血液透析患者血清瘦素水平与营养状态的研究

目的 研究维持性血透（MHD）患者血清瘦素（Leptin）的水平有与营养状态的关系。方法 采用放射免疫测定（RIA）方法，测定55例MHD患者和40例正常健康人血清瘦素水平，同时检测血浆白蛋白、总蛋白、甘油三酯、胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）及血清肌肝、尿素氮（BUN）等指标。结果 （1）健康对照组有MHD组男性血清瘦素水平明显低于同组女性（P＜0．001，P＜0．01），MHD男性和女性患者血清瘦素水平均显著高于同性别健康对照（P均＜0．05）。（2）MHD男性、女性患者血清瘦素水平均与体重指数（BMI）呈显著正相关（P＜0．01，P＜0．001），与血浆白蛋白、总蛋白、甘油三酯、胆固醇、HDL、LDL及血清肌肝、BUN无明显的相关关系。结论 健康女性及MHD女性血清瘦素水平均明显高于同组男性；MHD男性、女性血清瘦素水平均高于同性别健康人，且与BMI呈正相关而与血浆白蛋白、总蛋白、甘油三酯、胆固醇、HDL、LDL及血清肌酐、BUN无明显的相关关系。     

应用主观全面评定法评价维持性血液透析患者营养状况

目的应用主观全面评定法（SGA）对维持性血液透析患者（MHD）的营养状态进行评价。方法对116例MHD患者应用SGA方法进行营养评估，测定肱三头肌皮褶厚度、上臂围、上臂肌围（MAMC）等人体测量学指标和血清白蛋白（ALB）、C反应蛋白（CRP）等实验室指标，并进行相关性分析。结果SGA法的评定结果与年龄、透析时间、肱三头肌皮褶厚度、上臂围、MAMC、体质指数（BMI）、ALB、CRP均有显著相关性（P〈0．01）；与总蛋白、血清肌酐无相关性（P〉0．05）。多因素分析显示，在调节年龄、BMI后，SGA评分与CRP、ALB、MAMC仍存在显著相关性（相关系数分别为0．2816、0．3368、0．6143，P〈0．05）。结论SGA法在我国MHD患者的营养评价中适用，是一种经济、有效的营养评定方法。     

腹膜转运和营养状况在腹膜透析充分性评价中的作用

目的探讨腹膜转运特性对尿毒症腹膜透析患者营养状态的影响,评价二者在腹膜透析充分性评价中的地位。方法采用快速腹膜平衡试验判断腹膜转运功能[腹膜透析液肌酐与血肌酐的比值（D／Per）],将53例腹膜透析患者分为高转运（D／Per≥0．65）和低转运（D／Per〈0．65）两组。计算尿素清除指数（Kt／v）和总肌酐清除率（TCer）。采用实验室检查（血清白蛋白、前白蛋白和转铁蛋白,血红蛋白,瘦体重和瘦体重百分比）以及主观综合性评定法（SGA）评估患者的营养状况。结果低转运组包括患者30例,高转运组包括23例。高转运组患者的年龄、D／Per（0．82±0．15vs．0．55±0．08,P〈0．01）和TCer（62．93％±25．98％佛．49．69％±16．92％,P〈0．05）均显著高于低转运组,血清白蛋白和转铁蛋白,血红蛋白水平,瘦体重百分比和SGA评分均显著低于低转运组（P〈0．05）,血清白蛋白与Kt／v呈显著负相关（r=-0．2708,P〈0．05）。结论腹膜高转运者溶质清除率高但营养状态较低转运者差。营养状况是判定透析是否充分的条件之一。应加强高转运及高龄患者的饮食管理和指导。     

