肾衰血透患者射血分数、营养状况与静息能量代谢  

A SURVEY OF EJECTION FRACTION,MALNUTRITION STATUS AND RESTING ENERGY EXPENDITURE IN MAINTENANCE HEMODIALYSIS PATIENTS

作　　者：张汝忠[1] 孙敏[1] 孙建设[1] 林庆民 单琳[3] 

机构地区：[1]华东医院肾病科,上海市200040 [2]华东医院B超室,上海市200040 [3]华东医院呼吸科,上海市200040

出　　处：《老年医学与保健》2004年第2期84-86,101,共4页Geriatrics & Health Care

摘　　要：目的研究心功能减退(EF≤50%)的肾衰血透患者的营养状况和静息能量代谢。方法使用MIS系统对15名血透患者进行蛋白质能量营养不良症(PEM)评分,代谢车检测静息能量代谢,营养相关的人体、生化参数及炎性因子被测定,超声心动仪测定射血分数(EF),并以EF50%为界分两组,独立样本t检验检验两组参数间差异,多元逐步回归检测EF和多因素间关系。结果1.MIS评分为9.02±3.76分,轻度、中度PEM分别是10例(66.7%)、5例(33.3%);EF总的均值48.2±7.3%;EF≤50%7例,MIS评分轻度PEM2例,中度PEM5例;EF>50%8例,MIS评分均为轻度PEM;x2检验两组存在显著差异(P<0.01)。2.从回归分析可见:血清白蛋白、总蛋白、总胆固醇、BMI、舒张压、上臂围与EF相关;t检验EF≤50%组与EF>50%组在静息代谢、TSF、Fat(%)上比较,P<0.05。结论反映心功能程度的射血分数与诸多营养参数及舒张压相关,舒张压在一定程度上反映了交感神经的兴奋性,它可能是导致的血透患者有高静息能量代谢的原因。Objective To examine the relationship among ejection fraction, nutritional parameters and resting energy expenditure(REE) in maintenance hemodialysis patients. Methods Degree of protein-energy malnutrition(PEM) was evaluated by a malnutrition inflammation score (MIS) in 15 patients undergoing maintenance hemodialysis. Left ventricular ejection fraction(EF) was measured by echocardiography.The patients were divided into two groups based on value of EF more or less than 50%. The significance of the differences between the two groups was evaluated by the t-test for independent data. Energy expenditure was measured by indirect calorimetry by means of a SensorMedics Metabolic Cart in the resting state. Several laboratory values, including serum albumin,urea, creatinine, C-reactive protein, IL-6, parathyroid hormone(PTH),total cholesterol(TC), triglycerides, hemoglobin, lymphocyte count,etc. were measured. The relationship between EF and relative parameters was evaluated by Linear regression analysis. Results Ten patients(66.7%) had a mild malnutrition status, five patients(33.3%)had a moderate malnutrition status. There was higher REE, lower skinfold thickness and fat levels in EF≤50% group than in EF >50% group. The levels of other biochemical and anthropometric parameters were similar in the two groups. Linear regression analysis showed postdialysis diastolic blood pressure, mid-arm circumference, serum albumin, total protein, cholesterol and body mass index were associated with EF in the patients. Conclusions Level of EF was associated with nutritional parameters, for example, mid-arm circumference , serum albumin, TC and BMI levels in maintenance hemodialysis patients. There was higher REE in EF≤50% group than in EF >50% group, and higher postdialysis diastolic blood pressure seemed to show active systemic norepinephrine level and may act as an important effect on REE.

关 键 词：营养障碍 血液透析 能量代谢 心排血量 

分 类 号：R692.5[医药卫生—泌尿科学]