左旋卡尼丁治疗维持性血液透析患者微炎症状态的初步研究

目的:通过观察静脉注射左旋卡尼丁对维持性血液透析(maintenance hemodialysis,MHD)患者相关营养和炎症指标的影响,探讨左旋卡尼丁对MHD患者微炎症的治疗作用.方法:选择透析龄超过6个月的MHD患者62例,随机分为治疗组和对照组,已排除急性感染及其他活动性疾病,每次透析结束后,治疗组给予静脉注射左旋卡尼丁1 g,进行为期3个月随访,分别检测治疗前、治疗1月后、治疗3月末患者的主要人体学指标、改良SGA评分、血生化指标、C反应蛋白(CRP)、透析充分性(Kt/V)和蛋白分解代谢率(PCR).结果:(1)治疗组1月后,MHD患者的干体重、上臂肌围(MAMC)就有上升;治疗组3个月后,患者平均干体重、MAMC平均值较治疗前显著升高(均P＜0.05).改良SGA评分较治疗前明显下降(P＜0.01);对照组以上各项均无变化,治疗组与对照组比较有统计学差异(均P＜0.05).(2)治疗组3个月后,MHD患者的血白蛋白(Alb)(P＜0.05)、前白蛋白(PA)和血红蛋白(Hb)(均P＜0.01)较治疗前明显升高;对照组以上各项均无变化,治疗组与对照组比较有统计学差异(均P＜0.05).(3)治疗组CRP平均值较治疗前明显下降、与对照组相比差异十分显著(P＜0.01).(4)两组血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白(a)[Lp(a)]水平治疗前后无统计学差异(P＞0.05).(5)治疗组PCR值较治疗前明显上升,与对照组相比有统计学差异(均P＜0.01);两组Kt/V治疗前后无明显变化(P＞0.05).结论:左旋卡尼丁可明显改善患者的营养状态,同时降低血CRP浓度及微炎症状态,这种作用可能通过调整由前炎症因子和氧化应激造成的特异性胞内信号传导级联的激活,从而提高细胞对慢性炎症和氧化应激的防御功能.     

人体成分测量在血液透析患者营养状态评价中的运用价值

目的:评价人体成分测量在血液透析患者营养状态评估中的运用价值。方法:选择2017年02月～2018年10月间我院血液净化中心透析龄大于3个月的维持性血液透析(maintenance hemodialysis,MHD)患者196例,采用多频生物电阻抗法(bioelectric impedance analysis,BIA)进行人体成分测量,内容包括:体质量指数(BMI),体脂比,瘦体重(体重-脂肪重量),水过多(Over Hydration,OH),干瘦体重(瘦体重-OH),细胞外液与总体水之比(ECW/TBW),结合血清营养指标评价患者营养状态。结果:两两比较显示:对MHD患者营养不良判断的评价,人体成分测量中的干瘦体重指标明显优于瘦体重指标及血清中白蛋白(Alb),前白蛋白(PAB),转铁蛋白(Tf)、胆固醇(TC)对患者营养不良的判断(P0.01);瘦体重指标对患者营养不良的判断优于血清中白蛋白,前白蛋白,转铁蛋白、胆固醇对营养不良的判断(P0.01)。Spearman相关分析结果显示:人体成分测量中的干瘦体重与BMI、体脂百分比呈正相关(r=0.294及r=0.183,P均0.05),与患者年龄、ECW/TBW及OH值呈负相关(r=-0.215,r=-0.198及r=-0.447,P均0.05);Logistic回归分析显示:干瘦体重、年龄、OH值为MHD患者营养不良的独立危险因素。结论:生物电阻抗技术较血清学对MHD患者营养不良的评估具有无创、经济、灵活等优点,可用于MHD患者早期营养不良的判断及指导临床对患者营养不良进行干预。     