老年血液透析患者血清瘦素水平与营养状况的关系

目的 探讨老年血液透析(血透)患者血清瘦素水平与营养状况的关系。方法以本院老年组血透患者41例、非老年组血透患者19例和正常对照组20例为研究对象，采用ELISA法测定血清瘦素水平，分析瘦素水平与肾功能、前白蛋白、白蛋白、补体、转铁蛋白、血脂、人体学测定和主观全面营养评估指数的相关性。结果老年组和非老年组血透患者血清瘦素水平均显著高于对照组(P＜0．05)，且老年组血透患者血清瘦素水平较非老年组血透患者显著增高，差异有显著性(P＜0．05)；老年组血透患者血清白蛋白(r=-0．328，P＜0．05)、转铁蛋白(r=-0．254，P＜0．05)、补体(r=-0．322，P＜0．05)、相对体重(r=-0．253，P＜0．05)、三头肌皮褶厚度(r=-0．323，P＜0．05)、上臂周径(r=-0．257，P＜0．05)、上臂中部肌肉周径(r=-0．246，P＜0．05)等营养指标均低下，且与血清瘦素水平呈显著负相关；老年组血透患者血清瘦素水平与血总胆固醇(r=0．264，P＜0．05)和三脂酰甘油(r=0．234，P＜0．05)呈正相关。老年组血透患者存在营养不良，且营养状况越差，血清瘦素水平越高。结论老年血透患者血清瘦素水平较非老年血透患者和健康人显著增高；老年血透患者营养不良等级与血清瘦素水平呈正相关。     

尿毒症患者平均红细胞血红蛋白与铁含量的关系

目的探讨尿毒症患者平均红细胞血红蛋白与铁含量的关系。方法89例尿毒症患者按治疗方法分为三组（未透析组、腹透组及血透组），分别测定血红蛋白（Hb）、红细胞压积（Hct）、平均红细胞血红蛋白（MCH）、血清铁、总铁结合力、血清铁蛋白等，并计算转铁蛋白饱和度。结果血透组MCH较未透析组和腹透组均明显降低（P均〈0．05）；未透析组和腹透组间差异无统计学意义（P〉0．05）。血透组血清铁及转铁蛋白饱和度较腹透组均明显降低（P〈0．005或〈0．05）。MCH〈30Pg的患者转铁蛋白饱和度较MCH≥30Pg的患者明显减低（P〈0．05）；两者血清铁及铁蛋白水平差异均无统计学意义（P均〉0．05）。尿毒症患者MCH与转铁蛋白饱和度呈正相关，r=0．559，P〈0．001。结论尿毒症患者透析与否普遍存在贫血，腹透患者缺铁的程度较轻。MCH可替代转铁蛋白饱和度作为尿毒症患者铁状态的参考指标，血常规检查可以既简便又快速地初步了解尿毒症患者的铁状态。     

重组人生长激素对术后患者营养状态的影响

目的探讨小剂量重组人生长激素对腹部手术患者营养状态的影响。方法48例需行腹部手术的患者随机分为3组，A、B组每日给予重组人生长激素皮下注射0.15U·kg－1·d-1和0．075U·kg-1·d-1，C组为对照组，以生理盐水为安慰剂。每例患者进行体重、握力、上臂中部周长、尿中尿素氮、肌酐、血中转铁蛋白及淋巴细胞总数定期测定和相关性分析。结果A组患者的体重、握力较C组显著增加（P＜0.05）；A组累积氮平衡亦明显高于对照组（P＜0.05）;其余指标无显著改变。而B组各项指标变化与对照组比较均无统计学差异。结论重组人生长激素能促进术后患者的蛋白质合成，尽快达到正氮平衡，增加患者的体重和握力，提高术后生活质量和对手术打击的耐受性，加速患者恢复，其作用与剂量有关。     

