双能X线检查评价糖尿病肾病非透析患者营养状况的临床价值  

Assessment of nutritional status in diabetic nephropathy patients without dialysis by dual-energy X-Ray absorptiometry

作　　者：严艳[1] 汪年松[1] 简桂花[1] 薛勤[1] 高许萍[1] 

机构地区：[1]上海交通大学附属第六人民医院,上海200233

出　　处：《山东医药》2009年第21期25-27,共3页Shandong Medical Journal

基　　金：上海市自然科学基金资助项目(05ZR14086)

摘　　要：目的探讨双能X线（DEXA）检查评价糖尿病肾病（DN）非透析患者营养状况的临床价值。方法将143例慢性肾衰竭（CRF）4—5期的非透析患者按病因分为DN组和非DN组，用DEXA仪测定其全身肌肉及脂肪组织含量，并行人体学指标、生化指标检测和主观综合营养评估（SGA），评估两组的营养状况。结果与非DN组比较，DN组营养不良发生率高，血清白蛋白、前白蛋白降低，肾小球滤过率升高（P〈0．01或〈0．05）；男、女患者的肌肉组织含量均不同程度降低（P〈0．01或〈0．05），上臂中部肌肉周径减小（P〈0．05）。结论DN非透析患者营养不良发生率高，以低白蛋白血症、肌肉萎缩和负氮平衡为特征；DEXA能精确测定肌肉和脂肪含量，敏感地发现肌肉萎缩和蛋白一能量营养不良。Objective To evaluate the value of assessing the nutritional characters of diabetic nephropathy patients by using dual-energy X-ray absorptiometry （DEX.A）. Methods one hundred and forty-three chronic renal failure （CRF） patients in stage 4 - 5 without dialysis were enrolled and divided into diabetic nephropathy （DN）group and non-diabetic nephropathy（NDN） group. Body composition including lean body mass （LBM） and fat mass （FM） were evaluated by DEXA. Biochemical, anthropometric measurements and subjective global nutritional assessment（SGA） were performed at the same time. Results Compared with NDN group, there was a higher prevalence of malnutrition in DN patients （ SGA score 〉12） （55.1% Vs 34.5%, P 〈 0. 05）. DN patients showed lower senna albumin levels and pre-albumin levels, but higher CRP levels. For either men or women, body weight, BMI and FM-DEXA were little higher in diabetic CRF patients, not showing a statistical significance. In addition, mid-arm muscle circumference and LBM-DEXA were lower in the diabetic CRF patients. Conclusions Our study shows a high prevalence of malnutrition in diabetic CRF patients without dialy- sis. The malnourished patients were characterized by low serum albumin levels and low LBM-DEXA. DEXA cart exactly evat,rote muscle and fat content and it would be a good method for detecting early malnutrition in patients with diabetic nephropathy.

关 键 词：糖尿病肾病 慢性肾功能衰竭 营养状况 双能X线 

分 类 号：R587.2[医药卫生—内分泌] R445.4[医药卫生—内科学]