营养不良血透患者骨骼肌消耗的临床研究  

THE CLINICAL STUDY ON MUSCLE WASTING AND MRI IMAGES IN MAINTENANCE HEMODIALYSIS PATIENTS

作　　者：许烨[1] 王会玲[1] 陆石[1] 梁萌 张金元[1] 

机构地区：[1]上海解放军第四五五医院肾脏科南京军区肾脏专科中心,上海316003 [2]福建省厦门市174医院肾内科,厦门316003

出　　处：《营养学报》2011年第6期602-606,共5页Acta Nutrimenta Sinica

基　　金：上海启明星跟踪基金(No.07QH14020);上海浦江人才基金(No.10PJD016);厦门市科技计划医疗卫生项目(No.3502Z 20084032)

摘　　要：目的研究并发蛋白质能量消耗性（protein—energy wasting，PEW）营养不良的维持性血液透析患者骨骼肌消耗的临床表现及MRI改变。方法70例在我院血液净化中心行维持性血液透析、改良主观营养评价（MQSGA）评分〉10分的患者，观察体重指数等人体测量学指标、生化指标及血常规等，核磁共振（MRJ）测定右下肢骨骼肌肌肉面积和脂肪面积，分析营养指标与肌肉含量的相关性。以30例健康成人为对照组。结果70例血透患者MQSGA评分为12．97±2．36，患者的体重及BMI、肱三头肌皮褶厚度、中臂围、中臂肌围等均低于对照组，血清白蛋白和总蛋白水平略低于对照组；MRI结果显示血透患者与对照组股骨长度基本一致，但营养不良透析患者的右下肢横截面积（cross—sectional area，CSA）明显减少（P〈0．01）；患者肌肉／总面积比值均低于对照组（P〈0．01）；但脂肪面积／肌肉面积比值高于对照组（P〈0．05～0．01）。相关分析结果提示这与患者的胰岛素抵抗有关。结论并发PEW的血透患者，存在体重指数下降和肌肉量丢失，下肢骨骼肌肌肉含量降低，而相对脂肪含量较高，胰岛素抵抗可能与血透患者PEW的肌肉消耗有关。Objective To observe the muscle wasting and the magnetic resonance imaging （MRI） changes in maintenance hemodialysis （HD） patients with protein-energy wasting （PEW）. Method Seventy patients with malnutrition were enrolled according to the scores of modified quantitative subjective global assessment （MQSGA） over 10, with age and sex -matched 30 healthy adults as control. The biochemical, BMI and anthropometry were measured, and the right lower limb skeletal muscle area and fat area were determined by magnetic resonance imaging （MRI）. The correlation between nutritional indicators and data of MRI was analyzed. Results The MQSGA score was 12.97~2.36. The body weight, BMI, triceps skinfold （TSF） and mid-arm circumference （MAC）, the total protein and serum albumin in patients with malnutrition were lower compared with the healthy controls. The MRI results that showed that the length of thigh bone was not different between HD patients and the control subjects, but the cross-sectional area （CSA） of HD patients was significantly reduced compared with the control （P〈0.01）. The muscle area/total area ratio for all layers of HD patients were lower （P〈0.01）, but the fat area / muscle area ratio for all layers were higher compared with the controls （P〈0.05--0.01）. According to the Spearman correlation analysis, insulin-resistance was positively correlated to muscle wasting. Conclusion HD patients with PEW were characterized with loss of muscle mass and BMI. The lower limb muscle content was decreased, but fat content was increased, although the serum albumin levels still in the normal range. Insulin-resistance was positively correlated to muscle wasting of HD patients with PEW.

关 键 词：血液透析 营养不良 核磁共振 胰岛素抵抗 

分 类 号：R459.5[医药卫生—治疗学]