住院老年慢性肾功能不全患者的营养状况

目的应用微型营养评定（MNA）方法来评价住院老年慢性肾功能不全病人的营养状况。方法对97名上海三所综合医院的住院老年慢性肾功能不全病人采用微型营养评定（MNA）问卷调查法进行营养评定,同时结合人体测量、生化检查、24小时回顾性膳食调查。结果①根据MNA评分：营养不良者21名（21.6％）;营养不良危险者52名（53．6％）;营养良好者24名（24.7％）。②轻度,巾度、重度肾功能损害3组的营养不良及营养不良危险者发牛率分别为70、7％、78．1％、100．0％。③MNA评价的营养状况结果有效的反应人体测量、生化检查、膳食情况的差异性。结论①住院老年慢性肾功能不全病人的营养不良发生率较高。②微型营养评定（MNA）方法应用在住院老年慢性肾功能不全病人的营养状况评价中是可行的。     

老年人肾功能不全与心力衰竭

随着年龄的增长,人群中心力衰竭(心衰)的发病率也在增加;>65岁的人群中可达6%~10%。心衰主要是由心脏本身病变引发的,但是也可由一些相关的疾病引起;肾脏疾病就是其中之一。心脏与肾脏有时有一些共同的病理基础(如高血压、动脉粥样硬化、糖尿病等),可以引起各自的损害与功能不全,但是心功能与肾功能可以相互影响,心功能不全时可以引起肾脏损害及功能不全,肾功能是心功能不全的预测因子。蛋白尿和肾小球滤过率(glo-merular filtration rate,GFR)下降是心血管疾病进展的独立危险因素[1]。有作者报道GFR每下降1ml/(min.1.73m2)死亡率增加1%[…     

血清Cystatin C在老年人肾功能不全早期评估中的价值

目的 探讨半胱氨酸蛋白酶抑制剂C（Cystatin C）在老年人肾功能不全早期评估中的价值。方法 50例老年患者分为观察组（有慢性肾脏疾病史）38例,对照组（健康老年人）12例。观察组用MDRD公式计算GFR,再分为两组,肾功能正常或轻度下降组（Ⅰ）组：GFR≥60ml／min,18例;肾功能中-重度下降组（Ⅱ）组：GFR〈60ml／min,20例。分别测定患者血清Cystatin C浓度,BUN、Ser、24h Cer,测量患者身高和体重,用简化MDRD研究公式计算其GFR。结果Ⅱ组患者血清Cystatin C浓度高于Ⅰ组。Ⅰ组患者Scr仍可在正常范围．但血清Cystatin C与对照组比已经有升高。老年肾脏病患者血清Cystatin C水平与计算的GFR值明显相关,且优于与BUN、Scr,24h Ccr之间的相关性。结论血清Cystatin C水平对老年患者早期肾损害的诊断和老年CKD患者肾脏损害程度的判断有着良好的临床价植。     

微型营养评估法在心功能不全住院患者营养状况调查中的应用及评价

目的:采用微型营养评估法(MNA)评估心功能不全患者的营养状况,为进行营养指导提供科学依据.方法:应用MNA对心功能Ⅲ、Ⅳ级患者营养状况进行调查.结果:入院心功能Ⅲ、Ⅳ级患者中,8.3%营养状况良好,22.2%存在营养不良风险,69.4%有确定营养低下;MNA、BMI、ALB和HBG在心功能Ⅲ级和Ⅳ级组间存在着显著的差异.结论:心功能Ⅲ、Ⅳ级患者多数营养状况不良,心功能Ⅳ级患者全身营养状况、体内蛋白质储存和血红蛋白水平都不如心功能Ⅲ级患者,应早期及定期对心功能不全患者进行营养评估,对有确定营养不良患者进行营养支持.     

