摘要
目的探讨血液透析患者在补充口服营养补充剂后蛋白质-能量消耗(protein-energy wasting,PEW)的改善效果。方法收集江西省6所医院中进行维持性血液透析3个月以上且符合PEW诊断的患者共90例,按1:1的比例随机分为对照组及试验组各45人,对2组患者个体按标准体质量计算各营养素需要量后,进行膳食指导,试验组以口服营养补充剂[乐析能补充剂1罐/日(含热量450kcal,20.3g蛋白质)]代替,连续治疗3个月。观察补充乐析能前和试验3个月后2组的体质量指数、血红蛋白、白蛋白等实验室指标以及安全性效果评估等相关参数的变化。结果共纳入90例患者,最终有84例患者(对照组41例,试验组43例)按要求完成了全部试验,其中入组患者的平均年龄为(61.6±11.39)岁,男性47例(55.95%)。干预前对照组能量及蛋白质摄入分别为(1461.69±379.95)kcal,(53.81±21.87)g;试验组为(1522.14±402.27)kcal,(54.92±16.61)g,2组的能量及蛋白质平均摄入无统计学差异(t=0.269,P=0.650;t=0.122,P=0.422),2组间钾、钙、铁、磷等矿物质摄入平均水平无统计学差异(t=0.777,1.485,-0.853,-0.012,P=0.497,0.332,0.065,0.352)。干预3个月后,对照组体质量、体质量指数等体格测量相关数据的变化较试验前变化不明显(t=0.977、1.038,P=0.343,0.315),试验组干预前后体质量、体质量指数升高,主观综合性营养评分(subjective global assessment,SGA)下降(t=-2.325、-2.257、3.598,P=0.027,0.032,0.001);2组血清白蛋白、血红蛋白均较干预前上升,其中试验组血清白蛋白上升更明显[试验组前后差值=(3.40±3.78)g/L,对照组干预前后差值=(1.48±3.5)g/L,t=2.415,P=0.018];试验组血钙升高幅度高于对照组(t=3.126,P=0.002),试验组血糖变化幅度小于对照组(t=2.083,P=0.045)。结论维持性血液透析患者持续给予营养补充剂乐析能可从多方面有效改善血液透析患者PEW症状及其它并发症。
Objectives To investigate the improvement of protein-energy wasting(PEW)in hemodialysis patients after the addition of oral nutritional supplement.Methods A total of 90 patients on maintenance hemodialysis for more than 3 months and met the diagnosis of PEW in the hemodialysis units of the 6 hospitals in Jiangxi Province were recruited and randomly divided into a control group(n=45)and a test group(n=45).After calculating nutrient requirement for standard body weight,dietary guidance was given to the two groups of patients.The supplemental calories in the test group were given by the oral nutritional supplement(Lexineng nutrition supplement,containing 450 kcal and 20.3g protein per can,one can/day)for 3months.Changes in body mass index,laboratory parameters including hemoglobin and albumin,and safety assessment were observed in both groups before and after the intervention for 3 months.Results A total of 90 patients were included in this study,but 84 patients(41 in control group and 43 in test group)completed the trial.The mean age of the enrolled patients was 61.6±11.39 years old,and 47 patients(55.95%)were males.Before intervention,energy intake and protein intake were 1461.69±379.95 kcal and 53.81±21.87g respectively in control group,and were 1522.14±402.27 kcal and 54.92±16.61g respectively in test group,without significant differences between the two groups(t=0.269,P=0.650;t=0.122,P=0.422);the average intake of potassium,calcium,iron and phosphorus also had no significant differences between the two groups(t=0.777,1.485,-0.853 and-0.012 respectively;P=0.497,0.332,0.065 and 0.352 respectively).After the intervention for 3 months,body measurements such as body weight and BMI had no significant changes in control group(t=0.977 and 1.038,P=0.343 and 0.315),but body weight and BMI increased and the subjective global assessment(SGA)decreased intestgroup(t=-2.325,-2.257 and 3.598 respectively,P=0.027,0.032 and 0.001 respectively);serum albumin and hemoglobin increased in both groups,but the increased value of serum albumin was 3.40±3.78g/L in test group,higher than the value of 1.48±3.5g/L in control group(t=2.415,P=0.018);the increased amplitude of serum calcium was higher in test group than in control group(t=3.126,P=0.002);the amplitude of blood glucose change was lower in test group than in control group(t=2.083,P=0.045);blood lipids had no changes in both groups.Conclusion Continuous supplement of Lexineng has multiple effects to improve PEW symptoms and other complications in maintenance hemodialysis patients.
作者
王瑜
赵青
罗勇兵
冯晓然
张丰萍
余筱宇
刘飞燕
徐建华
吴国庆
陈钦开
WANG Yu;ZHAO Qing;LUO Yong-bing;FENG Xiao-ran;ZHANG Fengping;YU Xiao-yu;LIU Fei-yan;XU Jian-hua;WU Guo-qing;CHEN Qin-kai(Department of Nephrology,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Jiangxi Institute of Occupational Disease Control and Prevention,Nanchang 330006,China;Department of Nephrology,Jiujiang People's Hospital,Jiujiang 332001,China;Department of Nephrology,Fengcheng People's Hospital,Fengcheng 331104,China;Department of Nephrology,Nanchang First Hospital,Nanchang 330006,China;Department of Nephrology,Jiangxi Huimin Hospital,Nanchang 330006,China;Department of Nephrology,Jiangxi Provincial Hospital of Traditional Chinese Medicine,Nanchang 330006,China)
出处
《中国血液净化》
CSCD
2023年第1期11-16,共6页
Chinese Journal of Blood Purification
关键词
营养干预
血液透析
蛋白质-能量消耗
Nutritional intervention
Hemodialysis
Protein-energy wasting
