蛋白质-能量消耗对血液透析患者预后的影响  

Effect of protein-energy wasting on prognosis of maintenance hemodialysis patients

作　　者：蒲蕾 冯韵霖[1] 洪大情[1] 何强[1] 李贵森[1] 陈瑾[1] Pu Lei;Feng Yunlin;Hong Daqing;He Qiang;Li Guisen;Chen Jin(Renal Department and Institute of Nephrology,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Sichuan Clinical Research Center for Kidney Disease,Chengdu 610072,China)

机构地区：[1]电子科技大学附属四川省人民医院肾脏科暨四川省肾脏病临床研究中心,成都610072

出　　处：《中华临床医师杂志（电子版）》2023年第10期1051-1057,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：成都市第四批市级财政科技项目(2022-HM07-00049-SN)

摘　　要：目的营养状态异常是与维持性血液透析(MHD)患者预后不良密切相关的危险因素之一,为了对CKD患者存在的消耗,营养不良及炎症状态进行统一的描述,国际肾脏营养与代谢协会(ISRNM)提出了“蛋白质-能量消耗(PEW)”这个概念。本研究旨在应用该诊断标准评估本血液透析中心维持性血液透析患者的PEW患病情况及对患者预后的预测能力。方法纳入符合研究入组标准的四川省人民医院肾内科维持性血液透析患者共60名,前瞻性随访45个月,在基线时依据四类指标(血清白蛋白,体质量指数,肌肉容积及饮食摄入量)进行PEW诊断,同时进行改良量化主观全面评估(MQSGA)营养状态量表的评估。应用COX比例风险模型分析PEW及诊断标准的各组分与患者死亡的相关关系。结果60名MHD患者的平均年龄(59.65±13.18)岁,26.7%患者符合PEW的诊断,中位随访时间45月,有14名患者死亡。应用COX比例风险模型分析提示PEW与MHD患者死亡有独立的相关关系。PEW的单个诊断标准中,仅有血浆白蛋白<38 g/L与MHD患者死亡独立相关。以MQSGA>10分作为营养不良评价指标,与患者死亡无相关关系,而MQSGA评分每增加一分与患者死亡有独立相关关系。结论依据ISRNM标准进行PEW诊断可有效预测MHD患者的不良预后。诊断PEW的患者中,合并血清白蛋白<38 g/L的患者死亡风险更大。Objective Abnormal nutritional status is one of the risk factors closely related to poor prognosis in maintenance hemodialysis(MHD)patients.In order to provide a unified description of consumption,malnutrition,and inflammation in chronic kidney disease patients,The International Association of Renal Nutrition and Metabolism(ISRNM)has introduced the concept of"protein-energy wasting"(PEW).The purpose of this study was to evaluate the PEW status of MHD patients in our hemodialysis center and its ability to predict the prognosis of such patients.Methods A total of 60 MHD patients at the Sichuan Provincial People's Hospital who met the study enrollment criteria were prospectively followed up for 45 months.PEW diagnosis was performed at baseline according to four indicators(serum albumin,body mass index,muscle volume,and dietary intake),and the modified quantitative subjective global assessment(MQSGA)nutritional status scale was used to measure the nutritional status of patients.COX proportional risk model was used to analyze the relationship between PEW and the components of the diagnostic criteria for PEW and the death of patients.Results The mean age of the 60 MHD patients was(59.65±13.18)years,26.7%of the patients met the PEW diagnosis,and 14 patients died during a follow-up period of 45 months.COX proportional risk model analysis suggested that PEW was independently associated with death in MHD patients.Among the components of the diagnostic criteria for PEW,only plasma albumin<38 g/L was independently associated with death in MHD patients.MQSGA score>10 as the evaluation index of malnutrition had no correlation with patient death,but each point increase of MQSGA score had an independent correlation with the death of patients.Conclusion PEW diagnosis based on the ISRNM criteria can effectively predict the poor prognosis of MHD patients.Among patients diagnosed with PEW,those with serum albumin<38 g/L have a greater risk of death.

关 键 词：维持性血液透析 蛋白质-能量消耗 预后 

分 类 号：R692[医药卫生—泌尿科学]