瘦体质评估血透患者营养状态与长期预后的相关性

摘要

Objective:To evaluate the nutritional status of hemodialysis patients with lean body mass,and to observe the correlation between Lean Body Mass and other nutritional indexes,and the influence on the long-term prognosis of patients.Methods:The human body measurement and biochemical parameters were measured in 222 maintenance hemodialysis patients in the hemodialysis center.The lean body mass was calculated and the mortality and hospitalization were observed after 24 months.Results:Lean body mass be measured using creatinineindex(LBM-Scr) and serum albumin (Alb),prealbumin (PA),serum creatinine (Scr),blood urea nitrogen (BUN),normalized protein catabolic rate (NPCR) were positively related (P ＜ 0.05),and high density lipoprotein (HDL) negative correlation (P ＜ 0.05).Lean body mass be measured using humanmid-arm muscle circumference(LBM-MAMC) and serum albumin (Alb) serum creatinine (Scr),blood urea nitrogen (BUN),normalized protein catabolic rate (NPCR) were positively related (P ＜ 0.05),high density lipoprotein (HDL) negative correlation (P ＜ 0.05).Lean body mass (LBM-HGS) be measure using Hand-grip strengthand serum albumin (Alb),prealbumin (PA),serum creatinine (Scr),blood urea nitrogen (BUN),total iron binding capacity (TIBC),normalized protein catabolic rate (NPCR) were positively related (P ＜ 0.05),high density lipoprotein (HDL) negatively correlation (P ＜ 0.05).By the three methods of evaluation of lean body mass,low LBM is associated with higher mortality in patients on PD(P ＜ 0.05),the rate of hospitalization was significantly increased (P ＜ 0.05),especially in hospital due to infection and cardiovascular diseases.Conclusion:It is a simple method to evaluate nutritional status in hemodialysis patients bylean body mass be measured using the creatinine index derived,humanmid-arm muscle circumference measurement Hand -grip strength,and it can well predict the patient's risk of death and hospitalization.%目的:用瘦体质对血液透析患者营养状态进行评估,观察瘦体质与其他营养指标的相关性,及对患者长期预后的影响.方法:对在本血液透析中心222例维持性血液透析患者进行人体测量、生化参数的测定,计算瘦体质,观察24月后患者的死亡、住院情况.结果:肌酐法瘦体质与血清白蛋白、前白蛋白、血肌酐、血尿素氮、标准蛋白分解率呈正相关系(P＜0.05),与高密度脂蛋白(HDL)呈负相关性(P＜0.05).中臂围法瘦体质与血清白蛋白、血肌酐、血尿素氮、标准蛋白分解率呈正相关系(P＜0.05),与高密度脂蛋白呈负相关性(P＜0.05).握力指数法瘦体质与血清白蛋白、前白蛋白、血肌酐、血尿素氮、总铁结合力标准蛋白分解率呈正相关系(P＜0.05),与高密度脂蛋白呈负相关性(P＜0.05).由这三种方法评估的瘦体质,低瘦体质的患者死亡率明显高于高瘦体质的患者(P＜0.05),其住院率明显升高(P＜0.05),尤其是因感染、心血管相关疾病引起的住院.结论:肌酐法、中臂围法、握力指数法评估瘦体质是评价血液透析患者营养状态的简便方法,其能很好的预测患者的死亡和住院风险.