溃疡性结肠炎患者对C反应蛋白水平变化的临床疗效研究

目的探讨血C-反应蛋白（CRP）水平在溃病性结肠炎（UC）患者病情活动性与严重程度评价中的意义。方法对UC患者86例以及健康对照42例，采集外周血，检测血清CRP、血沉及其他生化指标（肝功能、肾功能、免疫球蛋白）水平，重点分析CRP在不同临床时期的变化，并评估其与其他临床指标之间的相关性。结果活动性UC患者血清CRP浓度明显高于健康人（P〈0．01）。重度UC患者血清CRP水平显著高于中度UC患者（P〈0．05）；中度UC患者血清CRP水平也显著高于轻度UC患者（P〈0．05）。活动性UC患者经过有效药物治疗后，血清CRP水平呈明显下降（P〈0．05）。相关分析发现活动性UC患者的临床严重程度与血清CRP水平之间呈正相关关系（r=0．91，P〈0．01），而其他实验室指标（如ESR、肝功能、肾功能、免疫球蛋白）之间无明显相关性（P〉0．05）。结论CRP水平变化可以准确地反映UC患者临床严重程度，为临床上治疗，控制病情发展，以及判断预后提供了重要的理论依据。     

儿童血清瘦素与能量代谢关系的研究

目的 研究儿童血清瘦素与能量代谢的关系。方法 对60名正常体重儿童（男，女各30名）采用开放式间接测热法其基础代谢，采用放射免疫法测定血清瘦素，并采用称重法进行为期3d的膳食调查。结果 男童血清瘦素水平与体脂百分比（％BF），脂肪组织（FM）呈正相关（P＜0．05），与能量摄入量，基础代谢无相关性（P＞0．05）；女童血清瘦素水平与BMI，％BF，FM，基础代谢呈正相关（P＜0．05），与能量摄入量无相关性（P＞0．05）。结论 瘦素可能通过其与基础代谢的关系来发挥其调节女童能量平衡及体重的作用。     

终末期肾脏病患者血清脂联素水平及与炎症因子的相关性研究

目的检测终末期肾脏病（ESRD）患者血清脂联素（ADPN）、肿瘤坏死因子-α（TNF—α）、超敏C反应蛋白（hs—CRP）及肾功能水平，探讨ESRD患者血清ADPN水平的变化及与炎症因子的关系。方法选择ESRD患者60例，分为3组：肾衰非透析组（18例）、血液透析组（22例）和腹膜透析组（20例）。另设健康对照组（20例）。用ELISA方法检测血清ADPN、TNF—α和hs—CRP。比较各组间的差别。结果ESRD患者血清ADPN水平在肾衰非透析组[（15．88±4．94）mg／L]、血液透析组[（14．26±4．54）mg／L]和腹膜透析组[（14．55±3．51）mg／L]均显著升高（与对照组[（4．95±2．19）mg／L]相比，P〈0．01），但非透析和透析各组之间的差异无统计学意义（P〉0．05）。ESRD患者的血清TNF—α和hs—CRP水平在透析和非透析各组亦显著升高（与对照组相比，P〈0．01），并且在透析患者显著高于非透析患者（P〈0．01）。ESRD患者的血清ADPN水平与TNF—α呈正相关（r≥0．478，P〈0．01），与肾小球滤过率呈负相关（r≥-0．582，P〈0．01）。结论ESRD患者的血清ADPN水平明显升高，并与TNF—α、肾小球滤过率等因素有关。     

早期肠内营养对急性重症胰腺炎炎症介质及营养指标的影响简

目的：探讨早期肠内营养对急性重症胰腺炎患者炎症介质、营养指标及临床恢复的影响。方法2006年1月至2010年3月收治的急性重症胰腺炎患者患者59例,随机分成早期肠内营养组31例,肠外营养组28例,观察上述两组治疗后1、3、7天血清中TNF-α、IL-1β、前白蛋白、清蛋白的水平;外周血淋巴细胞数;并观察两组血清淀粉酶恢复时间,全身炎性反应综合征（ Systemic infammactery response syndrome ,SIRS）、腹腔脓肿及肝功能异常例数,治疗费用等指标的差异。结果早期肠内营养组治疗后3、7天血清TN F-α、IL-1β浓度明显低于肠外营养组（ P＜0．05）,前白蛋白、清蛋白的水平、外周血淋巴细胞数明显高于肠外营养组（P＜0．05）,治疗费用低于肠外营养组（P＜0．05）,两组血清淀粉酶恢复时间,SIRS、腹腔脓肿及肝功能异常例数无明显差异（P＞0．05）。结论早期肠内营养在改善急性重症胰腺炎患者营养状态方面明显优于肠外营养,有利于提高机体的抗感染能力和各系统机能的恢复,是可靠、安全、经济的营养支持手段。     

Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients

BACKGROUND: Serum albumin has limitations as a nutritional marker in patients undergoing peritoneal dialysis (PD) in that it is affected by inflammation, systemic disease, overhydration, and urinary and dialysate protein loss. Handgrip strength is a simple, easily performed bedside test that has been shown to correlate with lean body mass in patients close to inception of dialysis. OBJECTIVE: We evaluated the associations of handgrip strength with other clinical factors and examined its relations with mortality and cardiovascular death in PD patients. DESIGN: We prospectively enrolled 233 chronic PD patients and assessed handgrip strength and other variables at baseline and then followed the patients for a mean (+/-SD) of 30 +/- 14 mo. RESULTS: Baseline handgrip strength was significantly associated with age, sex, height, diabetes, residual glomerular filtration rate (GFR), and hemoglobin but not with C-reactive protein (CRP). After adjustment for age, sex, and height, handgrip strength was most strongly correlated with lean body mass on the basis of creatinine kinetics (r = 0.334, P < 0.001), followed by serum albumin and subjective global assessment. Both men and women who died had lower handgrip strengths than did those who remained alive (P < 0.001). After control for age, sex, diabetes, atherosclerotic vascular disease, GFR, hemoglobin, CRP, and serum albumin, greater handgrip strength was predictive of lower all-cause [hazards ratio (HR): 0.95 (95% CI: 0.92, 0.99); P = 0.005] and cardiovascular [HR: 0.94 (0.90, 0.98); P = 0.004] mortality. CONCLUSIONS: Handgrip strength not only is a marker of body lean muscle mass but also provides important prognostic information independent of other covariates, including CRP and serum albumin. Our data suggest that handgrip strength may be used in conjunction with serum albumin as a nutrition-monitoring tool in patients undergoing PD.     

Handgrip Strength at Admission and Time to Discharge in Medical and Surgical Inpatients

Background and Objective: Handgrip strength is a relevant marker of functional status and is also a component of nutrition assessment. The simplicity of this measurement supports its usefulness as a tool to predict who will likely take longer to hospital discharge. The aim of this study was to quantify the association between sex‐specific handgrip strength at hospital admission and time to discharge alive. We intended to include a group of diverse diagnoses and to compare medical and surgical wards, taking into account the potential confounders’ effect of patients’ characteristics and severity of disease. Subjects and Methods: Prospective study in 2 public acute‐care general hospitals in Porto, Portugal, in 2004. Handgrip strength was evaluated using a handgrip dynamometer in a probability sample of 425 patients from medical and surgical wards. The association between baseline handgrip strength and time to discharge was evaluated using survival analysis with discharge alive as the outcome and deaths and transfers being censored. Results: In medical wards, women with high admission handgrip strength had a very short hospital stay (all had been discharged by the sixth day), and among men, patients with low handgrip strength had a particularly longer stay (approximately 50% were discharged after 15 days of hospitalization). In surgical wards, an increasing length of stay with decreasing handgrip strength quartiles was also observed in both sexes. Conclusions: Lower handgrip strength at hospital admission was associated with a longer time in the hospital, in patients of both sexes, in medical and surgical wards. Although this association was explained in part by age, height, education level, cognitive status, and disease severity, its direction remained unchanged regardless of the aforementioned factors.     

