维持性血液透析患者营养评估和人体成分分析

摘要

目的 调查维持性血液透析(maintenance hemodialysis,MHD)患者的营养现状、人体成分分布及其影响因素.方法 选择MHD患者123例,应用人体成分检测仪(body composition monitoring,BCM)、人体测量和生化指标评估患者营养和人体成分分布.结果 36.6％的MHD患者存在营养不良.营养不良组患者瘦组织指数(lean tissue index,LTI)显著低于营养良好组(11.598±2.700比12.958±2.531,t=-2.801,P=0.006).超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)升高是患者低瘦组织指数的独立危险因素(OR=2.431,95％ CI=1.136～5.201,P=0.022);而握力是瘦组织指数的保护因素(OR=-0.219,95％ CI=0.097～0.497,P＜0.001). 结论 营养不良MHD患者的人体成分表现为瘦组织量不足.瘦组织量的下降可能与炎症有关;握力可作为MHD患者肌肉量下降的监测指标.%Objective To investigate the nutritional status and body composition in maintenance hemodialysis (MHD) patients,and to explore the factors affecting the body composition.Methods A total of 123 MHD patients completed the body composition analyses by body composition monitoring (BCM),and nutritional assessment by biochemical and anthropometric measurements.Results Malnutrition was defined in 36.6％ patients by prealbumin level.A significant difference Significant difference in lean tissue index (LTI) was noted between malnutrition group and well-nourished group,with lower LTI (11.598±2.700 vs.12.958± 2.531,t=-2.801,P=0.006) in patients in malnutrition group.Higher hypersensitive C-reactive protein (hsCRP) was identified as an independent risk factor for lower LTI (OR=2.431,95％ CI 1.136～5.201,P=0.022),while handgrip strength was found to be a protective factor for LTI (OR=0.219,95％ CI 0.097～0.497,P＜ 0.001) in MHD patients.Conclusion Malnutrition patients tended to have lower lean tissue mass accompanied by higher inflammation markers.Handgrip strength could be used to monitor muscle mass in MHD patients.