维持性血液透析患者两种类型营养不良评价方法的比较研究  

The Comparative Study of Evaluating Method for Two Kinds of Malnutrition in Patients with Maintenance Hemodialysis

作　　者：王文龙 李云生 程勇军 柯颖杰 吴光华 郝世军 陈晓莉 吴小芬 罗筱云 郑丹 张近波 李传光 董志兵 

机构地区：[1]浙江省温岭市第一人民医院肾内科,317500

出　　处：《中国全科医学》2011年第3期232-235,共4页Chinese General Practice

基　　金：温岭市科技计划项目基金(2009WLCB0085)

摘　　要：目的维持性血液透析(MHD)患者存在两种类型的营养不良,即Ⅰ型营养不良和Ⅱ型营养不良。前者由蛋白质和能量摄入不足引起,后者的发生与炎症有关。既然引起营养不良的原因不同,那么两种营养不良的评价方法是否一致?本研究旨在探讨常用营养评价指标〔包括体质指数、肱三头肌皮褶厚度等人体测量学指标,转铁蛋白、胆固醇、血肌酐等生化指标和营养不良-炎症评分(MIS)、改良主观整体评估(MQSGA)等主观营养评价指标〕能否既可评价Ⅰ型营养不良,又可评价Ⅱ型营养不良。方法以2009年7月—2009年10月在温岭市第一人民医院血液净化中心行MHD的124例患者为研究对象。将MIS>0分作为营养不良的诊断标准,把透析前超敏CRP(hs-CRP)≥5 mg/L作为微炎症状态的诊断标准。把MIS>0分但hs-CRP<5 mg/L的MHD患者分入Ⅰ型营养不良组,把MIS>0分且hs-CRP≥5 mg/L的MHD患者分入Ⅱ型营养不良组,同期选取30例健康体检者做对照,观察各组组内营养指标和炎症指标(包括透析前后IL-6和hs-CRP)的相关性及血清清蛋白与其他营养指标的相关性。结果Ⅰ型营养不良者55人,占44.35%;Ⅱ型营养不良者69人,占55.65%;Ⅱ型营养不良组常用营养评价指标和炎症指标明显相关(P<0.05),而Ⅰ型营养不良组上述相关性几乎不存在;Ⅱ型营养不良组血清清蛋白与常用营养评价指标明显相关(P<0.05);Ⅰ型营养不良组清蛋白仅与MIS相关(P<0.05);对照组清蛋白与上述指标均无相关性。结论营养不良和微炎症状态是MHD患者常见并发症,其发病率很高;体质指数、肱三头肌皮褶厚度等人体测量学指标,转铁蛋白、胆固醇、血肌酐等生化指标和MQSGA等主观营养评价指标可能仅适合评价Ⅱ型营养不良,而不适合评价Ⅰ型营养不良。MIS既可评价Ⅰ型营养不良,又可评价Ⅱ型营养不良。Objective There are two kinds of malnutrition in patients on maintenance hemodialysis （MHD）. One is type Ⅰ malnutrition caused by taking less protein and energy, the other is type Ⅱ malnutrition caused by inflammation. Although the cause of malnutrition is different, we use the same parameters to evaluate, such as MIS, 7 - point SGA, serum total protein, albumin, transferrin, ferritin, total iron binding capacity, serum creatinine, uric acid, urea nitrogen and haemoglobin, body mass index （ BMI ） , triceps skinfold （TSF） , mid - arm circumference （ MAC ） and mid - arm muscle circumference （MAMC）. We aim to study these malnutrition evaluating methods to find whether they are fit to evaluate both type Ⅰ and type Ⅱ of malnutrition. Methods 124 patients admitted in Hemo - purified Center of the first people＇s hospital of Wenling from July 2009 to October 2009 were involved in the study. MIS 〉 0 was regarded as the criteria of malnutrition, and the predialysis CRP （hs- CRP） ≥5 mg/L was regarded as the criteria of microinflammation. MHD patients with MIS 〉 0 and hs -CRP 〈 5 mg/L were classified as type I malnutrition, patients with MIS 〉 0 and hs - CRP ≥ 5 mg/L were classified as type lI malnutrition. Meanwhile, 30 healthy people were involved as the control group. Correlation between nutrition and inflammatory parameters in each group （including IL -6 and hs - CRP before and after dialysis） and correlation between albumin and other nutrition parameters were analyzed. Results The incidences of type Ⅰ malnutrition and type Ⅱ malnutrition were respectively 44. 35% and 55.65%. The malnutrition parameter correlated significantly with inflammation parameters in type Ⅱ malnutrition group （ P 〈 0. 05 ）, however, there was no such correlation in type Ⅰ malnutrition group. And albumin correlated significantly with other malnutrition parameters in type Ⅱ malnutrition group, too. But albumin only correlated significantly with MIS in type I malnutrition group （P �

关 键 词：肾透析 营养不良 炎症 营养不良-炎症评分 

分 类 号：R459.52[医药卫生—治疗学]