老年人营养不良状况及影响因素分析

目的评估老年人的营养状况并分析其危险因素,以制定改善老年人营养状况的措施,提高老年人生活质量。方法应用微型营养评估简表(Mini-Nutritional Assessment Short-Form,MNA-SF),采取整群抽样方法,对2019年12月至2020年3月烟台市65岁以上262226例老年人进行营养评估,采用多因素Logistic回归分析一般人口学资料、功能状态和老年综合征对营养不良的影响。结果在烟台市219222例有效调查老年人中,24489例(11.2%)被评估为营养不良风险,1589例(0.7%)被评估为营养不良。单因素分析显示,营养不良风险及营养不良组与营养正常组年龄、文化程度、居住地、婚姻状况、养老模式、多重用药、自理能力、认知功能、误吸风险、跌倒风险、压疮风险、抑郁状态方面差异均有统计学意义(P<0.01)。多因素Logistic回归分析显示,高龄、居住城镇、机构养老、自理能力下降、认知功能障碍、误吸风险、跌倒风险、压疮风险、抑郁状态、多重用药是营养不良的危险因素,文化程度高、已婚是老年人营养不良的保护因素(P<0.01)。结论老年人营养不良受很多因素的影响,应重视对该群体营养状况的评估,以制订针对性的干预措施改善其营养状况。     

老年肾功能不全的评价及诊治进展

随着年龄的增长、生理性老化及多种疾病的共同作用,肾脏组织结构和功能发生明显变化。资料显示,人体30-40岁后,肾脏的重量开始逐渐减轻,肾小球滤过率（glomerular filtrationrate,GFR）进行性下降,65～70岁以后肾功能下降速度加快,70-80岁肾脏的重量下降约20％～30％。     

老年人慢性肾功能不全的蛋白营养治疗

在保证足够热量供应前提下，给慢性肾功能不全患者予低蛋白饮食治疗非常必要，这已成为共识。因为它有如下好处：（1）减少尿毒素产生，减轻氮质血症，改善代谢性酸中毒；（2）促进蛋白质合成，减少降解，改善蛋白质代谢；（3）减轻胰岛素抵抗，改善糖代谢；（4）提高脂酶活性，改善脂代谢；（5）降低高血磷，改善低血钙，减轻继发性甲状旁腺功能亢进；（6）减少蛋白尿排泄，延缓慢性肾脏病进展。     

老年人营养状况对生存质量影响的研究

目的：调查社区散居老人的营养和综合性生存质量现状,探讨营养状况对生存质量的影响。方法：采用二阶段随机抽样方法,入户调查120名（60－80岁）散居老人的营养状况（体质指数、膳食营养摄入、就餐习惯、就餐环境等）和生存质量（采用中华老年医学学会推荐的老年人生存质量和调查内容和评价标准）,结果：生存质量调查涉及的11项内容,评价为良的比例最低的是营养状况,评价为差的比例由高至低为生活满意度,营养状况和社会交往等。120名散居老人综合生存质量良、中、差的比较分别为25．0％、74．2％和0．8％。本组老人营养状况的高低与就餐环境（独居、两老单居、与小辈合居）密切相关,较为突出的营养问题是膳食能量,蛋白质和脂肪摄入过高的比例分别占总人数的25％、32％和53％,以致超重肥胖的比例高达41．7％,结论：老年人营养状况是影响其生存质量的重要因素之一,就餐环境对老年人营养状况的影响不容忽视。加强营养健康教育和膳食行为指导,保持良好的就餐习惯和氛围,有助于改善老年人的营养状况及生存质量。     

改良低蛋白饮食对慢性肾功能不全患者营养状况的影响

测定应用改良低蛋白饮食（LPD）前后慢性肾功能不全患者体重指数（BMI）、上臂肌围（MAMC）、血清白蛋白（ALB）、血红蛋白（Hb）、外周血淋巴细胞（TLC）等营养参数变化的情况。治疗后,患者BMI、MAMC、ALB平稳,Hb上升（P〈0．05）;与传统治疗组及对照组比较患者营养状况改善有显著差异。认为改良LPD可以显著改善慢性肾功能不全患者的营养状况。     

前列腺素E1对慢性肾功能不全患者肾功能的影响

前列腺素Ｅ１（ＰＧＥ１）是当前新一代广谱内源性活性物质,１９９５年２月～１９９８年３月,我们应用ＰＧＥ１静脉滴注治疗慢性肾功能不全病人３５例,临床上取得满意的效果。现报告如下。１资料和方法１．１临床资料本组６６例;男５１例,女１５例,年龄１９～６１岁...     

