不同步行数对CKD患者炎症及营养的影响

目的探讨每日不同步行数对慢性肾脏病患者临床指标、炎症指标、营养指标的影响。方法选取90例慢性肾脏病非透析患者作为研究对象。将90例患者随机分为3组，每组30例患者，每日步行数≤5 000步为A组，步行数为5 000~9 999步为B组，步行数≥10 000步为C组。每组均给予基础治疗和步行数的干预。收集纳入患者的个人基本资料、临床资料、炎症指标和营养学指标。分析运动前和运动3月后患者临床指标、营养学指标、炎症指标的变化情况。结果87例慢性肾脏病患者完成研究，运动治疗前A、B、C 3组患者（n=30，29，28）基线一致，运动治疗3月后，3组血肌酐稳定，血脂、血尿酸、甲状旁腺激素变化不明显，血红蛋白、铁蛋白、转铁蛋白饱和度较前升高，以C组变化最为明显，差异有统计学意义(P<0.05)。营养指标方面，运动后3组患者白蛋白、前白蛋白水平升高，但A组患者运动前后差异无统计学意义，B组、C组组间和组内比较均差异有统计学意义，以C组白蛋白变化最为明显。3组体质量指数（BMI）、上臂皮褶厚度、SGA评分无明显变化。炎症指标方面，运动后3组C反应蛋白、白介素-6(IL-6)水平均较运动前降低，但A、B组组间和组内比较差异无统计学意义，C组组内和与其他两组的组间差异有统计学意义。结论步行并不增加患者的肾脏负担，反而能改善患者营养和临床指标，降低炎症反应，以每日步行数大于10 000步效果最为明显。

Effect of Different Walking Number on Inflammation and Nutrition in Patients with Chronic Kidney Disease

ObjectiveTo ivestigate the effect of daily walking number on clinical,inflammatory and nutritional indexes for patients with chronic kidney disease. Methods90 non-dialysis patients with chronic kidney disease were selected and randomly divided equally into three groups,for groups A,B and C. 30 patients for group A were asked for the number of daily walk should less than 5 000 steps,while group B patients were asked for 5 000-9 999 steps of walk and group C for more than 10 000 steps. Basic treatments were given for each group of patients and basic information,clinical,inflammatory and nutritional datas of patients were collected. Results87 patients with chronic kidney disease completed the study,with baseline data between group A,B,C （n=30，29，28） consistently. After 3 months of exercise,there were no significant changes on blood lipids,serum uric acid and parathyroid hormone (PTH) for three groups,with serum creatinine of three groups stably. However,in group C,hemoglobin,ferritin,transferrin saturation were found increased significantly (P<0.05). For nutritional indexes,increasing of albumin and prealbumin level were found in three groups,while significant differences were only found in group B and C (P<0.05) and group C increased most. There were no significant change on body mass index (BMI),upper arm skinfold thickness and SGA score in three groups. For inflammatory data,significant decrease of C-reactive protein (CRP) and interleukin-6 (IL-6) were only seen in group C (P<0.05). ConclusionWalking does not increase the burden of the kidney,but can improve the nutrition and clinical indicators of patients,reduce inflammation.