老年腹膜透析患者预后判断的营养指标

目的观察稳定腹膜透析(PD)时老年患者的营养状态,评价各种营养指标对预测患者预后的意义。方法回顾性队列研究入选规律随访患者112例,年龄≥60岁,收集患者稳定透析时白蛋白、前白蛋白、血红蛋白、血脂、体质指数(BMI)、主观综合营养评估(SGA)、标准化的氮出现率相当蛋白(n PNA)等营养指标及一般临床数据。随访时间4年,以患者死亡为终点事件。采用Kaplan-Meier分析和多元Cox回归模型对预后的风险因素进行评估,ROC曲线用于评价各营养指标对预后的预测价值。结果 Cox多因素回归分析,评价营养的各项指标中,SGA、白蛋白、n PNA为影响老年PD患者预后的独立因素。三种指标预测死亡的ROC曲线下面积分别为0.764、0.693、0.628;灵敏度及特异度分别为84.3%、65.7%,71.2%、60.5%,69.4%、58.1%。结论老年PD患者营养状态较差者预后差,SGA是最有效预测患者生存预后的指标,更适合老年PD患者营养状况的评估。     

老年腹膜透析患者营养状况调查

目的 前瞻性观察老年腹膜透析（ＰＤ）患者的营养状况及影响因素。方法 采用主观整体营养评估法（ＳＡＧ）结合有关生化检查综合判断患者的营养状况。结果 ４０例患者中营养良好者１０例（２５％）;轻～中度营养不良者２４例（６０％）,重度营养不良者６例（１５％）。结论 老年ＰＤ患者营养不良发生率较高,上与蛋白质摄入不足、胃肠道消化吸收功能减退、基础疾病、透析时机、透前营养状况、残存肾功能、心理因素及社会或经济     

主观综合性营养评估法在腹透中的应用

主观综合性营养评估法在腹透中的应用姚强钱家麒严玉澄茅雪迎关键词主观综合性营养评估法腹膜透析营养状况中图法分类号Ｒ４５９．５如何正确评估腹透患者的营养状况已日益受到关注。通常，营养评估采用客观的生化检验或人体测量。但至今尚无一项指标能预示或作出营养不良...     

腹膜透析患者营养状况的动态观察

腹膜透析患者营养状况的动态观察王进学关键词腹膜透析终末期肾衰营养状况中图法分类号Ｒ４５９，５为探讨腹透患者营养状况的动态变化，作者连续观察了１２个月２６例腹透患者的营养指标。１对象和方法１．１一般资料ＣＡＰＤ患者男１４例，女１２例，年龄２０～７４岁（...     

腹膜清除效能与腹膜透析患者营养状况的关系

目的　回顾性分析腹膜清除效能与腹膜透析患者营养状况之间的关系。方法　选 取本院99例310例次行腹膜透析患者的随访资料,分别计算各例次的腹膜清除效能指标:腹膜尿 素Kt/v和腹膜Ccr。以蛋白呈现率(nPNA)、白蛋白、瘦体重百分比(%LBM)及主观综合评价法评 估营养状况;根据总尿素Kt/v分组,分析腹膜清除效能与营养状况间之的相关性。结果　A组 (Kt/v<1.7)的腹膜Kt/v、Ccr与白蛋白、%LBM、nPNA呈正相关;B组(1.7≤Kt/v≤2.0)腹膜Kt/ v、Ccr与白蛋白呈负相关;C组(Kt/v>2.0)腹膜Kt/v、Ccr与nPNA、%LMB呈正相关。结论　腹膜 清除效能与腹透患者营养状况之间在一定范围内呈负相关性,过高的腹膜清除对腹透患者的营养 状态并无益处。     

慢性腹透患者透析充分性和营养状况的临床评估

本文对53例慢性腹透（PD）患者通过测定整体尿素清除率（KT／V）、肌酐清除率（Ccr）、蛋白分解代谢率（PCR）、标准蛋白分解代谢率（nPCR）、白蛋白（ALB）、臂肌面积（AMA）来观察腹透的充分性和有关营养状况．结果表明：①KT／V与Ccr有显著相关性（r=067，P＜0．01），其中KT／V＜1．4的16例，Ccr＜50／周14例（占28.3％）；②KT／V、Ccr与PCR、nPCR有显著相关性（r=0．36～0．72，P＜0．01），W、Ts、AMA与PCR有显著相关性（r=0．29～0．27，P＜0．05）；③高龄者、近期透析者ALB偏低．提示KT／V、Ccr是了解透析充分性、调节透析量的有效手段．PCR、nPCR在评估PD患者营养状态中，肥胖及消瘦者可影响nPCR的结果．     

