MHD患者营养不良-炎症综合征与营养风险及生存质量的相关分析

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者营养不良-炎症综合征(malnutrition inflammation complex syndrome,MICS)与营养风险及生存质量的相关性.方法 选择在昆明医科大学第一附属医院和云南肾脏病医院接受血液透析治疗≥3个月的61例透析患者为研究对象,用NRS2002进行营养风险筛查,用营养不良-炎症评分(MIS)来判断其MICS,用SF-36量表进行生存质量调查.并根据MIS评分将存在MICS的患者分为轻度(MIS≤4)、中度(5≤MIS≤8)、重度(MIS≥9)三组.结果 ①MIS评分在有、无营养风险两组患者之间差异有统计学意义(P＜0.01),与NRS2002评分正相关(r=0.612,P＜0.01);②不同MICS组间握力差异有统计学意义(P＜0.05);③三组MICS组间比较体力所致工作和生活受限得分差异有统计学意义(P＜0.05),MIS评分与SF-36总分、生理和心理领域、体能、体力所致工作和生活受限、社会功能呈负相关,差异有统计学意义(P＜0.05);④有、无营养风险的两组MHD患者生存质量无差异(P＞0.05).结论 MHD患者营养风险越高其营养不良-炎症综合征越严重,营养不良-炎症综合征越严重其生存质量越差.     

维持性血液透析患者肌少症发生的危险因素分析

目的探讨维持性血液透析患者发生肌少症的危险因素。方法采用病例-对照研究,应用亚洲肌少症诊断标准,将37例存在肌少症的维持性血液透析患者作为病例组,选取同期维持性血液透析无肌少症的74例为对照组。使用Logistic回归分析筛选肌少症的危险因素。结果经Logistic回归分析,调整年龄、糖尿病肾病和骨骼肌质量指数后,BMI、透析龄、血磷、细胞外水分比率、经济状况、认知功能、体力活动为维持性血液透析患者发生肌少症的危险因素(P0.05,P0.01)。结论对年龄较大、透析龄长、认知功能障碍、体力活动不足的维持性血液透析患者,在血液透析期间应采取积极措施,尽量减少肌少症发生。     

维持性血液透析患者肌少症危险因素的Meta分析

目的 系统评价维持性血液透析患者肌少症的危险因素,为针对性干预提供参考。 方法 计算机检索PubMed、Web of Science、CINAHL、中国生物医学文献数据库、中国期刊全文数据库、万方数据知识服务平台等中外文主要数据库,采用RevMan5.4软件进行Meta分析。 结果 共纳入18篇文献3 109例患者。男性、高龄、低体重指数、体力活动不足、营养不良、超敏C反应蛋白水平升高、高血磷、认知功能障碍、经济困难、高细胞外水分比率、高体脂率是维持性血液透析患者肌少症的危险因素（均P＜0.05）;握力水平较好为保护因素（P＜0.05）。 结论 维持性血液透析患者肌少症影响因素较多,应进行针对性、个体化干预,防止肌少症的发生或加重,以提高患者生活质量。     

营养不良-炎症评分评估腹膜透析患者营养状态及相关影响因素

目的通过营养不良-炎症评分系统探讨腹膜透析患者的营养状态及相关影响因素。方法对安徽医科大学第二附属医院腹膜透析中心行维持性腹膜透析的患者进行营养不良-炎症评分(malnutrition-inflammation score,MIS),同时检测腹膜透析患者人体测量指标、握力、生化指标(包括血红蛋白、血清白蛋白、前白蛋白、转铁蛋白、总铁结合力、钠、超敏C反应蛋白、β2微球蛋白),并分析MIS与各项指标的相关性。结果符合纳入标准的腹膜透析患者共91例,其中男43例,女48例,平均年龄为(49.3±17.2)岁,均为营养不良者,其中轻度43例,中度46例,重度2例。中重度营养不良患者的体质量指数、上臂肌围及握力均较轻度营养不良患者明显下降(P0.05);与营养相关的生化指标包括白蛋白、前白蛋白亦明显下降(P0.05);在铁代谢指标中总铁结合力和转铁蛋白饱和度明显降低(P0.05);而微炎症指标超敏C反应蛋白在中重度营养不良患者中则明显升高。MIS与体质量、上臂肌围、白蛋白、前白蛋白、尿酸、握力、转铁蛋白、总铁结合力呈负相关,而与铁蛋白、超敏C反应蛋白、甲状旁腺素呈正相关。而性别、握力及白蛋白对MIS有显著影响。结论 MIS可用以评估腹膜透析患者的营养状态,随着MIS分值的增加,患者的营养不良炎症状态也越重。而高龄、白蛋白水平低或握力低的患者有较高的MIS分值,营养状况更差。     

