等方面均高于老齡組（P<0.05）；老齡組MQSGA、MIS評(píng)分等方面均高于非老齡組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.01）。根據(jù)C反應(yīng)蛋白（CRP）水平分為CRP<1組和CRP≥1組，結(jié)果顯示兩組人體測(cè)量指標(biāo)及評(píng)分方面比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。MAC、TSF、MAMC、BMI、MQSGA與MIS評(píng)分有明顯的相關(guān)性。結(jié)論：本院血液透析中心MHD患者整體營(yíng)養(yǎng)狀態(tài)較好。MHD患者血液透析充分，營(yíng)養(yǎng)不良的主要原因是蛋白質(zhì)攝入不足。年齡越大，越容易出現(xiàn)營(yíng)養(yǎng)不良。

【關(guān)鍵詞】 血液透析； 營(yíng)養(yǎng)狀態(tài)； 營(yíng)養(yǎng)不良-炎癥評(píng)估

Analysis of Nutritional Status in Maintenance Hemodialysis Patients/ZHANG Shuhua，XIA Qun.//Medical Innovation of China，2017，14（32）：037-040

【Abstract】 Objective：To evaluate the use of malnutrition inflammation（MIS） method for comprehensive assessment of maintenance hemodialysis（MHD） patients nutritional status，and find out the main causes of malnutrition，analysis of the related risk factors of malnutrition in patients.Method：Nanjing Pukou Central Hospital，101 cases of hemodialysis patients，according to MIS they were divided into mild malnutrition group and moderate to severe malnutrition group，the differences between two groups in biochemical and anthropometric parameters were observed.Result：Age，creatinine，ferritin，MAC，upper arm circumference，triceps skinfold（TSF），mid arm muscle circumference（MAMC），body mass index（BMI），urea clearance rate（KT/V），the modified subjective comprehensive evaluation（MQSGA） of mild malnutrition group and moderate to severe malnutrition group，the differences were statistically significant（P<0.05）.According to the age they were divided into aging group and non elderly group age，non aged group were higher than those of aging group in urea，creatinine and uric acid（P<0.05），aged group was higher than that of non aged group in MQSGA and MIS scores，the differences were statistically significant（P<0.01）.According to C reaction protein（CRP） levels，they were divided into CRP<1 group and and CRP≥1 group，the results showed that two groups in terms of anthropometric indexes had no significant differences（P>0.05）.MAC，TSF，MAMC，BMI and MQSGA were significantly correlated with MIS scores.Conclusion：The nutritional status of MHD patients in our hemodialysis center is better.Hemodialysis is the cause of malnutrition in MHD patients.The main cause of malnutrition is insufficient protein intake in patients.The older you are，the more likely you are to become malnourished.endprint

【Key words】 Hemodialysis； Nutritional status； Malnutrition inflammation evaluation

First-authors address：Nanjing Pukou Central Hospital，Nanjing 211800，China

doi：10.3969/j.issn.1674-4985.2017.32.009

血液透析是終末期腎臟病（ESRD）患者的主要治療方式之一。維持性血液透析（MHD）延長(zhǎng)了生命，但同時(shí)也加重了患者的營(yíng)養(yǎng)不良。改善營(yíng)養(yǎng)狀態(tài)不僅可以降低患病率和死亡率，還可以改善生活質(zhì)量[1]。因此正確評(píng)估、早期診斷和糾正影響營(yíng)養(yǎng)不良發(fā)生發(fā)展的因素對(duì)于ESRD患者至關(guān)重要。現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料 選取2016年10月-2017年4月在南京市浦口區(qū)中心醫(yī)院血液凈化中心進(jìn)行MHD治療的患者。納入標(biāo)準(zhǔn)：（1）規(guī)律血液透析6個(gè)月以上，每周2～3次；（2）近期無(wú)惡性腫瘤、傳染性疾病等引起營(yíng)養(yǎng)不良的其他因素；（3）未接受腸外營(yíng)養(yǎng)者；（4）近期無(wú)嚴(yán)重水鈉潴留等嚴(yán)重并發(fā)癥者；……