维持性血液透析患者蛋白质摄入与临床营养评估  

Protein intake and nutrition assessment in patients on maintenance hemodialysis

作　　者：张瑜凌 张家瑛[1] 王梦婧[1] 俞苹[1] 袁立[1] 李海明[1] 陈靖[1] 

机构地区：[1]复旦大学附属华山医院肾内科,上海200040

出　　处：《中国血液净化》2014年第12期810-814,共5页Chinese Journal of Blood Purification

基　　金：上海市优秀学科带头人培养计划XBR2013080

摘　　要：目的 为了避免营养不良,2001年K/DOQI指南建议维持性血液透析（MHD）患者每天蛋白摄入量（DPI）不得少于1.2g/kg体质量,然而近来有不少研究对此提出了异议.本研究旨在比较不同蛋白摄入量对MHD患者营养和临床状况的影响,探讨中国MHD患者最合适的蛋白摄入量,为血透营养治疗提供依据. 方法 筛查上海复旦大学附属华山医院血液透析中心饮食稳定的MHD患者189例,指导患者记录3日饮食日记,利用开同营养评估软件分析营养素摄入量.开展营养相关的体表测量,采用主观综合营养评估法（SGA）对患者进行营养评估.同时收集患者透析前血标本,检测相关营养指标及生化、代谢指标. 结果 在189例筛查的血液透析患者中,应用膳食评估和nPNA检测,选取DPI≥0.8 g/（kg·d）的142例,分为3组：①0.8g/（kg·d）≤DPI＜1.0 g/（kg·d） （n=43）,②1.0g/（kg·d）≤DPI＜ 1.2 g/（kg·d）（n=61）,③DPI≥1.2 g/（kg·d） （n=38）.3组患者每日能量摄入均低于指南推荐值,但3种营养素（碳水化合物、蛋白质、脂肪）的摄入比例无明显差异.SGA评分及人体测量结果显示3组患者无显著性差异.血液生化检测显示血红蛋白、白蛋白、总胆固醇等营养相关指标在各组间无显著性差异,但是尿素氮、肌酐、血磷及酸中毒情况随着蛋白摄入增加而显著上升,各组间差别有统计学意义.结论 中国MHD患者每日蛋白摄入量在0.8～1.2 g/kg体质量能够维持较好的营养状态,并有助于减轻高磷血症及酸中毒.Purpose The K/DOQI nutrition guidelines recommend that maintenance hemodialysis （MHD） patients should have a dietary protein intake （DPI） of at least 1.2 g/kg/day to avoid malnutrition.However,there were conclusions different from this recommendation from many studies in recent years.In this study,we compared the nutritional and clinical status in MHD patients using different DPI to discuss the most appropriate protein intake and provide the basis for nutritional therapy in MHD patients.Methods A total of 189 MHD patients treated in our dialysis center and with stable dietary were enrolled in this study.The patients were asked to record their diet in detail for 3 days,and the records were analyzed by dietitians using Keto nutritional assessment software.Nutritional evaluation including subjective global assessment （SGA）,anthropometric and laboratory examinations were collected.Results In the 189 patients,126 patients with DPI ≥0.8 g/（kg·d） were selected and divided into three groups：①DPI ＞0.8 g/（kg·d） and ＜ 1.0 g/（kg·d）,n=43; ②DPI ＞1.0 g/（kg·d） and ＜1.2 g/（kg·d）,n=61; ③DPI ≥1.2 g/（kg·d）,n=38.Dietary energy intake was lower than the recommendation in all 3 groups,and the proportion of nutrient intake including protein,carbohydrate and lipids was similar among the three groups.SGA,anthropometric data and laboratory examinations including hemoglobin,albumin and total cholesterol showed no differences among the three groups.However,BUN,serum creatinine,serum phosphate and acidosis increased along with the increase of DPI,and were significantly different among the three groups.Conclusion DPI between 0.8 and 1.2 g/（kg· d） can maintain better nutritional status and ameliorate hyperphosphatemia and acidosis in Chinese MHD patients using low-flux dialyzers.

关 键 词：维持性血液透析 营养状况 每日蛋白摄入量 

分 类 号：R318.16[医药卫生—生物医学工程]