精细化管理ORTCC模型在维持性血液透析肌少症患者管理中的应用

目的 探讨精细化管理ORTCC模型在维持性血液透析肌少症患者管理中的应用效果。方法 将2022年2～6月行维持性血液透析治疗的62例肌少症患者按病区分为对照组与干预组,各31例。对照组采用常规护理,干预组在此基础上采用精细化管理ORTCC模型(围绕目标、规则、训练、考核和文化5个要素)实施管理,干预6个月后评价效果。结果 干预组患者骨骼肌质量指数、上臂肌肉围度、简易躯体功能量表评分,握力、步速、知识掌握率显著高于对照组(均P<0.05)。结论 精细化管理ORTCC模型的应用可改善肌少症相关指标,提高机体功能,提升患者知识掌握度,利于对患者的精准管理。     

有氧联合抗阻运动对老年维持性血液透析肥胖型肌少症患者的影响

目的 探讨有氧联合抗阻运动对老年维持性血液透析肥胖型肌少症患者的影响,为制订有效的运动干预措施提供参考。方法 采用便利抽样法,选取行维持性血液透析的肥胖型肌少症患者随机分配为干预组(n=30)和对照组(n=30)。对照组给予常规护理,干预组在对照组基础上,给予上肢弹力球、下肢弹力带加空中踩脚踏车的有氧联合抗阻运动。干预12周,对两组重要肌肉、肥胖、实验室指标及生活质量得分进行比较。结果 干预组29例、对照组30例完成研究。6周后干预组内脏脂肪面积显著低于对照组;12周后干预组握力、血清白蛋白及生活质量得分显著高于对照组,体脂率、内脏脂肪面积显著低于对照组(均P<0.05)。结论 有氧联合抗阻运动可有效改善老年维持性血液透析肥胖型肌少症患者的肌肉力量及营养状况,提高生活质量。     

中药对血透患者营养不良-炎症综合征的影响

目的:研究中药对慢性肾衰竭维持性血透患者营养不良-炎症反应综合征(MICS)的影响.方法:MHD患者60例,随机分为治疗组和对照组各30例,治疗组在常规治疗中加入中药益气固肾液,对照组为常规血液透析液.观察治疗后患者血TNF-α、IL-6水平及营养指标(Alb、TF).结果:治疗组与对照组治疗后比较,血浆TNF-α水平明显下降(P＜0.05),各项营养指标BW、TSF、AMC以及Alb、TF均提高(P＜0.05).结论:中药益气固肾液能降低血浆TNF-α水平,提高BW、TSF、AMC以及Alb、TF水平,提示能改善维持性血透患者营养不良-炎症综合征.     

