不同年龄慢性肾功能衰竭维持性血液透析患者的蛋白质和能量贮备  

Protein and energy reserves in chronic renal failure patients undergoing maintenance hemodialysis at different ages

作　　者：马杰[1] 叶文玲[1] 蔡建芳[1] 石涛[1] 孙威[1] 李雪梅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,100730

出　　处：《中华临床营养杂志》2012年第3期136-142,共7页Chinese Journal of Clinical Nutrition

摘　　要：目的评估不同年龄慢性肾功能衰竭长期血液透析患者的蛋白质消耗及能量贮备状态。方法共入组129例血液透析患者，男性62例、女性67例，平均年龄（56．33±14．14）岁。将其分为〈40岁、40～59岁、60～69岁以及I〉70岁等年龄组。根据血清前白蛋白、白蛋白、胆固醇、肌酐、体重指数（BMI）、标准化蛋白分解率（nPCR）等指标分析不同年龄段血液透析患者的营养状态，并采用多频人体成分分析仪检测瘦肉及脂肪质量，以83例性别年龄匹配的健康人为对照，分析不同年龄段患者的人体组成改变。结果血液透析患者与对照组相比，BMI差异无统计学意义。在血液透析患者中38％的患者BMI高于正常高限，BMI低于18．5kg,／m^2者占6．2％，〈40岁、40－59岁、60—69岁、／〉70岁各组低体重者分别占各年龄段患者的0、6．2％、4．8％和11．1％。t〉70岁组nPCR（1．46±0．28）∥（kg·d）较40—59岁组（1．54±0．28）g／（kg·d）明显降低（P=0．004），肌酐（834．08±184．96）μmol／L较40～59岁组（976．24±186．86）p,mol／L明显降低（P=0．037），前白蛋白（272．65±79．78）mg／L较40—59岁组（332．07±73．03）mg／L明显降低（P=0．026）。血液透析患者人体细胞质量（22．81±8．12）kg较对照组（29．95±6。73）kg明显下降（P〈0．001）、瘦肉组织质量（40．16±11．90）kg较对照组（47．22±9．84）kg明显下降（P〈0．001），瘦肉质量指数（14．75-±3．57）kg／m^2较对照组（17．57±3．10）kg／m^2明显下降（P=0．001），脂肪组织质量（17．45±8．83）kg较对照组（13．66±7．28）kg明显增加（P〈0．001），脂肪质量指数（8．86±4．53）kg／m^2较对照组（6．93±3．67）kg／m^2明显增加（P=0．001）。印～69岁以及≥70岁组人体细胞质量明显低于对照组（P=0．006，P〈0001），〈4JD岁患者瘦肉质量指数亦明显低于�Objective To investigate the protein wasting and energy reserve in chronic renal failure （CRF） patients undergoing maintaining hemodialysis （I-II）） at different ages. Methods A total of 129 CRF pa- tients （62 men and 67 women） aged （56. 33 ± 14. 14） years on HD were enrolled in this study. They were divided into four age groups ： below 40, 40-69, 60-69, and over 70 years. Nutritional status was assessed by body mass index （BMI）, normalized protein catabolic rate （nPCR）, and biochemical parameters including pre-albumin,cholesterol, and creatinine. Body composition was tested with multi-frequency bioelectric impedance analysis. Meanwhile, 83 healthy subjects, matched for age and sex, were enrolled as controls. Results BMI showed no significant difference between healthy controls and HD patients. Among HD patients, 38% had an BMI higher than the normal high limit and 6. 2% had a BMI less than 18.5kg./m2 ; patients with a low body weight accounted for O, 6. 2% , 4. 8% , and 11.1% in the 〈40 years group, 40-59years group, 60-69 years group, and above 70 years groups, respectively, nPCR in the above 70 years group was （ 1.46 ±0. 28 ） g/（ kg . d）, which was significantly lower than that in the 40-59 years group [ （1.54 ± 0. 28 ） g/（ kg . d） ; P = 0. 004） ; the serum creatinine in the the above 70 years group was （834. 08 ± 184.96） μmol/L, which was significantly lower than that in 40-59 years group [ （976.24 ± 186. 86） μmol/1] （P =0. 037） ; the prealbumin in the the above 70 years group was （272.65 ± 79. 78 ） mg./L, which was significantly lower than that in 40-59 year group [ （ 332. 07 ±73.03 ） mg./L ] （ P = 0. 026）. Body cell mass in HD patients was （22. 81 ±8.12） kg, which was significantly lower than that in the control group [ （29.95 ±6. 73） kg] （P 〈0. 001 ） ; furthermore, the lean tissue mass （LTM） [ （40. 16 ± 11.90） kg vs. （47.22 ± 9. 84） kg] and fat [ （ 17.45 ±8.83 ） vs. （ 13.66 ± 7.28 ） kg] w

关 键 词：血液透析 营养 人体成分 

分 类 号：R692.5[医药卫生—泌尿科学]