摘要
目的探讨长期血液透析患者透析间期体重增加（interdialytic weight gain，IDWG）与其营养状况和死亡率之间的关系。方法观察2004年1月～2005年12月我院80例维持性血液透析患者，按IDWG分为两组，IDWG〈干体重的3％／d为A组，IDWG〉干体重的3％／d为B组。营养状况调查采用生化法（包括清蛋白、前清蛋白、总胆固醇、肌酐、透前血钾和血磷浓度）、标准蛋白分解率（nPCR）、人体测量（包括体重、体重指数、三头肌皮褶厚度）。结果A组前清蛋白、清蛋白、血钾、血磷、血肌酐水平较B组低，A组nPCR、体重、体重指数、三头肌皮褶厚度较B组低，差异均有统计学意义；生存曲线表明，A组患者2年存活率显著低于B组，71．8％VS92．7％，Pd0．01；血白蛋白水平〈4g／dl的患者较白蛋白水平〉4g／dl患者有较低的生存率，61．9％vs91．5％，P〈O．03。结论IDWG与血液透析患者营养参数密切相关，持续低水平的IDWG提示患者可能存在营养不良和较高的死亡率，临床应重视该类患者的营养支持。
Objective To investigate the relationships between interdialytic weight gain with nutritional status and mortality risk in hemodialysis（HD） patients. Methods To study 80 HD patients in Department of Nephrology of Xinqiao Hospital between January 2004 and December 2005. The patients were divided into two groups according to their IDWG as Group A （IDWG〈3% of dry weight/d） and Group B（IDWG〉3% of dry weight/d）. To investigate malnutrition through biochemical analysis （prealbumin , albumin, total cholesterol, creatinine, predialysis potassiuman and phosphorus levels）, normalized protein catabolic rate （nPCR）, anthropometric measurements（body weight,body mass index,triceps skinfold thickness）. Results During the 24-month period of the study, Group A had significantly lower prealbumin, albumin, predialysis creatinine, potassium and phosphorus levels than Group B. Group A had significantly lower nPCR, body weight, body mass index and triceps skinfold thickness during whole 24 months. According to the survival curves prognosis was significantly poorer for Group A than Group B （2-year survival 71.8% and 92. 7%, P〈0. 01）. The patients with low albumin levels had the worst survival rate （61.9 %） than the patients with high albumin levels （91.5 %）. Conclusion A greater IDWG is directly associated with a better nutritional status, although it is also associated with higher dialysis blood pressure. HD patient with low IDWG has a possible risk of developing malnutrition and mortality risk. Poor nutritional status needs to be viewed with great concern and avoided where possible.
出处
《重庆医学》
CAS
CSCD
2007年第5期400-402,共3页
Chongqing medicine