维持性血液透析患者慢性牙周疾病与营养不良-炎症复合性综合征相关性的研究

目的探讨维持性血液透析(MHD)患者慢性牙周疾病与营养不良-炎症复合性综合征(MICS)的相关性。方法选择2016年1月至2017年12月在武汉市中心医院肾内科血液净化中心维持性血液透析的符合实验纳入及排除标准的患者共64例,根据牙周病的诊断标准,分为无牙周病组(No)16例、轻度牙周病组(Mild) 18例、中度牙周病组(Moderate)15例、重度牙周病组(Severe)15例,各组患者均进行血红蛋白(Hb)、血清白蛋白(Alb)、血清铁(Fe)、铁蛋白(Ferritin)、营养不良-炎症评分(MIS)等营养相关指标检测以及血清超敏C蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)相关炎症指标检测。采用多因素线性回归评估并比较各组营养状况指标及炎症相关指标的差异,采用偏相关分析评估MIS与炎症相关指标、牙周病严重程度的相关性。结果与重度牙周病组相比,其他各组Hb、Alb、Fe水平、hs-CRP、TNF-α、Ferritin水平均显著下降,差异具有统计学意义(P0.01)。无牙周病组MIS值为(8.8±1.2);轻度牙周病组MIS值为(14.0±1.2);中度牙周病组MIS值为(17.7±1.4);重度牙周病组MIS值为(22.0±1.1);各组MIS值与重度牙周病组相比均有统计学意义(P0.05)。在控制了年龄、糖尿病与否、透析时间后采用偏相关分析牙周病指数(PDI)和MIS值与炎症指标之间的关系,结果显示PDI与血清超敏C蛋白之间显著相关(r=0.258,P0.05),MIS值与血清超敏C蛋白(r=0.297,P0.01)、TNF-α水平(r=0.243,P0.01)、PDI(r=0.328,P0.01)显著相关。结论牙周病的严重程度、炎症因子水平增加,均可加重MICS。对于MHD患者需积极的防治慢性牙周疾病.     

新乡地区维持性血液透析患者贫血现况调查及相关因素分析

目的 探讨维持性血液透析患者的贫血现况及相关影响因素.方法 收集2012年1月至3月新乡地区4家综合医院364例维持性血液透析3个月以上患者的临床资料.分析维持性血液透析患者贫血现况及其与促红细胞生成素、铁剂、营养不良、透析充分性、微炎症、甲状旁腺激素等因素的关系.结果 364例患者中促红细胞生成素治疗率为97％,铁剂治疗率为87％,贫血治疗达标率仅为30％,贫血治疗达标组患者的血白蛋白、转铁蛋白饱和度、透析龄、尿素清除指数、铁蛋白和转铁蛋白饱和度两者均达标率患者非达标组比较差异有统计学意义(P均＜0.05).而贫血治疗达标组患者的血红蛋白、透析频率、铁蛋白值、前白蛋白、铁蛋白和转铁蛋白饱和度达标率与非达标组比较差异有统计学意义(P均＜0.01),C反应蛋白值与非达标组比较差异有统计学意义(P＜0.01).贫血治疗达标组促红细胞生成素治疗量在与未达标组比较差异无统计学意义(P＞0.05),但其用量远低于肾脏病预后质量指南中推荐的量.多因素Logistic回归分析结果显示白蛋白、前白蛋白、尿素清除指数、透析频率是维持性透析贫血的独立影响因素.结论 新乡地区大部分维持性血液透析贫血患者均接受促红细胞生成素和铁剂治疗,但治疗仍不充分,达标率较低.营养不良、微炎症、透析不充分、性别也是贫血治疗达标率低的原因,但白蛋白、前白蛋白、尿素清除指数、透析频率是维持性血液透析贫血的独立影响因素.提示我们在采用充足的促红细胞生成素和铁剂治疗维持性血液透析贫血患者的同时,应加强其营养治疗和充分透析的宣传教育.     

维持性血液透析患者微炎症与肌少症相关性研究

目的:探讨维持性血液透析(Maintenance hemodialysis,MHD)患者微炎症与肌少症的相关性研究。方法:收集我院门诊及住院的维持血液透析3个月以上且病情稳定的患者145例,依照欧洲老年肌少症工作组(EWGSOP)制订的诊断标准,分为无肌少症组、肌少症前期组及肌少症期组,检测各组生化指标及微炎症因子水平。结果:1.各组患者一般情况比较:患者的透析龄、BMI、i PTH、CRP、NF-κB具有统计学差异,而Scr、BUN、UA、Hb、生化离子、血脂等无统计学意义。2.危险因素分析:透析龄、BMI及高CRP水平是MHD患者肌少症的独立危险因素。结论:本研究结果表明,微炎症反应是MHD患者肌少症发病的重要危险因素,其具体机制有待于进一步研究。     

