慢性肾衰竭患者的营养状态变化的研究  

Changes of Nutritional Status in Patients with Chronic Renal Failure

作　　者：周胜元[1] 杨波[2] 侯长青[1] 孟祥震[1] 杨洪涛[2] 

机构地区：[1]天津中医药大学第二附属医院肾病科,天津300150 [2]天津中医药大学第一附属医院肾病科,天津300193

出　　处：《中国中西医结合肾病杂志》2017年第1期26-29,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然科学青年科学基金资助项目(No.81303092)

摘　　要：目的:从慢性肾衰竭(CRF)患者脂代谢、蛋白代谢及体内电解质水平方面进行研究,探讨CRF患者的营养状态的变化规律,从而指导临床的治疗。方法:连续收集2015年4月~2015年10月在天津中医药大学第二附属医院肾内科住院的CRF的患者134例,根据肾小球滤过率(GFR)水平,将CRF患者分为CKD2期(GFR 89~60 ml/min)38例,CKD3期(GFR 59~30 ml/min)32例,CKD4期(GFR 29~15 ml/min)32例,CKD5期(GFR<15 ml/min)32例,另选取40例无肾功能损害的体检者作为正常对照组。同时检测患者血清电解质钾、钠、氯、磷、镁、钙水平,蛋白质水平、血脂及血红蛋白水平,并留取患者一般资料,分析各种电解质、血脂、蛋白、血红蛋白的变化规律。结果:五组间的钾、磷、镁、钙离子、高密度脂蛋白、总蛋白、白蛋白、血红蛋白、红细胞的变化差异有统计学意义,CKD5期的钾、磷、镁水平最高,钙、高密度脂蛋白、总蛋白、白蛋白、血红蛋白、红细胞水平最低。CKD3、4、5期的钾高于对照组,钙、总蛋白、白蛋白、血红蛋白、红细胞均低于对照组;CKD4、5期的磷高于对照组;CKD5期的镁、低密度脂蛋白高于对照组,高密度脂蛋白低于对照组(P<0.05或P<0.01)。与CKD2期相比,CKD3、4、5期的钙、总蛋白、白蛋白、血红蛋白、红细胞水平降低,CKD4、5期钾、磷水平升高,CKD5期镁升高,高密度脂蛋白降低(P<0.05或P<0.01)。与CKD3期相比,CKD4、5期组的血红蛋白、红细胞降低,CKD5期的磷、镁升高,高密度脂蛋白降低(P<0.05或P<0.01)。与CKD4期相比,CKD5期的磷水平升高,高密度脂蛋白、血红蛋白、红细胞水平降低(P<0.05或P<0.01)。结论:CRF患者随着病情的进展,电解质、蛋白、血脂、血红蛋白均会出现一系列变化,应尽早进行饮食干预、制定营养治疗方案,预防患者上述营养不良情况的发生。Objective：To explore the changes of nutritional status in patients with chronic renal failure by Analysing the changes of serum electrolytes ,protein and blood fat. Methods：Patients were consecutively collected from April 2015 to October 2015 in the Department of Internal Medicine of the Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. According to Glomerular filtration rate（GFR） , all patients were divided into five groups： CKD2 group （GFR 89 -60 ml/min, n = 38） , CKD3 group （ GFR 59 - 30 ml/min, n = 32 ） , CKIM group （ GFR 29 - 15 ml/min, n = 32 ）, CKD5 group （ GFR 〈 15 ml/min, n = 32 ） and Normal control group （ n = 40）. The levels of serum electrolytes including potassium （ K ＋ ） , sodium （ Na ＋ ） , chorine （ Cl - ） , phos- phorus （p^3-） , magnesium （Mg^2＋ ） , and calcium （Ca^2＋ ） , the levels of protein, blood fat and hemoglobin. The clinical characteristics were recorded. The relationship between various electrolytes, protein, blood fat, hemoglobin and CRF was analyzed. Results：K ＋ , p3 - , Mg2 ＋ , Ca2 ＋ , HDL - C, TP, Alb, Hb and RBC were significantly different among the five groups. In uremic group, the levels of K^＋ , P^3- , Mg^2＋ were higher, while the levels of Ca2~ , HDL - C, TP, Alb, Hb, RBC were lower than those of other groups. In renal dysfunction in compensatory group, renal failure group and uremic group the level of K were significantly higher than that of nor- mal control group, and Ca2 ＊ , TP, Alb, Hb and RBC were lower than those of normal control group. In renal failure group and uremic group, the levels of p3 - was significantly higher than that of normal control group. In uremic group, the levels of Mg2 ~ , LDL - C were significantly higher than those of normal control group, the levels of HDL - C was significantly lower than that of normal control group （P 〈0.05 or P 〈0.01 ）. Compared with renal function reserve group, the levels of Ca2＋ , TP, Alb, Hg and RBC were lower in r

关 键 词：慢性肾衰竭 电解质 血脂 蛋白 血红蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]