维持性血液透析患者营养不良、炎症、心血管疾病及MIA综合征的发生情况及其对预后的影响研究  

Incidences of Malnutrition,Inflammation,Cardiovascular Disease and MIA Syndrome in Maintenance Hemodialysis Patients and Their Effect on Prognosis

作　　者：杨松涛[1] 覃莲香[1] 孙克冰[1] 肖跃飞[1] 

机构地区：[1]北京航天中心医院(北京大学航天临床医学院)肾内科,北京市100049

出　　处：《中国全科医学》2013年第14期1617-1619,1622,共4页Chinese General Practice

摘　　要：目的探讨维持性血液透析(MHD)患者营养不良、炎症、心血管疾病(CVD)及MIA综合征(即同时存在营养不良、炎症、心血管疾病)的发生情况及其对预后的影响。方法采用横断面调查,于2010年6—8月对我院67例MHD患者通过主观综合性营养评估(SGA评分)方法进行营养评价,测量高敏C反应蛋白(hs-CRP)作为炎症标志物并记录心血管并发症。然后对这些患者随访24个月,记录其生存、转归情况及死亡原因。采用Kaplan-Meier法和Log-Rank检验对患者的生存情况进行分析。结果经过24个月的随访,67例MHD患者中有16例(23.9%)死亡,2例(3.0%)进行肾移植,49例(73.1%)继续在我院行血液透析治疗。死亡原因为心血管疾病7例,感染性疾病4例,消化道出血1例,其他4例。SGA评分营养正常者生存率高于营养不良者(88.2%和63.6%,P<0.05);hs-CRP<8 mg/L者生存率高于hs-CRP≥8 mg/L者(83.7%和59.1%,P<0.05);合并心血管疾病者生存率低于无心血管疾病者(53.3%和94.6%,P<0.05);合并MIA综合征3个危险因素者生存率低于合并0～2个危险因素者(33.3%和85.5%,P<0.05)。结论部分MHD患者存在营养不良、炎症、心血管疾病及MIA综合征,并且上述因素是MHD患者生存率下降的影响因素。Objective To investigate the incidences of malnutrition, inflammation, cardiovascular disease （CVD） and MIA syndrome in maintenance hemodialysis （MHD） patients and their effect on prognosis. Methods A cross - sectional study was performed in 67 MHD patients form June to October. Subjective global assessment （SGA） was used to assess nutritional status, hs -CRP measured as a marker of inflammation, incidence of CVD recorded. Follow -up lasted 24 months. Patients＇ survival, outcome and death reasons were recorded. Kaplan - Meier and Log - Rank test were performed to analyze patients＇ sur- vival. Results After 24 months of follow - up, 16 patients died （23.9%）, 2 had renal transplantation （3.0%）, 49 contin- ued to receive MHD （73. 1% ）. 7 patients died of CVD, 4 of infectious diseases, 1 of gastrointestinal bleeding, 4 of other cau- ses. By SGA, the survival rate was higher in patients with normal nutrition than in those with malnutrition （88.2% vs. 63.6%, respectively, P 〈 0. 05）, higher in patients with hs - CRP 〈 8 mg/L than in those with hs - CRP ≥ 8 mg/L （83.7% vs. 59. 1%, respectively, P 〈0. 05）, lower in patients complicated by CVD than in those without （53.3% vs. 94. 6%, re- spectively, P 〈0. 05）, and lower in patients with 3 risk factors of MIA syndrome than in those with 0 ~2 risk factors （33.3% vs. 85. 5%, respectively, P 〈 0.05）. Conclusion Malnutrition, inflammation, CVD and MIA syndrome, occurring in some MHD patients, are reasons for reduction of survival rate of MHD patients.

关 键 词：肾透析 营养不良 炎症 心血管疾病 预后 

分 类 号：R459.52[医药卫生—治疗学]