不同营养状态老年慢性心力衰竭病人血清IGF-1及IL-17的表达及其影响因素

目的研究不同营养状态老年慢性心力衰竭(CHF)病人血清胰岛素样生长因子1(IGF-1)及IL-17的表达及其影响因素。方法选取200例2016年12月至2018年12月我院收治的60岁以上的老年CHF病人,根据微型营养评估量表(MNA)评分将病人分为有营养不良风险及营养不良(营养不良)组(MNA<24分)和营养正常组(MNA≥24分)。测量病人身高和体质量并计算病人BMI,测量臂围(AMC)、小腿围(CC)、三头肌皮褶厚度(TSF);测定病人血清中总蛋白(TP)、转铁蛋白(TRF)、前白蛋白(PA)、TC、TG和Hb水平。采用多元线性回归分析IGF-1、IL-17与病人状态的关系。结果营养正常组IGF-1水平显著高于营养不良组,IL-17水平显著低于营养不良组(P<0.05);营养正常组BMI、AMC、CC和TSF水平及TP、TRF、PA、TC、TG和Hb水平均显著高于营养不良组(P<0.05);病人BMI、AMC、CC、TSF、TP、PA、Hb与IGF-1水平呈正相关,与IL-17水平呈负相关,是IGF-1和IL-17水平的独立影响因素。结论在老年CHF病人中,IGF-1和IL-17水平与营养状态关系密切,营养不良影响老年CHF病人预后。     

中老年人轻度肾功能减退与血脂异常

目的 探讨中老年人轻度肾功能减退者的血脂特征。方法将266例中老年人按照估测肾小球滤过率（eGFR）水平分为正常、轻度降低和中度降低3组；方差分析各组之间血脂以及相关生化指标的差异；多变量协方差分析校正年龄对肾功能和血脂的影响。结果3组中低密度脂蛋白胆固醇（LDL—C）在eGFR正常组最低（P〈0．05），高密度脂蛋白胆固醇（HDL—C）在eGFR正常组最高（P〈0．01）。载脂蛋白A（ApoA）在eGFR中度降低组比轻度降低组显著降低[（1．14±0．25）g/L比（1．30±0．26）g/L，P〈0．01]。结论轻度肾功能减退中老年人存在血脂代谢异常，以HDL—C和ApoA降低、LDL—C升高为主要表现；血脂异常可能与肾功能减退的进展和不良预后有关。     

老年营养风险指数用于消化内科住院老年患者营养评估

目的探讨老年营养风险指数(geriatric nutritional risk index,GNRI)用于≥80岁高龄患者营养评估的效果。方法选取消化内科住院老年患者96例,采用GNRI进行营养评估,测定12项营养相关指标,分析营养相关指标与GNRI评分的相关性。结果分别通过测量身高或膝高计算理想体质量的方法所得GNRI各营养分组的比率差异无统计学意义(P0.05)。GNRI营养评估的4个营养分组之间体质量指数(BMI)、上臂围(MAC)、小腿围(CC)、三头肌皮褶厚度(TSF)、总蛋白(TP)、前白蛋白(PAB)、血红蛋白(HB)的差异具有统计学意义(P0.05),转铁蛋白(TRF)、三酰甘油(TG)、总胆固醇(TC)、总淋巴细胞计数(TLC)、C反应蛋白(CRP)的差异无统计学意义(P0.05)。GNRI评分与BMI、MAC、CC、TSF、TP、PAB具有明显的相关性(P0.05)。结论 GNRI适用于消化内科住院老年患者营养评估,消化内科住院老年患者营养不良发生率较高,应当尽早进行营养干预。     