Muscle mass evaluation and influential factors of sarcopenia in maintenance hemodialysis patients

Objective To evaluate the muscle mass in maintenance hemodialysis (MHD) patients and analyze the influential factors. Methods Ninety-seven patients on MHD and 34 healthy people were recruited. Muscle mass was measured by bioelectrical impedance analysis and compared. Patients'age, sex, height, body weight, walking activity, modified quantitative subjective global assessment (MQSGA) score and laboratory tests were recorded. The relationship of appendicular skeletal muscle mass/height2 (ASM/H2) and other factors were analyzed using multivariate linear regression. Results Compared with normal cohort, the MHD patients showed lower body fat rate and lower ASM/H2 (both P＜0.05). In 97 MHD patients, 21.4% of male patients suffered from sarcopenia, and 24.4% of female patients suffered from sarcopenia. Patients were divided into two groups according to the level of ASM/H2 (male＜7.0 kg/m2, female＜5.8 kg/m2). The grip strength, serum creatinine, 1,25(OH)2D and mid-arm muscle circumference in low ASM/H2 group were lower than those in normal ASM/H2 group, and the differences were significant (all P＜0.05). In multivariable regression model, male (β=0.534, P=0.003), 1,25(OH)2D (β=0.582, P=0.024), creatinine (β=0.421, P=0.037), grip strength (β=0.681, P=0.001), and lg[NT-proBNP] (β=-1.760, P=0.042) were independently associated with ASM/H2 in MHD patients. Conclusion The prevalence of sarcopenia is much higher in MHD patients than in healthy people. The levels of grip strength, NT-proBNP, creatinine and 1, 25(OH)2D are the important influential factors for muscle mass in MHD patients.     

维持性血液透析患者心血管钙化的发生率及相关因素

目的 探讨维持性血液透析患者心血管钙化的发生率及相关因素.方法 选择接受维持性血液透析≥3月的非住院患者60例,完善相关实验室检查,腹部侧位X线片检测腹主动脉钙化评分(Kauppila法),心脏超声检测心脏瓣膜钙化情况,并计算心血管钙化指数.结果 本组患者影像学检查可见钙化的总发生率为68.3％,腹主动脉钙化的患者中5≤腹主动脉钙化评分＜ 16者占41.4％,瓣膜钙化以主动脉瓣为主(占64.5％).有钙化组与无钙化组患者的年龄、血钙、心血管钙化指数存在差异(均P ＜0.05),而透析龄(月)、身高、体质量、握力、血磷、血红蛋白、血清总蛋白、血清白蛋白、血脂未见差异(均P≥0.05).结论 本组患者心血管钙化部位不均衡,随患者年龄和血钙水平的增加,心血管钙化的发生风险升高.     

Sarcopenia in patients undergoing maintenance hemodialysis: incidence rate,risk factors and its effect on survival risk

Background Sarcopenia is a degenerative syndrome mainly characterized by the atrophy of skeletal muscle, along with the decrease of muscle strength and function. However, there are currently few studies concerning sarcopenia in patients undergoing maintenance hemodialysis dialysis (MHD). This study was aimed to investigate the incidence of sarcopenia in MHD patients and its influencing factors, as well as its impact on survival risk. Method All 131 MHD patients enrolled in our study were tested with bioelectrical impedance analysis (BIA) and grip strength. Demographic data was collected and anthropometric measurement and laboratory examination were conducted. Results The total incidence of sarcopenia within the 131 MHD patients was 13.7% and the incidence of sarcopenia in patients over 60 years was 33.3%. The dialysis duration, with or without diabetes, serum phosphorus and pre-albumin levels of sarcopenic patients were significantly different from those of non-sarcopenicones; the modified quantitative subjective global assessment (MQSGA) scores of sarcopenic patients were higher than those without sarcopenia. Multivariate analysis showed that dialysis duration, diabetes and serum phosphorus level were independent risk factors for sarcopenia in MHD patients. Kaplan–Meier survival analysis showed a one-year survival of 88.9% in sarcopenic patients, which was significantly lower than non-sarcopenic patients. Conclusion The incidence of sarcopenia in MHD patients was high and increased gradually with age. Dialysis duration, diabetes, serum phosphorus level and malnutrition predisposed the patients to sarcopenia. One-year follow-up found that the mortality risk of sarcopenic patients was higher than that of non-sarcopenic patients.     