The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction

BACKGROUND: Muscle dysfunction is a common finding in malnourished patients and is associated with poor outcome. We investigated whether the Subjective Global Assessment (SGA) is a valuable tool for identifying malnutrition-related muscle dysfunction. METHODS: Two hundred eighty seven consecutive patients were assessed on admission to hospital according to the SGA, anthropometric measurements, and to the results of bioelectrical impedance analysis. The SGA was used as the main criterion for the classification of malnutrition. Muscle function was assessed by handgrip strength. RESULTS: Maximal voluntary handgrip strength was significantly lower in malnourished than in well-nourished male and female patients (45.22 (13.51-67.7)kg versus 30.82(11-48) kg in men; 23.81 (5.60-56.5) kg versus 18.5 (5.90-48.8) kg in women). Handgrip strength tended to decline with age. Handgrip strength was positively correlated to body cell mass (BCM) (r=0.72, P<0.001 in men and: r=0.56, P<0.001 in women) and to body mass index (r=0.271, P=0.03 in men and r=0.183, P=0.02 in women). BCM was identified as a powerful contributor to the variation in handgrip strength (delta r2=0.645, P<0.001). CONCLUSION: The SGA appears to be a reliable bedside assessment tool for malnutrition and malnutrition-related dysfunction. Patients classified malnourished according to the SGA have an impaired functional status. Every effort should be made to provide both nutritional and physical therapy in order to improve the patients' outcome.     

Évaluation du handgrip préradiochimiothérapie des patients présentant un cancer des voies aérodigestives supérieures

IntroductionThe updated diagnosis criteria for adult undernutrition introduced assessment of muscle mass and/or muscle function. As undernutrition is a factor in the interruption of radio-chemotherapy treatments for head and neck cancer, we evaluated the association between pre-therapeutic muscle function according to handgrip strength and treatment interruptions.Materials and methodsAncillary study of an observational, mono-centric, prospective cohort evaluating the benefit of systematic, global and early supportive care in patients with head and neck cancer before radio-chemotherapy concomitant. Were included patients for whom radio-chemotherapy concomitant was being considered for radical treatment of head and neck cancer and who had a pre-therapeutic handgrip test.ResultsThirty-nine patients were included from July 2019 to February 2020. Nine patients were undernourished and three had pathological handgrip strength. Handgrip test permitted to reclassify three patients as undernourished. Radiotherapy discontinuation was significantly associated with a pathological pre-therapeutic handgrip strength (P = 0.0359). No association was found for discontinuation of chemotherapy (P = 1).ConclusionPre-therapeutic handgrip test for patients with head and neck cancers is of interest on the oncological treatments choice regarding toxicities risk that may lead to treatment discontinuation.     

Validation of handgrip strength and endurance as a measure of physical function and quality of life in healthy subjects and patients

ObjectiveHandgrip strength (HGS) is often used as a bedside measurement of muscle function in the hospital setting. The aim of this study was to investigate the extent to which HGS, endurance, and work (force during endurance × time) are related to physical function as measured by mobility and physical activity (PA) in young, healthy volunteers. Further, the relations between HGS, mobility, PA and quality of life (QoL) in patients were investigated.MethodsNinety-two healthy subjects (45% men, mean age 30 y) and 45 patients (56% men, mean age 55 y) were assessed for HGS, handgrip endurance, and handgrip work, mobility (timed up-and-go test), and PA (Baecke questionnaire or Bouchard activity diary). The patients were further assessed for QoL (SF-36).ResultsThere was a correlation between HGS and mobility in healthy subjects (r = ?0.31, P = 0.0028) and patients (r = ?0.59, P < 0.0001). Further, HGS and mobility were related to physical and mental component summary scores of QoL in patients. There was also a relation between HGS and PA in healthy female subjects and male patients.ConclusionHandgrip strength is a valid measurement of mobility and QoL in patients and of PA in healthy female subjects and male patients. Handgrip endurance and work were not found to be valid measurements of mobility and PA in healthy subjects or of QoL in patients.     