生物电阻抗评估透析病人营养状态与动脉硬化相关性分析

目的:结合生物电阻抗(bioimpedence analysis,BIA)及颈动脉超声对透析病人营养不良状态与动脉硬化相关性进行早期评估。方法:随机选择我院维持性血液透析病人(maintenance hemodialysis,MHD)46例,透析时间均大于3个月,根据颈动脉彩超有无颈动脉粥样斑块形成分为两组,颈动脉斑块形成31例,无颈动脉粥样斑块形成15例,分别测定两组患者的超敏C反应蛋白(hs-CRP)、血清前白蛋白(PA)、白蛋白(Alb)、血红蛋白(Hb)、颈动脉中层厚度(IMT)。生物电阻抗测定体质指数(BMI)、去脂体重(FFM)、体脂百分比(Fat%)、体脂肪量。结果:两组患者的体脂百分比差异存在统计学意义(P<0.01),两组患者的体重指数、去脂体重、白蛋白、前白蛋白、H-CRP、Hb、i PTH、收缩压及透析龄亦差异存在统计学意义(P<0.05)。结论:BIA可以反应病人营养状况,尤其是肌肉含量减少,脂类含量异常,与hs-CRP升高及动脉硬化正相关性,与血清白蛋白、血红蛋白呈负相关,可较好预测营养状态及动脉硬化风险。     

老年维持性血液透析患者死因分析

目的：探讨老年维持性血液透析（ MHD）患者的死亡原因及相关危险因素。方法：回顾性分析2009年9月~2013年10月在我院行MHD治疗的76例老年患者，统计死亡原因；比较死亡组（研究组）和存活组（对照组）间的人口学资料、原发疾病、透析3个月时的血红蛋白、血清白蛋白、钙、磷等相关临床指标；分析死亡的危险因素。结果：心血管疾病、感染、脑血管疾病和消化道出血是老年MHD患者的主要死亡原因；与存活组相比，死亡组患者中男性多于女性（P〈0.05）；使用导管作为血管通路的患者多于使用动静脉内瘘的患者（P〈0.05）；患者的透析龄、BMI、透析3个月时的Hb、Hct、Alb、TC、P3-、iPTH、Scr低于存活组患者（P〈0.05）；CRP高于存活组患者（P〈0.05）。 Logistic回归分析显示，高CRP和低iPTH是死亡的独立危险因素（P〈0.05）。结论：在老年MHD患者中，心血管疾病是首要的死亡原因；高CRP和低iPTH是死亡的独立危险因素。     

维持性血液透析及腹膜透析患者骨密度的评估

目的了解我院MHD及PD患者BMD状况,探讨BMD与临床资料、骨代谢指标及生化指标的相关性及危险因素分析。方法选择我院住院及门诊随访的MHD及PD患者,透析龄均超过3个月,收集患者临床资料及血尿标本。采用超声骨密度仪检测患者BMD状况,对骨量异常患者的BMD及患者一般临床及实验室资料进行相关性分析,并进一步分析透析患者骨量异常的危险因素。采用SPSS19.0软件包进行数据统计及分析。结果 MHD组及PD组骨量异常发生率分别为57.98%,48.54%,有显著统计学差异;随着透析龄的延长,透析患者BMD下降,透析龄3年以上的PD患者比MHD患者的TScore值相对较高,两组间也存在统计学差异。高龄、高透析龄、高BMI、高血磷及高ALP血症是透析患者发生骨量异常的危险因素。结论 MHD患者比PD患者更易发生骨量异常,且随着透析龄的延长,透析患者骨量异常发生率增高,高龄、高透析龄、高BMI、高血磷及高ALP血症是透析患者发生骨量异常的危险因素。     

维持性血液透析患者主动脉钙化相关影响因素分析

目的：探讨维持性血液透析（MHD）患者主动脉钙化的相关影响因素。方法：采用胸部正位X线成像技术检测183例MHD患者主动脉钙化情况,将入选患者分为主动脉钙化组（A组）和主动脉无钙化组（B组）,透析前抽血检测血钙、血磷、全段甲状旁腺激素（iPTH）、C反应蛋白（CRP）和血清白蛋白（Alb）等指标,并计算钙磷乘积,比较两组年龄、透析龄和血清学指标的差异,将上述指标与主动脉钙化进行相关性分析,并对筛选出来的危险因素进行非条件Logistic回归分析。结果：A组和B组在年龄、透析龄、血磷、钙磷乘积和CRP水平方面,差异均有统计学意义（P〈0.01或P〈0.05）;MHD患者主动脉钙化的相关影响因素包括：年龄、透析龄、血磷、钙磷乘积及CRP;Logistic回归分析表明,年龄、透析龄和血磷是主动脉钙化的独立危险因素（P〈0.01）。结论：MHD患者主动脉钙化相当常见,主动脉钙化与年龄、透析龄、钙磷代谢和炎症状态有关。     

