运用患者主观全面评定法对维持性血液透析患者蛋白能量消耗状态的调查及可干预危险因素分析  

Investigation and interventionable risk factors analysis of protein energy wasting status in maintenance hemodialysis patients by patient-generated subjective global assessment

作　　者：陈学勋[1] 朱子豪 刘志民 张成银[4] 张海波 赵学兰[1] 徐慧颖[1] 李璇 曹波[1] 柴春香[1] 郭民[1] 武文斌[4] CHEN Xue-xun;ZHU Zi-hao;LIU Zhi-min;ZHANG Cheng-yin;ZHANG Hai-bo;ZHAO Xue-lan;Xu Hui-yin;LI Xuan;CAO Bo;CHAI Chun-xiang;GUO min;WU Wen-bin(Department of Nephrology,Affiliated Hospital of Weifang Medical University,Shandong Province,Weifang 261000,China;Graduate School of Clinical Medical College,Weifang Medical University,Shandong Province,Weifang 261000,China;Department of Nephrology,Weicheng Economic Development Zone Hospital of Weifang,Shandong Province,Weifang 261000,China;Department of Nephrology,Weifang Yidu Central Hospital,Shandong Province,Qingzhou 262500,China;Department of Nephrology,People's Hospital of Xiashan Ecological and Economic Development Zone of Weifang City,Shandong Province,Weifang 261000,China)

机构地区：[1]潍坊医学院附属医院肾内科,山东潍坊261000 [2]潍坊医学院临床医学系研究生院,山东潍坊261000 [3]山东省潍坊潍城经济开发区医院肾内科,山东潍坊261000 [4]山东省潍坊市益都中心医院肾内科,山东青州262500 [5]山东省潍坊市峡山生态经济开发区人民医院肾内科,山东潍坊261000

出　　处：《中国当代医药》2020年第9期149-152,共4页China Modern Medicine

基　　金：山东省潍坊市软科学研究计划项目(2019RKX088、2019RKX132、2018RXX014)。

摘　　要：目的运用患者主观全面评定法(PG-SGA)对维持性血液透析(MHD)患者蛋白能量消耗(PEW)状态情况调查及可干预危险因素分析。方法选取2018年9~12月选取潍坊医学院附属医院、潍坊市益都中心医院、潍城经济开发区医院、潍坊市峡山生态经济开发区人民医院四个透析中心共收治的432例MHD患者作为研究对象,采用横断面研究,运用PG-SGA结合问卷调查、人体测量、生化指标对MHD患者进行PEW状态评估及影响因素分析。结果432例MHD患者中PEW总发生率为52.78%。合并糖尿病、酸中毒、透析不充分Kt/V<1.2、年龄≥65岁、透析时间≥5年的患者PEW总发生率均分别高于非糖尿病、非酸中毒、透析充分、年龄<65岁、透析时间<5年的患者,差异有统计学意义(P<0.05)。体重指数(BMI)、上臂中点周径(MAC)、三头肌皮褶厚度(TSF)、上臂肌肉周径(MAMC)、清蛋白(ALB)、血红蛋白(Hb)各项指标在3个PG-SGA不同评分中的比较,PG-SGA C低于PG-SGA A和PG-SGA B,PG-SGA B低于PG-SGA A,差异均有统计学意义(P<0.05)。Logistic多因素分析显示,糖尿病(OR=3.01,95%CI:1.52~5.84)、酸中毒(OR=1.92,95%CI:1.13~3.34)、透析不充分Kt/V<1.2(OR=1.73,95%CI:1.05~3.68)均是导致MHD患者发生PEW的可干预危险因素(P<0.05)。结论MHD患者PEW发生率高,合并糖尿病患者尤甚;糖尿病、酸中毒、透析不充分Kt/V<1.2是导致MHD患者发生PEW的可干预危险因素。Objective To investigate the protein energy wasting(PEW)status of patients with maintenance hemodialysis(MHD)by patient-generated subjective global assessment(PG-SGA)and analyze the interventionable risk factors.Methods From September to December 2018,432 patients with MHD were selected as research objects from four dialysis centers of Affiliated Hospital of Weifang Medical University,Weifang Yidu Central Hospital,Weicheng Economic Development Zone Hospital,People's Hospital of Xiashan Ecological and Economic Development Zone of Weifang City.A cross-sectional study was conducted.The PG-SGA combined with questionnaires,anthropometry and biochemical indicators were used to evaluate PEW status and analyze influencing factors in MHD patients.Results The total incidence rate of PEW in 432 patients with MHD was 52.78%.The total incidence rates of PEW in patients with diabetes,acidosis,inadequate dialysis Kt/V<1.2,age≥65 years,and dialysis time≥5 years were higher than those in non-diabetes,non-acidosis,adequate dialysis,age<65 years,and dialysis time<5 years patients,the differences were statistically significant(P<0.05).In different PG-SGA qualitative evaluation,individual nutritional indicators such as body mass index(BMI),upper arm midpoint circumference(MAC),triceps skin fold thickness(TSF),upper arm muscle circumference(MAMC),albumin(ALB),and hemoglobin(Hb),PG-SGA C was lower than PG-SGA A and PG-SGA B,and PG-SGA B was lower than PG-SGA A,with statistically significant differences(P<0.05).Logistic multivariate analysis showed that diabetes(OR=3.01,95%CI:1.52-5.84),acidosis(OR=1.92,95%CI:1.13-3.34),inadequate dialysis Kt/V<1.2(OR=1.73,95%CI:1.05-3.68)were all interventionable risk factors for PEW in MHD patients(P<0.05).Conclusion The incidence of PEW is high in MHD patients,especially in patients with diabetes.Diabetes,acidosis and inadequate dialysis Kt/V<1.2 are interventionable risk factors for PEW in MHD patients.

关 键 词：维持性血液透析 蛋白质能量消耗 患者主观全面评定法 可干预危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]