Association Between Aerobic Exercise and Handgrip Strength in Adults: A Cross-Sectional Study Based on Data from the Korean National Health and Nutrition Examination Survey (2014–2017)

Handgrip strength is an easy-to-assess indicator of overall muscle strength and can be used to evaluate health status. Although previous studies have reported an increase in grip strength due to aerobic exercise, such a study has not been conducted on Korean participants. This study aimed to investigate the effects of aerobic exercise on handgrip strength and examine the association between these two variables in Korean patients with hypertension or diabetes. Cross-sectional study. This study used data from the 6th and 7th Korean National Health and Nutrition Examination Survey (2014–2017). A total of 19,650 individuals aged ≥19 years who had responded to questionnaires concerning aerobic exercise and handgrip strength were analyzed. The relationship between aerobic activity and handgrip strength was examined by logistic regression analysis. The mean age of individuals in the low muscle strength group was higher than that in the normal muscle strength group. The odds ratio for low handgrip strength was higher in individuals who did not perform aerobic exercise than in those who performed aerobic exercise. Following adjustment for covariates, the odds ratios (95% confidence intervals) for low handgrip strength were 1.415 (0.187–1.688) in the total sample, 1.799 (1.376–2.352) in patients with hypertension, and 1.811 (1.208–2.715) in patients with diabetes. The results of our study indicated a strong association between aerobic exercise and handgrip strength in the Korean population.     

中国10个地区成年人骨骼肌质量和手握力的描述性分析

目的 描述中国10个地区成年人骨骼肌质量和手握力的地区和人群分布特征。方法 对来自中国慢性病前瞻性研究项目第2次重复调查的24 533名研究对象进行分析。采用生物电阻抗分析法测量四肢和躯干的肌肉质量,通过Jamar手持握力计测量手握力来衡量肌肉力量水平,并根据亚洲肌少症工作组（AWGS）推荐的标准判断人群低肌肉质量和力量的比例。分地区和人群特征,报告肌肉质量和手握力的均值及标准误,以及低肌肉质量和力量的百分比。结果 男性的四肢和全身肌肉质量分别为（22.0±0.02）kg和（49.7±0.05）kg,高于女性的（15.9±0.02）kg和（37.2±0.04）kg;男性手握力为（32.6±0.06）kg,高于女性的（19.9±0.05）kg。绝对肌肉质量和手握力均呈现北方高于南方、城市高于农村的地区差异（P<0.001）。而身高和体重调整的肌肉质量的地区差异规律相反。随着年龄的增加,肌肉质量各项指标和手握力均呈线性下降趋势（线性趋势P<0.001）,且手握力下降幅度更大。进一步按照AWGS判断,低肌肉质量和力量的比例随年龄增加而不断上升,≥ 80岁的老年男性低肌肉质量和力量的比例分别达到56.2%和74.5%,女性分别达到35.7%和66.0%。结论 中国成年人肌肉质量和手握力的分布存在明显的地区和人群差异,尤其以老年人低肌肉质量和手握力的比例最高。     

