不同腹膜转运功能的腹膜透析患者的营养不良-微炎症状态评估

目的 评价不同腹膜转运特性的持续性非卧床腹膜透析(CAPD)患者的营养不良-微炎症状态.方法 选择本院稳定腹膜透析半年以上的患者170例,按照腹膜平衡试验计算结果,将患者分为高转运组、高平均转运组、低平均转运组和低转运组.对各组患者的营养及炎症指标进行检测,检测指标包括人体测量指标和生化指标,并根据营养不良-炎症评分表,对每组患者进行评分.对四组患者的各项指标进行方差分析,对各组间指标的均数进行两两比较,并将腹膜平衡试验的D/Pcr与营养不良-微炎症指标进行相关性分析,综合评估各组患者的营养不良-微炎症状态严重程度.结果 符合纳入标准的患者中高转运组24例、平均转运组42例、低平均转运组50例、低转运组54例.MIS分值越高,患者的营养状况越差,微炎症状态越严重,D/Pcr与PD患者人体测量指标、贫血指标和营养指标呈负相关,与炎症指标呈正相关.四组患者的相关指标均有显著性差异,按营养不良-微炎症状态的严重程度排列为:高转运＞高平均转运＞低平均转运＞低转运.结论 不同腹膜转运特性对腹膜透析患者的营养不良-微炎症状态有不同的影响,高通透性腹膜功能患者营养不良-微炎症状态较低通透性者差,故应加强对高通透性CAPD患者的腹透方案调整及营养管理.

Evaluation of malnutrition-inflammation status in peritoneal dialysis patients with different peritoneal transportation function

Objectives To investigate the malnutrition-inflammation status in continuous ambulatory peritoneal dialysis patients with different peritoneal transportation function.Methods Data from 170 patients receiving peritoneal dialysis for at least 6 months were analysed.According to peritoneal equilibration tests (PET), Patients were divided into four groups, named high transport group, high average transport group,low average ransport group and low transport group.Parameters about nutritional and inflammatory status were anaysed, including anthropometric and biochemical indexes.MIS was then used to assess the nutritional status of these patients.Analysis of variance was implemented for indicators of four groups.The correlation between D/Pcr and malnutrition-inflammation parameters were also analyzed, and the severity of malnutrition-inflammation status in each group were such compared.Results Altogether 24 patients were divided into high transport group,42 patients were divided into high average transport group ,50 patients were divided into low average transport group, and 54 into low transport group.Higher MIS score indicated the worse nutritional status and the more severe inflammation status.D/Pcr was negative related to anthropometry, anemia and nutritional parameters,yet positive related to inflammation parameters. Parameters were significant difference between four groups of patients.According to malnutrition-microinflammation severity, Patients were arranged as follows : high transport group ＞ high average transport group ＞ low average transport group ＞ low transport group.Conclusions Different peritoneal transportation function has different effects on malnutrition-inflammation status of peritoneal dialysis patients.The malnutrition-inflammation status of higher-petitoneal-transport patients are worse as compared to lower transport ones.Adjustment of dialysis programs and nutritional management should be strengthened on the patients with higer peritoneal transportation function.