腹膜透析患者的营养问题

腹膜透析患者的营养问题俞雨生关键词腹膜透析；机体代谢；营养随着腹膜透析装置的不断改善，透析合并感染的机会明显减少，而营养不良等合并症则日显突出。据统计，在连续不卧床腹膜透析（ＣＡＰＤ）的患者中，营养不良的发生率约占１７％～５６％，且随着腹膜透析（ＰＤ...     

腹膜透析患者微炎症状态对营养状况的影响

目的探讨腹膜透析患者体内炎症因子水平对营养状况的影响。方法采用酶联免疫吸附ELISA法检测60例腹膜透析患者和25例健康人的血清hs-CRP、IL-6、TNF-α表达水平,按照hs-CRP≤3 mg/L和hs-CRP〉3mg/L将60例腹透患者分为两组,比较两组间营养指标的变化及其与炎症指标的关系。结果腹膜透析组患者血清hs-CRP、IL-6、TNF-α水平均高于健康对照组（P〈0.01）;hs-CRP升高者血清白蛋白、前白蛋白、转铁蛋白和主观营养评估低于hs-CRP正常者（P〈0.01）。结论腹膜透析患者存在的微炎症状态加重了营养不良的发生。     

腹膜透析患者营养状况的随访研究

目的观察腹膜透析（以下简称腹透）患者营养状况的动态变化,探讨影响腹透患者营养状况的临床影响因素。方法选2002年6月至2003年6月进入持续非卧床腹透（CAPD）的43例患者,每隔6个月进行营养状况[主观综合性营养评估法（SGA）,血白蛋白（Alb）水平]及其临床影响因素（包括肾脏和透析溶质清除率,蛋白质能量摄入水平,炎症和容量状况,代谢性酸中毒和急慢性合并症）的调查,共4次,随访2年。结果（1）43例CAPD患者随访2年中肾脏尿素清除指数（Kt／V）、肌酐清除率（Ccr）和总Kt／V明显下降（P=0．02）,但营养不良发生率从65．12％下降至25．58％,血Alb从（34．53±5．10）g／L上升至（37．01±4．39）s／L（P=0．01）。（2）43例患者中14例（32．56％）始终营养良好（A）,18例（41．86％）由透析前的轻中度营养不良转为营养良好（B）（其中4例于透析后1年营养改善）,3例处于营养波动状态（C）,8例始终为轻中度或重度营养不良（D）。将A和B合并为Ⅰ组,C和D合并为Ⅱ组,Ⅱ组患者血C反应蛋白、容量负荷状态及感染、心脑血管事件、创伤等急性并发症发生次数均高于Ⅰ组（P〈0．05）,平均血Alb、蛋白质明显低于Ⅰ组（P〈0．05）。（3）C反应蛋白（P=0．011）、标化的细胞外液（P=0．019）是导致营养不良或波动的重要危险因素。结论大部分CAPD患者（74．4％,32／43）在透析2年内营养状况明显好转,而持续营养不良或营养状况波动者伴随明显的蛋白质摄入不足、炎症状态、容量负荷及发生急性合并症。     

改良主观法评价老年血液透析患者营养状况

随着血液透析技术的发展和普及,终末期肾脏病患者的生存期明显延长,老年血液透析患者的数量也明显增多.营养不良是影响维持性血液透析(MHD)患者长期存活和生活质量的重要因素.     

Simple assessment of the efficacy of peritoneal transport in continuous ambulatory peritoneal dialysis patients

The efficacy of peritoneal transport was assessed in 13 permeability studies in 11 continuous ambulatory peritoneal dialysis (CAPD) patients. During each study the in situ intraperitoneal volume was measured as well as the dialysate and plasma concentrations of various solutes with a molecular weight range from 60 to 5,500. As clearance estimations are unsuitable for the purpose of permeability studies, mass transfer area coefficients were used. By applying a simple mathematical model assuming first-order kinetics, these coefficients were calculated for urea, lactate, creatinine, glucose, kanamycin, and inulin. The accuracy of the calculations is indicated by their r values. After pooling these correlation coefficients, the mean approached 1.00 for all solutes with high confidence limits, indicating the usefulness of the model. A further simplification was tested using only an initial- and end-dialysate sample and two blood samples, without the measurement of the in situ intraperitoneal volume. Except for inulin the results of this simplification correlated well with the results described above. The reproducibility of the simplified mass transfer area coefficient calculations was investigated on 15 occasions in 3 other CAPD patients. The coefficients of variation of low molecular weight solutes varied between 15 and 20%. It is concluded that mass transfer area coefficient estimations using the latter method can be performed in any CAPD patient and probably yield sufficient information to establish the efficacy of the membrane transport mechanism during clinical follow-up.     

Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis

IntroductionMucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections.ObjectiveThe aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis.MethodsForty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1 mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed.ResultsPatient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p < 0.05).ConclusionsUnique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate.     

The impact of new comorbidities on nutritional status in continuous ambulatory peritoneal dialysis patients

OBJECTIVE: To study the prevalence and risk factors for malnutrition in a peritoneal dialysis (PD) center with an active PD program. METHODS: We assessed the nutritional status in 205 continuous ambulatory peritoneal dialysis (CAPD) patients, including stable and unstable patients, by subjective global assessment (SGA), dietary diaries and biochemistry index. Serum C-reactive protein (CRP) levels were examined as inflammatory marker. Fluid status including extracellular water (ECW), intracellular water, and total body water (TBW) was evaluated by multiple-frequency bioelectrical impedance analysis and brachial blood pressure was measured. New comorbidities included systemic infection, congestive heart failure and trauma that occurred within 1 month or less. Cardiovascular disease (CVD) was recorded too. Dialysis adequacy and residual renal function were calculated by a standard technique. RESULTS: Based on SGA, 15.6% of our CAPD patients were malnourished. The malnourished patients had advanced age, higher CRP and ECW/TBW levels than normally nourished patients (age: 68.78 +/- 11.92 vs. 59.26 +/- 13.46 years, p = 0.001; CRP: 11.98 +/- 20.22 vs. 5.56 +/- 8.30 mg/l, p = 0.004; ECW/TBW: 0.55 +/- 0.16 vs. 0.52 +/- 0.04, p = 0.049). Patients with malnutrition were more prone to have CVD (53.13 vs. 31.79%, p = 0.004) and new comorbidities (65.62 vs. 4.62%, p = 0.023). Multivariate analysis showed new comorbidities, mostly systemic infection, which were associated with nutritional status (p < 0.001). Both ECW/TBW and new comorbidities were associated with serum CRP, CVD and malnutrition (p < 0.001-0.05). In contrast, some traditional factors which were recognized as contributing to malnutrition such as residual renal function, dialysis adequacy, metabolic acidosis, total protein loss, diabetes and Charlson indexes were not different between normally nourished and malnourished patients in the present study. CONCLUSIONS: Our results suggest that only 15.6% of patients were malnourished in our PD program. Old age, inflammation, CVD, fluid overload and new comorbidities were all associated with malnutrition, with new comorbidities, mostly systemic infections, being the most significant risk factor. However, many traditional factors such as residual renal function, dialysis adequacy and diabetes were not.     

MNA联合SGA在炎症性肠病患者营养评价中的应用

目的:探讨炎症性肠病(inflammatory bowel disease,IBD)患者营养评估的合理方法.方法:选择微型营养评定法(MNA)联合营养状况主观综合评估(SGA)对IBD患者进行营养状态评估,同时结合包括血红蛋白(Hb)、总淋巴细胞计数(TLC)、前白蛋白(PA)、白蛋白(ALB)以及血浆钠、钾和钙浓度等实验室指标进行相关性分析.结果:Pearson相关分析显示,MNA值与Hb、ALB、和Na+有显著相关性(r=0.281,P=0.013;r=0.413,P=0.000;r=0.309,P=0.014).Kendall'stau-b相关方法分析证明MNA与SGA两种营养评估方法具有很好的相关性(r=0.772,P=0.000).结论:MNA联合SGA对IBD患者进行营养状况评估科学、准确.     