Relationship of rest metabolic rate with anthropometry in maintenance hemodialysis patients

Objective To explore the feasibility of bioelectrical impedance analysis in assessing resting energy metabolism (REM) and the association of REM with anthropometry in hemodialysis patients. Methods Adult hemodialysis patients from 11 hemodialysis facilities in Guizhou Province were enrolled in this study. Bioelectrical impedance analysis was used to measure the rest metabolic rate (RMR) and body composition of 765 patients undergoing regular dialysis. A standard method was used to measure their height, weight, upper arm circumference, triceps skinfold thickness, left calf circumference and grip strength. The upper arm muscle circumference was also calculated. The level of RMR and body composition in hemodialysis patients were compared by gender grouping. The patients were then divided into four groups according to the RMR quartile. Spearman correlation analysis and multiple linear regression analysis were derived to analyze the relationship between RMR and anthropometry. Results The level of RMR in male patients was significantly higher than that in female patients [1591(1444, 1764) Rcal/d and 1226(1104, 1354) Rcal/d, P＜0.001]. Compared with the first quartile of RMR group, upper arm circumference, upper arm muscle circumference, left calf circumference and grip strength in the fourth quartile group were increased significantly (all P＜0.05). Multiple linear regression analysis showed that height (β=0.572), left calf circumference (β=0.273), upper arm muscle circumference (β=0.092) and suffering from protein energy wasting (PEW, β=-0.184) were independent influential factors of RMR (all P＜0.05). Conclusions RMR levels in patients with maintenance hemodialysis are associated with left calf circumference and upper arm muscle circumference, which may become a new index to evaluate energy consumption and malnutrition in MHD patients.     

维持性血液透析患者营养不良-炎性反应状态与其住院及死亡风险的临床研究

目的 探讨维持性血液透析(MHD)患者营养和炎性反应状态与其住院和死亡情况的关系,并寻找能够反映MHD患者住院和死亡风险的营养及炎性反应指标.方法 随访观察1年我院血透中心MHD患者的营养和炎性反应状况,比较住院和非住院患者的营养及炎性反应状态的差别;并通过Cox比例风险模型寻找能够反映患者1年内首次住院及死亡风险的营养及炎性反应指标.结果 入组患者118例,轻、中、重度营养不良的住院率分别为32.93％、56.67％和83.33％;病死率分别为3.66％、6.67％和80.00％;存在微炎性反应状态和不存在微炎性反应状态患者的住院率分别为56.45％和46.43％,病死率分别为14.29％和1.61％.住院患者营养不良-炎性反应评分(8.36比5.86,P＜0.05)和改良主观营养评价得分(14.49比12.88,P＜ 0.05)均高于未住院患者,差异有统计学意义.与非住院患者比较,住院患者Scr (886.83 μmol/L比991.76 μmol/L,P＜ 0.05)、白蛋白(38.57g/L比40.27g/L,P＜0.05)较低,差异有统计学意义.住院患者TNF-α高于非住院患者(65.41 μg/L比59.76 μg/L,P＜ 0.05),差异有统计学意义.Cox比例风险模型显示营养不良炎性反应评分(MIS)和TNF-α 与患者首次住院的危险性有关,其值越大,1年内首次住院的危险性越大.结论 MHD患者营养不良与炎性反应状态的程度越重,其住院和死亡的风险越大.营养不良-炎性反应评分和TNF-α水平越高,1年内首次住院的危险性越大.     