维持性血液透析患者营养不良情况及其影响因素分析

目的:分析维持性血液透析(MHD)患者营养不良发生率以及营养不良的影响因素。方法:选择2015年~2016年在我院进行MHD治疗的142例患者作为研究对象,采用改良定量主观整体评估表(MQSGA)结合实验室生化指标、人体测量学指标综合评估透析患者营养状况,并分析MHD患者发生营养不良的危险因素。结果:MQSGA评估结果显示营养正常组有63例,占总人数44.37%,营养不良组有79例,占总人数55.63%,其中轻中度营养不良有68例,占总人数47.88%,重度营养不良有11例,占总人数7.74%。营养正常与营养不良组间CRP、Alb、BUN、TSF、BMI、kt/v、年龄、透析龄比较差异有统计学意义(P0.05)。Logistics回归模型结果显示KT/V1.2,年龄、透析龄、Alb是营养不良的独立危险因素。结论:MHD患者营养不良的发生率较高,影响因素多,其中KT/V1.2,年龄、透析龄、Alb是其危险因素,可作为评估患者营养状况的指标。     

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。     

维持性血液透析患者颈动脉钙化相关因素分析

目的：探讨慢性肾衰竭维持性血液透析（MHD）患者颈动脉钙化情况并分析相关因素。方法：对35例MHD患者应用彩色B型超声仪观测双侧颈动脉内膜-中膜厚度（IMT）及钙化情况,同时记录透析龄、收缩压、脉压差,抽血检测血钙、磷、血胆固醇、三酰甘油、白蛋白、C反应蛋白（CRP）、甲状旁腺素,并计算钙磷乘积。结果：35例终末期肾病（ESRD）患者18例（51.4%）存在颈动脉钙化。钙化组IMT值较无钙化组显著增高（P〈0.01）,透析龄、收缩压、脉压差、血磷、钙磷乘积、CRP较无钙化组明显增高（P〈0.05）,而钙化组血浆白蛋白较无钙化组显著降低（P〈0.05）。结论：IMT值、透析龄、血磷、钙磷乘积增高是颈动脉钙化的主要影响因素,收缩压、脉压差、CRP升高和低血浆白蛋白与颈动脉钙化密切相关。MHD患者存在较高的颈动脉钙化率。     

MHD患者血清瘦素和炎症反应及营养状况的研究

目的：探讨不同透析方式对维持性血液透析（MHD）患者血清瘦素（Leptin）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）水平及营养状况的影响。方法：选取MHD患者60例,随机分为低通量血液透析组（A组）、高通量血液透析组（B组）,血液透析滤过组（C组）,20例健康体检者作为正常对照组（D组）,分析MHD患者血清瘦素、炎症水平及营养状况的相互关系及影响因素。统计参数包括一般资料;实验室及透析相关参数：透析时间、透析剂量、超滤量、血红蛋白、体重指数、Leptin浓度、IL-6浓度、电解质水平、尿素氮清除率（Kt/V）等。结果：（1）MHD患者Leptin、CRP、IL-6水平较正常对照组升高（P〈0.05）,Alb、BMI较正常对照组降低（P〈0.05）。（2）A组透析6个月后Leptin、CRP、IL-6、Alb,BMI无明显变化,B、C两组透析6个月后Leptin、CRP、IL-6水平降低,Alb、BMI指数升高,差异有统计学意义。（3）MHD患者Leptin与CRP、IL-6水平呈正相关,与Alb呈负相关,CRP、IL-6与BMI,Alb呈负相关。结论：高通量血液透析与血液透析滤过能够减轻高瘦素血症及炎症反应,改善营养不良。     

The evaluation of some nutritional indexes in nutritional status of patients with maintenance hemodialysis