腹膜透析和血液透析患者与正常人群体液状况的比较

目的　比较并分析持续性非卧床腹膜透析 (CAPD)及血液透析 (HD)患者的体液状况。方法　通过无创性方法 (Xitron 42 0 0生物电阻抗分析仪 )分别测定 45例CAPD患者、44例HD患者和 46例正常人的细胞外液 (ECW )、细胞内液 (ICW )和总体液量 (TBW ) ,用标准体重 (身高 -10 5 )进行标准化后比较。结果　CAPD组标准化细胞外液 (nECW )比HD透析前、HD透析后及对照组均高。HD透析前组nECW比对照组高 ,但透析后组与其比较无显著性差异。HD透析前与透析后组的标准化细胞内液 (nICW )没有显著变化 ,但是与CAPD组及对照组比较均有显著性差异 ;而CAPD组与对照组间比较 ,无显著性差异。在体液分布 (ECW /TBW )上 ,各组间比较均有显著性差异。CAPD组与HD组患者间干体重比较无显著性差异 ;CAPD组患者体重与干体重之差为 ( 2 .6± 2 .4)kg ,与HD透析前组比较差异无显著性 ,而与HD透析后组 [( 0 .3± 2 .5 )kg ]比较 ,有显著性差异。结论　慢性腹膜透析患者普遍存在比血液透析患者更严重的容量超负荷。而腹透患者体液过多的原因可能与其过多水分摄入有关     

Impact of global and subjective mini nutritional assessment (MNA) questions on the evaluation of the nutritional status: the role of gender and age

Undernutrition is a quite common condition in the elderly, often identified using the mini nutritional assessment (MNA) test. The aim of this research was to study the independent value of the global and the subjective MNA questions to predict undernutrition according to the full MNA score, and to analyze the influence of gender and age on such items. A total of 22,007 Spanish people 65 years of age or older were evaluated using the MNA test. These data were obtained by trained community pharmacists. The subjective assessment was further evaluated on the basis of their sensitivity and specificity, by using receiver operating characteristic (ROC) curves. About 4.3% of the studied population were classified as undernourished according to the full MNA test. The subjective subscore (two questions) presented better predictive value than the global one (six questions). Indeed, 99.5% of subjects detected as well nourished using the MNA test were also correctly classified using only the two subjective questions. In the present study, it was identified that the two subjective MNA questions can be an efficient tool for a quick screening to rule out non undernourished subjects.     

Neutrophil function in patients on continuous ambulatory peritoneal dialysis

Frequent and recurrent episodes of peritonitis are a major cause of morbidity in patients on continuous ambulatory peritoneal dialysis (CAPD). One factor contributing to this problem may be an abnormality of neutrophil function in these patients. We have therefore quantified phagocytosis and killing by circulating and peritoneal neutrophils from patients on CAPD with and without peritonitis. Circulating neutrophils from uninfected patients showed reduced phagocytosis of both Staphylococcus epidermidis and Candida guilliermondii because of an opsonic defect in CAPD serum and because of a defect of the neutrophils themselves. In contrast, phagocytosis by circulating and peritoneal neutrophils from patients with peritonitis was normal. Intracellular killing of C. guilliermondii was normal in all groups of neutrophils but killing of S. epidermidis, the organism most commonly isolated in CAPD peritonitis, was reduced. The possible mechanisms for the enhanced neutrophil activity seen in peritonitis, and for the decreased killing of S. epidermidis in contrast to normal killing of C. guilliermondii are discussed. A defect in killing of S. epidermidis may explain why peritonitis caused by this organism can be difficult to erradicate.     

Diaphragmatic function in patients on continuous ambulatory peritoneal dialysis

We investigated 8 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for diaphragmatic strength and the neuromechanical efficiency of the diaphragm while the abdomen was filled with dialysate and while it was empty. Maximum transdiaphragmatic pressure (Pdi_max) served as parameter for diaphragmatic strength; diaphragmatic efficiency was assessed by simultaneously monitoring transdiaphragmatic pressure (Pdi) and diaphragmatic electromyogram (EMGdi) during room-air breathing and hyperoxic CO₂-rebreathing. After instilling dialysate, Pdi_max increased from 76.7 ± 12.1 cmH₂O to 92.2 ± 16.3 cmH₂O (P < 0.05). While the slopes of the regression lines relating minute ventilation (VE) to arterial CO₂ tension, and the change in VE for a given change in Pdi during hypercapnic rebreathing were similar in both states, the slope of EMGdi vs Pdi was significantly steeper when the abdomen was filled (P < 0.05). The increase in Pdi_max observed in the filled state may suggest an adaptive rightward shift in the diaphragm's force-length relationship in CAPD patients, although this mechanism is insufficient to prevent a reduction of neuromechanical efficiency of the diaphragm. Offprint requests to: T. Wanke