非脂肪组织含量在评价维持性血液透析患者营养状态及短期预后中的作用  

Significance of fat-free mass on evaluation of the nutrition status and prognosis in maintenance hemodialysis patients

作　　者：孟宇[1] 陈勇[1] 尹良红[1] 

机构地区：[1]暨南大学附属第一医院肾内科,广州510630

出　　处：《肾脏病与透析肾移植杂志》2011年第6期517-521,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:前瞻性分析生物电阻抗分析法(bioelectic impadance anlysis,BIA)测定的非脂肪组织含量(fat-freemass,FFM)是否能反映维持性血液透析(MHD)患者的营养状态,探讨FFM评估患者预后的意义。方法:分析45例MHD患者干体重状态下的FFM值,依FFM是否高于均值,分为大于或等于均值组(FFM-H组),及小于均值组(FFM-L组),并设定40例健康成年人对照。比较组间营养指标及炎症指标的差异;分析FFM与营养、炎症指标的相关性;随访12月后分析不同FFM组住院率、平均住院天数及死亡率的差异。结果:(1)MHD患者的血清白蛋白(Alb)及FFM值低于对照组,CRP及IL-6水平高于对照组(P<0.05);(2)MHD患者组间比较,FFM-L组的Alb低,而反应炎症状态的的指标如CRP及IL-6则高于FFM-H组(P<0.05);(3)干体重状态下经体表面积校正后的FFM值与Alb及体质量指数(BMI)呈正相关(相关系数r分别为0.421和0.608,P<0.01),与CRP或IL-6呈负相关(相关系数r分别为-0.786和-0.485,P<0.01);(4)平均随访13.6±0.6月,FFM-L组与FFM-H组住院率(39.13%vs26.31%,P<0.05)及死亡率(13.04%vs5.26%,P<0.05)均存在明显差异。住院原因分层后发现,FFM-L组因感染住院的平均天数及百分比明显高于FFM-H组。结论:MHD患者较健康人普遍存在营养不良。经体表面积校正的FFM在一定程度上可以反映营养状态,并且对MHD患者的预后具有的预示作用,可以作为评价预后的指标之一。Objective ： To investigate the significance of fat-free mass （FFM） on evaluation of the nutrition status and prognosis in maintenance hemodialysis （MHD） patients. Methodology：Forty-five cases with MHD were enrolled in this study. They were divided into two groups ： the higher FFM group （ FFM-H group, n = 20 ） and the lower FFM group （ FFM-L group, n = 25 ） according to the FFM higher or lower than the mean. 40 healthy adults were as the control group. The clinical features, biochemical examinations and inflammatory parameters were summarized. For the purpose of outcome analysis, MHD patients with a follow-up ≥ 12 months were included. Results ： （ 1 ） Compared with the healthy adults, the MHD patients had lower levels of albumin and FFM （ P 〈 0. 05 ） , and higher levels of C reactive protein （ CRP ） and interleukin-6 （IL-6） （ P 〈 0.05 ） ; （2） Compared with the patients of FFM-H group, the patients of FFM-L group had lower albumin, and BMI, but higher CRP and IL-6; （3） The FFM was correlated significantly with albumin and BMI（ r = 0. 421, 0. 608,P 〈 0. 01 ）, and CRP and IL-6 （ r = - 0. 786, - 0. 485, P 〈 0. 01 ） ; （4） The hospitalization （ 39. 1% vs 26. 3% ） and mortality（ 13.0% vs 5.26% ） were different between the FFM-L and the FFM-H （ P 〈 0. 05 ）. Four deaths （ 8. 8% ） occurred during the follow-up period. Three eases were in FFM-L, and one was in FFM-H. For infection hospital days, the FFM-L had more days than the FFM-H （ P 〈 0. 05 ）. Condusion： The MHD patients mostly have malnutrition status.FFM can reflect the nutrition Status and is a useful parameter to evaluate the prognosis of MHD patients.

关 键 词：维持性血液透析 生物电阻抗分析 非脂肪组织含量 住院率 死亡率 

分 类 号：R459.5[医药卫生—治疗学]