能量代谢对腹膜透析患者代谢综合征发生及维持的影响

目的 探讨腹膜透析患者代谢综合征（MS）的发生及维持与其能量代谢的关系，尤其透析液糖负荷在其中的作用。 方法 采用回顾性自身前后对照的方法观察126例腹膜透析患者近1年前后MS、透析液糖负荷及摄入能量的变化情况，研究能量摄入对MS的影响。采用横断面研究的方法对MS状态稳定的患者测定静息能量代谢，并通过活动记录评估身体活动水平来研究能量消耗对腹膜透析患者MS的影响。 结果 由非MS变为MS的患者在糖负荷增加组中的比例明显高于在糖负荷不变或减少组中的比例（κ2 = 9.552，P = 0.002）。在糖负荷增加的非MS变为MS亚组中，后半年比与前半年比较，血三酰甘油（TG）显著升高（P < 0.01），高密度脂蛋白胆固醇（HDL-C）显著下降（P < 0.05），而腰围及血糖无显著变化；MS变为非MS组患者后半年C反应蛋白（CRP）比前半年显著下降（P < 0.05）。MS变为非MS组患者前后半年饮食能量摄入差异无统计学意义（P > 0.05），非MS变为MS组患者后半年饮食能量摄入没有比前半年增加，反而有所减少（P < 0.05）。在36例MS状态稳定且透析液糖负荷稳定的患者中，MS组和非MS组的每日每体表面积静息能量消耗水平差异无统计学意义（t = 0.840，P > 0.05），但MS组的身体活动水平显著低于非MS组（t = 2.358，P < 0.05）。 结论 透析液糖负荷的增加是MS发生的重要影响因素之一，主要通过对血TG、血HDL-C的影响改变腹膜透析患者MS状态。炎性反应也是腹膜透析患者MS维持或改变的重要影响因素。尽管研究未发现饮食能量摄入和静息能量代谢影响腹膜透析患者MS的发生及维持，但活动少的生活习惯在腹膜透析患者MS的维持中起到重要作用。

Effect of energy metabolism on the onset and maintenance of metabolic syndrome in peritoneal dialysis patients

Objective To clarify the association of onset and maintenance of metabolic syndrome (MS) with energy metabolism imbalance, especially with dialysate glucose load in peritoneal dialysis (PD) patients. Methods Using retrospective self-controlled study, the changes of MS, dialysate glucose load and dietary energy intake (DEI) in 126 PD patients in about 1 year were collected and analyzed to define the effect of energy intake on MS. Resting energy expenditure (REE) was measured and physical activity level (PAL) was evaluated based on the activity records in PD patients with unchanged MS state and their impacts on MS were analyzed. Results The incidence of changing from non-MS to MS was higher in glucose load increasing group than that of glucose load unchanged or decreasing group. When glucose load increased, patients developing MS had significantly increased serum triglyceride (TG) level (P<0.01) and significantly decreased serum high density lipoprotein cholesterol (HDL-C) level (P<0.05), while the waist circumference and blood glucose level did not alter significantly. In patients changing from MS to non-MS, their serum C reactive protein (CRP) levels significantly decreased during the follow-up (P<0.05). No significant difference was found in DEI in patients changing from MS to non-MS. However, in patients changing from non-MS to MS, their DEI decreased during the follow up (P<0.05). In a subgroup analysis in 36 PD patients who maintained their metabolic status and did not change their glucose load, there was no difference in REE per body surface per day between the MS group and the non-MS group (t=0.840, P>0.05). However, the PAL was lower in the MS group than that of the non-MS group (t=2.358, P<0.05). Conclusions The increase of dialysate glucose load may be an important factor leading to the onset of MS, by altering serum TG and HDL-C level. Inflammation and the sedentary life also contribute to the MS state.