Objective To evaluate the diagnostic value of serum albumin (Alb), total protein (TP), body mass index (BMI), Mini Nutritional Assessment (MNA) and hand strength in the nutritional status in maintenance hemodialysis (MHD) patients. Methods A total of 126 MHD patients were included in this study who had been on MHD for at least 3 months. Depending on the levels of Alb, patients were divided into two groups：normal nutrition group (group A) and malnutrition group (group B). TP, BMI, MNA and hand strength were also detected at the same time. Independent samples t test, Spearman correlation analysis, ROC curve were used to analyze their difference between the two groups and evaluate their diagnostic value in nutritional status in MHD patients. Results Age, sex, height, weight and dialysis ages had no statistical significant difference (P＞0.05) between group A and group B, whileAlb, TP, BMI, MNA and hand strength had statistical significant difference (P＜0.05) between two groups. After adjusting for age, sex and hemodialysis age, Alb, TP, BMI, MNA and hand strength were positively correlated with each other (P＜0.05).Since the area under the ROC curve of BMI was the smallest, BMI had the lowest diagnostic value in evaluation of the nutritional status in those patients. Conclusions Alb, TP, MNA and hand strength are good indexes in evaluation of the nutritional status in MHD patients but BMI is not.     

Exercise activities are impaired in maintenance dialysis patients and its correlative factors

Objective To investigate the exercise performance in maintenance dialysis patients, and analyze its correlative factors. Methods Maintenance dialysis patients admitted in Tongji Hospital of Shanghai from December 2014 to March 2015 were enrolled, with their baseline data and biochemical measurement being collected. The anthropometric indexes including arm circumference, triceps skinfold, waist circumference and hip circumference were detected. The exercise activity was assessed by hand grip test, timed up and go test (3mTUG) and five times sit-to-stand test (FTSST). Patients were divided into fast group (3mTUG≤12 s) and slow group (3mTUG＞12 s). Univariate and multivariable analyses were used to evaluate the factors influencing exercise performance in maintenance dialysis. Results There were 121 patients enrolled: 62 on peritoneal dialysis and 59 on hemodialysis, 76 men and 45 women. Patients' average age was (61.6±13.0) years and median dialysis age was 31.7(12.3, 69.0) months. There was no statistical difference between fast group (n=80) and slow group (n=41) in gender, dialysis method, dialysis age, body mass index (BMI), arm muscle area (AMA), waist-hip ratio (WHR), hemoglobin (Hb) and total cholesterol (TC). Patients in fast group were younger, had higher serum albumin, prealbumin, serum phosphate and iPTH, and less prevalence of diabetes than those in slow group. In exercise activity, patients in fast group had better performance in handgrip, 3mTUG and FTSST (all P＜0.05). Univariate analysis showed that, handgrip was correlated with sex (male), AMA, BMI, age, diabetes, serum phosphorus and TC; scores in FTSST was correlated with age, BMI, diabetes, WHR, dialysis method, dialysis age, prealbumin and serum phosphorus; scores in 3mTUG was correlated with age, diabetes, WHR, dialysis method and dialysis age, prealbumin, serum phosphorus and iPTH (all P＜0.05). Multiple stepwise regression analysis showed that sex (male), age, AMA and diabetes were independently correlated with handgrip in dialysis patients (all P＜0.05); age, dialysis method, BMI and diabetes were independently correlated with scores in FTSST (all P＜0.05); age, dialysis method, diabetes and WHR were independently correlated with scores in 3mTUG (all P＜0.05). Conclusions The exercise performances of patients on maintenance dialysis are impaired. Age and diabetes are independent factor associated with the exercise performances of patients on maintenance dialysis. AMA is independently associated with upper limb movement, and dialysis method, BMI and WHR are independent factors associated with lower limb movement in dialysis patients.     

Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis.

