相位角在腹膜透析及血液透析患者营养评估中的应用  

Application of phase angle in nutritional assessment of peritoneal dialysis and hemodialysis patients

作　　者：王善志 刘楠 朱永俊[1] 王颖[1] 吕潇阳 王婷婷[1] 韦传娃 钟良宝[1] WANG Shan-zhi;LIU Nan;ZHU Yong-jun;WANG Ying;LV Xiao-yang;WANG Ting-ting;WEI Chuan-wa;ZHONG Liang-bao(Department of Nephrology,the First Affiliated Hospital of Hainan Medical University,Haikou 570100,Hainan,CHINA)

机构地区：[1]海南医学院第一附属医院肾内科,海南海口570100

出　　处：《海南医学》2021年第11期1373-1376,共4页Hainan Medical Journal

基　　金：国家自然科学基金(编号:82060143);海南省卫生计生行业科研项目(编号:18A200004、19A200016)。

摘　　要：目的评价相位角(PA)在腹膜透析及血液透析患者营养评估中的应用价值,并探讨相位角与患者临床参数的相关性。方法选择2018年1月至2020年10月在海南医学院第一附属医院肾内科治疗的58例腹膜透析患者为腹透组(PD组),73例血液透析患者为血透组(HD组),并选择238例健康体检者作为对照组。PD组及HD组患者进行营养不良-炎症评分(MIS)及相位角测量,对照组只行相位角测量。以MIS为诊断营养不良金标准,绘制受试者工作特征曲线(ROC)对相位角进行诊断一致性评价。通过独立样本t检验比较PD组及HD组的白蛋白、体质量以及甲状旁腺素等临床参数差异性,通过单因素方差分析比较PD组、HD组及对照组的相位角差异,通过Spearman双变量线性相关检验分析PD组及HD组患者PA与身体质量指数(BMI)、上臂肌围(AMC)、尿素清除指数(Kt/V)等临床参数的相关性。结果PD组与HD组患者的营养不良发生率分别为98.28%、95.89%,差异无统计学意义(P>0.05),其中轻-中度营养不良占绝大部分;PD组与HD组患者的白蛋白[(31.64±4.24)g/L vs(36.36±7.24)g/L],体质量[(59.83±9.68)kg vs(66.72±13.01)kg]比较,PD组明显低于HD组,甲状旁腺素[(315.26±169.73)ng/L vs(303.48±189.54)ng/L]比较,PD组明显高于HD组,差异均有统计学意义(P<0.05);PA(50kHz)评估轻-中度腹膜透析及血液透析营养不良ROC曲线下面积(AUC)分别为0.714、0.615,敏感性分别为85.29%、77.50%,特异性分别为66.67%、69.23%;PA临界值分别为4.50°、4.48°;PD组、HD组及对照组的PA(50kHz)分别为(4.09±0.89)°、(4.26±1.24)°、(5.07±1.07),差异有统计学意义(P<0.05),而PD组与HD组比较差异无统计学意义(P>0.05);PD组、HD组患者的PA与年龄及超敏C反应蛋白呈负线性相关(P<0.05),与白蛋白、前白蛋白、总铁结合力、BMI、AMC以及Kt/V呈正线性相关(P<0.05)。结论无论何种透析方式,终末期肾脏病患者均有很高的营养不良发生率,其�Objective To evaluate the application value of phase angle(PA)in nutritional assessment of peritoneal dialysis and hemodialysis patients,and to explore the correlation between PA and clinical data.Methods A total of 58 peritoneal dialysis patients(PD group),73 hemodialysis patients(HD group)and 238 healthy persons(control group)were selected from the Department of Nephrology,the First Affiliated Hospital of Hainan Medical University from January 2018 to October 2020.Malnutrition inflammation score(MIS)and phase angle were measured in PD group and HD group,while phase angle was only measured in control group.Taking MIS as the gold standard for malnutrition diagnosis,the receiver operating characteristic curve(ROC)was drawn to evaluate the consistency of diagnosis.The differences of albumin,body mass,parathyroid hormone and other clinical parameters between PD group and HD group were compared by independent sample t-test.The phase angle differences among PD group,HD group and control group were compared by one-way ANOVA.The correlation between PA and body mass index(BMI),upper arm muscle circumference(AMC),urea clearance index(Kt/V)and other clinical parameters in PD group and HD group was analyzed by Spearman bivariate linear correlation test.Results The incidence of malnutrition in PD group and HD group was 98.28%and 95.89%,respectively,with no statistically significant difference(P>0.05),and mild to moderate malnutrition accounted for the majority;albumin and body mass in PD group were(31.64±4.24)g/L and(59.83±9.68)kg,respectively,which were significantly lower than corresponding(36.36±7.24)g/L and(66.72±13.01)kg in HD group,and parathyroid hormone in PD group was(315.26±169.73)ng/L,which was significantly higher than(303.48±189.54)ng/L in HD group(P<0.05);the area under ROC curve(AUC)of mild to moderate peritoneal dialysis and hemodialysis malnutrition evaluated by PA(50 kHz)was 0.714 and 0.615 respectively,the sensitivity was 85.29%and 77.50%respectively,the specificity was 66.67%and 69.23%respectively,a

关 键 词：相位角 腹膜透析 血液透析 营养不良-炎症评分 营养评估 诊断一致性 

分 类 号：R459.5[医药卫生—治疗学]