Handgrip strength predicts pressure ulcers in patients with hip fractures

ObjectivePressure ulcer (PU) is a frequent complication of hip fracture. Studies were carried out to identify the risk factors of PU development after hip fractures. The objective of the study was to determine the role of anthropometric measurements and handgrip strength as predictors of PUs in patients with hip fractures during their hospital stay and 30 d after discharge, which has not yet been established.MethodsNinety-two consecutive patients with hip fractures who were older than 65 y old and admitted to an orthopedic unit were prospectively evaluated. Within the first 72 h of admission, each patient’s characteristics were recorded, anthropometric measurements were taken (circumferences of the arm, waist, thigh, calf, triceps, and biceps and subscapular and suprailiac skinfolds), handgrip strength was measured, and blood samples were collected. PU evaluations were performed during the hospital stay and 30 d after hospital discharge.ResultsThree patients were excluded because of PUs before hospitalization. Eighty-nine patients (average age 80.6 ± 7.5 y) were studied; 70.8% were women, and 49.4% developed PUs during their hospital stay. In a univariate analysis, length of hospital stay (P = 0.001) and handgrip strength (P = 0.02), but not body circumferences and skinfolds, were associated with PUs during a hospital stay. Only handgrip strength (P = 0.007) was associated with PUs 30 d after hospital discharge. In a multivariate analysis, only handgrip strength was found to predict PU development at these points.ConclusionHandgrip strength was found to predict PU development in patients with hip fractures during their hospital stay and 30 d after discharge.     

NLR与MLR对腹膜透析患者腹腔感染的诊断及预后评估价值

目的探讨中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)对腹膜透析患者腹腔感染的诊断及预后评估价值。方法采用回顾性研究方法,选择池州市人民医院肾脏内科2015年9月-2018年12月进行腹膜透析的患者416例为研究对象。收集患者透析前临床资料,连续随访观察至2019年12月31日。根据患者透析前NLR、MLR水平,分为NLR升高组、NLR正常组和MLR升高组、MLR正常组。采用Log-rank法比较其差异,诊断价值分析采用受试者工作特征曲线(ROC)评价NLR、MLR对患者腹腔透析期间发生腹膜炎的诊断价值。结果Kaplan-Meier生存分析结果显示,NLR、MLR升高组患者首次透析至腹膜炎发生的时间缩短(P<0.05);ROC分析结果显示,NLR、MLR、NLR+MLR对于腹膜透析患者发生腹膜炎诊断的曲线下面积分别为0.715、0.749、0.831(P<0.05);多发性腹膜炎组基线NLR、MLR水平高于单发性腹膜炎组(P<0.05);因腹膜炎病死患者基线NLR、MLR水平高于存活患者(P<0.05)。结论基线NLR、MLR升高的腹膜透析患者较早发生腹膜炎,其水平对于腹膜炎发生具有预测价值,且对于判断是否为多发性感染及患者死亡具有一定意义。     

腹膜透析患者营养指标的评估

目的 :　对腹膜透析患者的一些营养指标进行评估。方法 :　对 90例持续性不卧床腹膜透析 ( CAPD腹透 )患者进行主观综合性营养评估 ( SGA)、膳食调查、直接人体测量、生化参数的测定 ,计算氮出现率相当蛋白 ( n PNA)、瘦体重和 %瘦体重。结果 :　依据 SGA评分 ,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较 :平均每日每公斤体重能量和蛋白质摄入 ( DEI、DPI)、血白蛋白、n PNA、瘦体重及 %瘦体重 ,均有显著性差异 ( P<0 .0 0 1～ 0 .0 5 )。但营养良好组的 DPI和 DEI异常率 70 .2 1 % ,血白蛋白和 %瘦体重异常率 31 .91 %和 5 1 .0 6% ,而轻中度营养不良组血白蛋白和 %瘦体重正常率为 49.39%和 67.74% ,仅重度营养不良组中各指标异常率均在 80 %以上。直接人体测量指标体重指数、三头肌皮褶厚度和上臂肌围在本组患者中的异常率为 4.44% ,6.67%及 1 3.33%。血前白蛋白、转铁蛋白与白蛋白有显著相关 ( P<0 .0 0 1 ) ,与 DPI、DEI、n PNA及 %瘦体重均无相关。结论 :　SGA是评价腹透患者营养状况的简便方法 ,但还需其它反映营养状况不同侧面的指标的补充 ,如 DEI、DPI、血白蛋白、n PNA、瘦体重及 %瘦体重。其中用肌酐动力学公式计算瘦体重是反映肌肉蛋白质贮存的有效方法。直接人体测?