生物电阻抗法对维持性血液透析患者营养状况的评估价值  

Bioelectrical impedance analysis to evaluate nutritional status in hemodialysis patients

作　　者：卓飞霞[1] 韩宗萍[1] 李芳[1] 殷金梅 陈辰[3] 郑晶[3] Zhuo Feixia;Han Zongping;Li Fang;Yin Jinmei;Chen Chen;Zheng Jing(Department of Nutrition, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China;Hemodialysis Center of the Department of Nephrology, the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China;School of Nursing, Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第五医院营养科,珠海519000 [2]中山大学附属第五医院血液净化中心,珠海519000 [3]中山大学护理学院,广州510080

出　　处：《中国实用护理杂志》2019年第15期1136-1141,共6页Chinese Journal of Practical Nursing

基　　金：2018年中山大学护理青年人才培育基金(N2018Y06).

摘　　要：目的探讨生物电阻抗法对维持性血液透析患者营养状况的评估价值。方法采用横断面研究设计对193例维持性血液透析患者分别运用生物电阻抗法、改良定量主观综合评估法、人体学测量、生化检查等方法评估维持性血液透析(MHD)患者的营养状况,分析各指标间的相关性并比较生物电阻抗法测定的指标对患者营养不良的预测效果。结果生物电阻抗法测得患者的肌肉量(44.06 ± 8.84)kg,体脂肪率(19.81 ± 8.89)%,去脂体质量指数(17.70 ± 2.45)kg/m^2,推定骨量(2.49 ± 0.46)kg,细胞外液率(40.54 ± 3.75)%。生物电阻抗指标和大多数其他营养评价指标显著相关(P<0.05)。营养不良组的肌肉量和推定骨量低于营养良好组(P<0.01)。多元Logistic回归分析显示,体脂肪率(OR=0.94,95%CI 0.89~0.99)、去脂体质量指数(OR=0.79,95%CI 0.66~0.93)是预测患者发生营养不良的保护因素;患者的年龄(OR=1.08,95% CI 1.04~1.12)、透析龄(OR=1.02,95%CI 1.01~1.04)、超敏C反应蛋白(OR=1.11,95%CI 1.03~1.23)是预测患者营养不良的独立危险因素。结论生物电阻抗法对维持性血液透析患者营养状况有良好评估作用。患者营养不良发生率较高;体脂肪率越高、去脂体质量指数越高的患者发生营养不良的风险较低;年龄越大、透析龄越长、超敏C反应蛋白越高的患者发生营养不良的风险较高。Objective To explore the value of bioelectrical impedance analysis in evaluating hemodialysis patients′ nutritional status. Methods Cross-sectional design was employed to evaluate 193 hemodialysis patients′ nutritional status in a Level 3 hospital in Zhuhai, with bioelectrical impedance analysis, modified quantitative subjective global assessment, physical and biochemical measurement. The correlation between each index and the predictive effect of bioelectrical impedance analysis on malnutrition of patients were analyzed. Results According to bioelectrical impedance analysis, hemodialysis patients′ average muscle mass was (44.06±8.84) kg, body fat rate was (19.81±8.89)%, fat free mass index was (17.70±2.45) kg/m2, presumed bone mass was (2.49±0.46) kg, and extracellular water rate was (40.54±3.75)%. The bioelectrical impedance analysis indexes were significantly correlated with most other nutritional evaluation indexes (P<0.05). The muscle mass and bone mass of the malnourished group were lower than that of the well-nourished group (P<0.01). Multivariable logistic regression analysis found that body fat rate (OR=0.94, 95%CI 0.89-0.99), fat free body mass index (OR=0.79, 95%CI 0.66-0.93) were associated with lower risk of malnutrition, age (OR=1.08, 95% CI 1.04-1.12), dialysis age (OR=1.02, 95%CI 1.01-1.04), high sensitive C reactive protein (OR=1.11, 95%CI 1.03-1.23) were associated with higher risk of malnutrition. Conclusion Bioelectrical impedance analysis is a valid measurement on evaluating maintenance hemodialysis patients′ nutritional status. There has a high prevalence of malnutrition in hemodialysis patients. The lower risk of malnutrition is associated with higher body fat rate and higher fat free mass index, and the higher risk of malnutrition is associated with older age, longer dialysis age and higher level of high sensitive C reactive protein.

关 键 词：电阻抗 血液透析 营养状况 

分 类 号：R473.5[医药卫生—护理学]