Patients on maintenance hemodialysis (MHD) often show substantial reductions in quality of life (QoL). The SF36 (Short Form with 36 questions), a well-documented, self-administered QoL scoring system that includes eight independent scales and two main dimensions, has been widely used and validated. In 65 adult outpatients on MHD, the SF36 and its scales and dimensions, scored as a number between 0 and 100, and the nutritional and inflammatory state measured by subjective global assessment, near-infrared (NIR) body fat, body mass index (BMI), and pertinent laboratory values, including hemoglobin, albumin, and C-reactive protein were assessed. Twelve-month prospective hospitalization rates and mortality were used as the clinical outcomes. Multivariate (case-mix) adjusted correlation coefficients were statistically significant between SF36 scores and serum albumin and hemoglobin concentrations. There were significant inverse correlations between SF36 scores and the BMI and NIR body fat percentage. Hypoalbuminemic, anemic, and obese patients on MHD had a worse QoL. Prospective hospitalizations correlated significantly with the SF36 total score and its two main dimensions (r between -0.28 and -0.40). The Cox proportional regression relative risk of death for each 10 unit decrease in SF36 was 2.07 (95% CI, 1.08 to 3.98; P = 0.02). Of the eight components and two dimensions of the SF36, the Mental Health dimension and the SF36 total score had the strongest predictive value for mortality. Thus, in patients on MHD the SF36 appears to have significant associations with measures of nutritional status, anemia, and clinical outcomes, including prospective hospitalization and mortality. Even though obesity, unlike undernutrition, is not generally an indicator of poor outcome in MHD, the SF36 may detect obese patients on MHD at higher risk for morbidity and mortality.     

高通量血液透析对维持性血液透析患者营养状态的影响

目的 研究高通量血液透析对维持性血液透析患者透析期间营养状态的影响.方法 采用前瞻性、自身对照设计.44例常规低通量血液透析患者转换为高通量透析(Fresenius FX60-FX80,超纯透析液)治疗半年.采用单因素方差分析比较试验前(0月)、试验后6个月与试验后12个月患者食欲评分、主观综合性营养评估、体质指数、透析前血肌酐、尿素氮、尿酸、血磷、血钙、全段甲状旁腺激素、白蛋白、C-反应蛋白、血红蛋白、红细胞压积等指标水平的变化.结果 高通量透析6、12个月后,较低通量透析时患者食欲、主观营养评估及体质指数均有改善,差异有统计学意义.血尿素氮、肌酐、尿酸、血钙等生化指标在转化为高通量透析后与低通量时比较差异无统计学意义(均P＞0.05).高通量透析后12个月与6个月比较,C反应蛋白、白蛋白、全段甲状旁腺激素、血磷、血红蛋白、红细胞压积等指标亦有改善,差异有统计学意义(P＜0.05).结论 高通量透析能提高患者的食欲,改善营养状态,降低炎症指标,改善贫血和钙磷代谢紊乱,进而提高血液透析患者的生存质量.     

The deleterious effect of metabolic acidosis on nutritional status of hemodialysis patients

One of the main causes of protein-energy malnutrition in patients on maintenance hemodialysis (MHD) is metabolic acidosis. The aim of this study was to evaluate the effect of metabolic acidosis on nutritional status in a group of MHD patients with adequately delivered dialysis treatment. Of 165 eligible anuric MHD outpatients with Kt/V ≥ 1 and no underlying inflammatory diseases, 47 subjects were enrolled. In order to evaluate the effect of different parameters on serum albumin, we measured the pre-dialysis serum albumin, blood pH, serum bicarbonate (HCO 3￣ ), Kt/V, normalized protein catabolic rate (nPCR) and body mass index (BMI) in these patients. The mean age of the study patients was 55 ± 13.8 years; there were 22 females and six diabetics. The average Kt/V was 1.22 ± 0.16, pH was 7.40 ± 0.15, serum HCO 3￣ was 23.18 ± 2.38 mEq/L, serum albumin was 4.03 ± 0.56 g/dL, nPCR was 1.00 ± 0.16 g/kg/day, post-dialysis body weight was 58.50 ± 11.50 kg and BMI was 23.47 ± 2.70 kg/m 2 . There was a statistically significant direct correlation between serum albumin and BMI (r = 0.415, P = 0.004), and between serum albumin and serum HCO 3 (r = 0.341, P = 0.019). On multiple regression analysis, the predictors of serum albumin were serum HCO3￣ and BMI (direct effect) and nPCR (inverse effect). In 17 patients on MHD with serum HCO3￣ <22 mEq/L, there was a significant inverse correlation between HCO 3 and nPCR (r = 0.492, P = 0.045), and these patients had significantly lower serum albumin compared with patients with serum HCO3￣ >22 mEq/L (P = 0.046). These data demonstrate that patients on MHD with metabolic acidosis had a lower serum albumin concentration despite adequate dialysis treatment. The inverse effect of nPCR on serum albumin concentration in acidotic MHD patients may be due to hypercatabolism in the setting of metabolic acidosis, leading to deleterious effects on the nutritional status of patients on MHD.     