维持性血液透析患者三种营养状况评估方法的比较研究

目的：比较营养不良-炎症评分（MIS）、改良SGA（MQSGA）和血清白蛋白三种维持性血液透析（MHD）患者营养评估方法,为选择MHD患者营养评估方法提供依据。方法：选取我院血透中心行MHD3个月以上患者为研究对象,观察指标：（1）营养不良指标：MIS、MQSGA和血清白蛋白。（2）人体测量学指标：体重指数（BMI）、肱三头肌皮褶厚度（TSF）、上臂围（MAC）、上臂肌围（MAMC）等。（3）生化指标：血清白蛋白、转铁蛋白、总胆固醇、肌酐、铁蛋白。统计分析MIS、MQSGA和白蛋白与其他营养指标的相关性,并对所有患者追踪1年,分为住院组和未住院组,比较两组中MIS、MQSGA和白蛋白的差异,然后建立COX比例风险模型,分析这3个指标与MHD患者住院风险有无关系。结果：（1）MIS标准：118例MHD患者全部为营养不良占100%;MQSGA标准：营养不良占74.57%;白蛋白标准：营养不良占16.95%。（2）白蛋白、MQSGA和MIS与血液生化和人体测量指标呈现相关性（P〈0.05）,但是以MIS与其他营养指标的相关系数最大。（3）118例MHD患者中,住院组MIS和MQSGA均显著高于未住院组（P〈0.05）。（4）Cox风险比例模型显示MIS与患者住院风险有关。结论：MIS对营养不良的检出率最高,与其他营养评价指标的相关性更好,可以预测MHD患者的住院风险。     

Effects of intradialytic resistance exercise on systemic inflammation in maintenance hemodialysis patients with sarcopenia: a randomized controlled trial

Purpose

To investigate the effect of intradialytic resistance exercise on inflammation markers and sarcopenia indices in maintenance hemodialysis (MHD) patients with sarcopenia.

Methods

Forty-one MHD patients with sarcopenia were divided into an intervention group (group E, n?=?21) and a control group (group C, n?=?20). Group C patients only received routine hemodialysis care, whereas group E patients received progressive intradialytic resistance exercise with high or moderate intensity for 12 weeks at three times per week (using the weight of the lower limbs and elastic ball movement of the upper limb) on the basis of routine hemodialysis care.

Results

After 12 weeks, a significant difference in physical activity status (maximum grip strength, daily pace, and physical activity level), Kt/V, and C-reactive protein was found between groups E and C. Inflammatory factors (interleukin (IL)-6, IL-10, and tumor necrosis factor(TNF)-α) increased or decreased more significantly in group E than in group C.

Conclusions

This study showed that intradialytic resistance exercise can improve physical activity effectively and reduce microinflammatory reactions even if this simple exercise does not affect the muscle mass in MHD patients with sarcopenia.

     

血液透析患者营养不良与动脉粥样硬化的关系

目的 研究维持性血液透析患者营养不良与颈动脉粥样斑块发生率及颈动脉内膜中层厚度(CIMT)的关系.方法 选取同济大学附属东方医院血液透析中心行维持性血液透析治疗98例患者,将所有患者分为动脉粥样硬化组(AS组,52例)和非动脉粥样硬化组(N-AS组,46例),分析两组营养不良状况差异.并根据GNA评分结果,将患者分为营养良好组(54例)和营养不良组(44例),分析CIMT与各营养指标相关性.结果 AS组GNA营养不良发生率较N-AS组显著升高(P＜0.05);AS组与N-AS组相比HDL-C、Allb、PA、TRF、Scr、Kt/v、Lc、DPI水平显著降低,差别有统计学意义(P＜0.05);对营养不良组患者CIMT值与各营养指标进行多元线性回归分析,结果显示MHD患者CIMT与HDL-C、Alb、Scr、Lc、Kt/v、GNA评分密切相关(P＜0.05).结论 颈动脉内膜中层厚度(CIMT)的形成和发展与HDL-C、Alb、Scr、Lc、Kt/v、GNA评分密切相关.MHD患者动脉粥样硬化与营养不良密切相关.