不同通量透析对维持血液透析患者叶酸、维生素B12等贫血相关指标的影响及其与贫血的关系研究

目的 探讨不同通量透析对维持血液透析(MHD)患者叶酸、维生素B12及其他贫血相关指标水平的影响及其与贫血的关系.方法 将本院血液透析中心进行维持透析的69例患者随机分为高通量透析组(HFHD组)和低通量透析组(LFHD组),观察两组患者入组时及治疗1年后血清叶酸、维生素B12、C-反应蛋白(CRP)、甲状旁腺素(PTH)等指标变化情况,并分析上述指标变化与贫血之间的关系.结果 经过治疗,两组平均Hb水平均有明显增加,和治疗前比较差异均有统计学意义(P＜0.05);LFHD组治疗前后其他指标均无明显变化(P＞0.05);HFHD组患者叶酸、维生素B12、Hct水平和初始值比较均明显增加(P＜0.05),CRP、PTH水平以及EPO使用量均明显下降(P＜0.05),和LFHD组比较差异均有统计学意义(P＜0.05).HFHD组叶酸、维生素B12、CRP以及PTH等4个指标的变化与贫血是否达标有明显的相关性(r =0.370 ～0.448,P＜0.05),HFHD组上述指标的变化与贫血相关性不强(r=0.017 ～0.241,P＞0.05).结论 高通量透析可以降低维持血液透析患者体内毒素水平,提高叶酸、维生素B12等造血原料营养物质水平,比低通量透析更加利于改善患者贫血状态.     

Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients.

BACKGROUND: Markers of malnutrition-inflammation complex syndrome (MICS) are reported to predict mortality and hospitalization in maintenance haemodialysis (MHD) patients. However, it is not clear which one is a more sensitive and stronger predictor of outcome. METHODS: We examined the utility of 10 markers of MICS as predictors of prospective mortality and hospitalization, which included malnutrition-inflammation score (MIS), a fully quantitative score adopted from subjective global assessment, and serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), albumin, pre-albumin, total iron binding capacity, creatinine, total cholesterol and normalized protein nitrogen appearance. A cohort of 378 MHD patients, who were randomly selected from eight DaVita dialysis facilities in the South Bay Los Angeles area, was studied. RESULTS: Patients, aged 54.5+/-14.7 years, included 53% men, 47% Hispanics, 30% African-Americans and 55% diabetics, who had undergone MHD for 37+/-34 months. Over a 12-month follow-up, 39 patients died and 208 were hospitalized at least once. Multivariate Cox and Poisson models that included 11 covariates [gender, age, race, ethnicity, diabetes, dialysis vintage, Charlson co-morbidity index (CCI), insurance status, Kt/V, body mass index and history of cardiovascular disease] were explored for the highest quartiles of inflammatory markers or the lowest quartiles of nutritional markers. The magnitude of relative risk of death and hospitalization was greatest for MIS, CRP and IL-6. In extended multivariate models that included all 10 MICS markers and 11 additional covariates simultaneously, CRP, MIS and CCI were the only consistent predictors of mortality and hospitalization, and their outcome predictabilities were superior to serum albumin. CONCLUSIONS: The MIS appears to be a useful, short-term tool to risk-stratify MHD patients and may circumvent the need for measuring inflammatory markers such as CRP or IL-6.     

Correlates of habitual physical activity in chronic haemodialysis patients.

BACKGROUND: Results of physical performance tests may not reflect the level of habitual physical activity and health status of the dialysis patients. The aim of our study was to assess interdialytic spontaneous physical activity in chronic haemodialysis (HD) patients in relation to their nutritional status, severity of anaemia, inflammation and dialysis adequacy. METHODS: Sixty HD patients [27 female, 33 male; mean age 60+/-13 years, time on dialysis 46.2+/-62.1 months and body mass index (BMI) 25.1+/-4.7 kg/m2] without physical and neurological disabilities and 16 healthy individuals (10 female, six male, mean age 56+/-6 years, BMI 26.6+/-4.9 kg/m2) were enrolled into the study. In all patients, spontaneous daily physical activity was measured during 48 h between mid-week dialysis sessions by pedometers. Nutritional status was estimated by anthropometric methods (BMI and mid-arm muscle circumference) and serum albumin concentration. Additionally, body composition was estimated using a multifrequency phase-sensitive bioimpedance analysis (BIA). Severity of anaemia was determined by blood haemoglobin level and haematocrit value, and the presence of inflammatory state was determined by high sensitivity plasma C-reactive (CRP) protein measurements. RESULTS: The total number of steps during daily activities in dialysis patients and in healthy individuals was 6896+/-2357 vs 14 181+/-5383 per 48 h, respectively (P<0.001). Dialysis patients showed typical signs of malnutrition in the BIA, i.e. high extracellular mass/body cell mass index (1.17+/-0.28 in dialysis patients vs 0.97+/-0.1 in controls; P<0.001), low percentage cell mass (46.7+/-5.6 and 51.0+/-3.6, respectively; P = 0.002) and low phase angle (5.1+/-0.9 and 5.8+/-0.7, respectively; P = 0.006). Dialysis patients also showed lower serum albumin and blood haemoglobin and higher serum CRP levels than healthy controls. In dialysis patients, the number of steps taken positively correlated with body water (R = 0.28, P = 0.03), fat mass (r = 0.29, P = 0.04), BMI (R = 0.25, P = 0.04), lean body mass (R = 0.26, P = 0.04), intracellular water (r = 0.30, P<0.01), phase angle (R = 0.40, P = 0.002), serum albumin (R = 0.32, P = 0.01), haematocrit (R = 0.46, P = 0.001) and haemoglobin (R = 0.44, P = 0.001). Furthermore, the number of steps taken correlated significantly with mid-arm muscle circumference (r = 0.35, P = 0.006). A negative correlation was found between the number of steps and extracellular mass/body cell mass index (R = -0.37; P = 0.004). No significant relationships were found between the measures of physical activity and high sensitivity CRP or adequacy of dialysis. Multiple regression analysis revealed the independent associations between the number of steps taken by the patients and haemoglobin concentration, age, total body water, extracellular mass/body cell mass index and phase angle. CONCLUSIONS: Low habitual physical activity assessed in HD patients with simple portable pedometers is strongly related to several factors of major clinical importance in this population.     

前白蛋白与维持性血液透析患者死亡的关系

目的探讨前白蛋白与维持性血液透析(MHD)患者死亡的关系。 方法回顾分析了2012年1月至2018年6月北京民航总医院行维持性血液透析(透析龄≥3月)的患者的一般情况、生化指标以及预后;以死亡患者为研究组,存活患者为对照组;以t检验、非参数检验、χ²检验将两组患者数据进行比较,并使用Logistic回归分析的方法分析与MHD患者全因死亡相关的危险因素。 结果①纳入研究患者325例,平均年龄(63.4±13.4)岁,透析龄64.0(41.5±98.5)月,存活组210例、死亡组115例,死亡原因主要包括感染(24%)、心血管疾病(17%)、脑血管疾病(16%)、恶液质(12%)、肿瘤(10%)等。②死亡组白蛋白、前白蛋白、血肌酐、尿素氮、血磷、全段甲状旁腺激素均明显低于存活组(P<0.05);CRP(Z＝－5.824)、透析龄(Z＝－2.827)及年龄(t＝7.672)明显高于存活组(P<0.05)。男性与女性的死亡率无明显差别(χ²＝0.274,P>0.05),糖尿病组与非糖尿病组死亡率具有明显差异(χ²＝7.230,P<0.05)。③多因素Logistic回归分析显示年龄、透析龄、是否合并糖尿病、白蛋白、前白蛋白与MHD患者死亡独立相关;白蛋白(OR＝0.854)及前白蛋白(OR＝0.983)是独立保护因素(P<0.05);增龄(OR＝1.046)、透析龄延长(OR＝1.012)、合并糖尿病(OR＝2.201)是独立危险因素(P<0.05)。④前白蛋白与白蛋白正相关(r＝0.609,P<0.001),前白蛋白与其他营养指标相关性比白蛋白强。 结论前白蛋白与白蛋白对MHD患者的死亡具有独立保护作用,在预测MHD患者死亡时至关重要。