Immune response to influenza vaccine in the elderly: Association with nutritional and physical status

Aim: To investigate the distribution of hemagglutination inhibition (HI) titers before and after influenza vaccination and to examine the relationship between physical and nutritional factors and the change in HI titer after influenza vaccination in the elderly. Methods: Pre‐post‐vaccination HI titers were determined from 203 individuals aged 65 years or older residing in a nursing home. For the assessment of physical and nutritional status, information was retrieved from care records. Results: The immune response to vaccination was assessed as good in 122 subjects based on a fourfold rise or more in HI titer after vaccination for at least one of three vaccine strains. In univariate logistic regression analysis with poor versus good immune response as the dependent variable, factors found to be significantly associated with a poor immune response were disability, a combination of body mass index less than 18.5 and bodyweight loss in 6 months or 5% or more, mid‐upper‐arm circumference of less than 80%, arm muscle circumference of less than 80% and total protein of less than 6.5 g/dL. Physical and nutritional indicators might be useful in identifying individuals who are unlikely to have a good immune response to influenza vaccination. In a multivariate analysis, the association remained significant for a low level of activities of daily living and a combination of body mass index of less than 18.5 and bodyweight loss in 6 months of 5% or more. Conclusion: Elderly individuals with poor physical and nutritional status tended to respond poorly to influenza vaccination. A low level of activities of daily living and a combination of being underweight and having had recent bodyweight loss are good indicators of a poor immune response. Geriatr Gerontol Int 2011; 11: 63–68.     

强化谷氨酰胺及合生元的肠内营养对老年住院患者营养状况与胃肠道耐受性的影响

目的研究强化谷氨酰胺和合生元的肠内营养对老年住院患者营养状态与胃肠道耐受性的影响。方法选取2013年1月至2016年12月于广西医科大学第一附属医院住院并接受肠内营养支持治疗的老年住院患者182例,采用随机数字表法分为两组:治疗组(n=90)和对照组(n=92)。对照组接受常规肠内营养治疗;治疗组在常规肠内营养治疗基础上每天加用谷氨酰胺与合生元。治疗10 d后对比治疗前后两组患者血清白蛋白(ALB)、前白蛋白(PA)和血红蛋白(Hb)水平,同时比较两组患者的胃肠道耐受性。采用SPSS 17.0软件进行数据处理,依据数据类型,组间比较分别采用t检验或x~2检验。结果治疗后治疗组患者的ALB[(37.16±4.94)vs(33.10±4.97)g/L]、PA[(218.26±89.57)vs(175.12±88.42)mg/L]和Hb[(104.99±16.47)vs(97.04±16.86)g/L]值均显著高于治疗前,差异有统计学意义(P0.05)。治疗后治疗组的ALB[(37.16±4.94)vs(34.67±4.51)g/L]、PA[(218.26±89.57)vs(211.83±98.39)mg/L]和Hb[(104.99±16.47)vs(102.20±20.35)g/L]值均显著高于对照组,差异有统计学意义(P0.05)。治疗组腹泻(6.67%vs 16.30%)、腹胀(7.78%vs 20.65%)以及恶心和呕吐(3.33%vs 10.87%)的发生率均显著低于对照组(P0.05)。结论强化谷氨酰胺及合生元的肠内营养能够改善老年住院患者的营养状态,提高肠道耐受性。     

老年冠心病合并慢性肾功能不全患者介入治疗围术期应用不同剂量依诺肝素抗凝的有效性和安全性

目的探讨不同剂量依诺肝素抗凝在老年冠心病合并肾功能不全患者介入治疗围术期的安全有效剂量。方法分析2009年1月至2012年12月在我科住院的108例冠心病合并肾功能不全介入治疗围术期应用依诺肝素的患者,按依诺肝素应用剂量共分为3组。A组（n=31）：依诺肝素40mg,皮下注射,每12小时1次。B组（n=35）：依诺肝素40mg,皮下注射,每日1次。C组（n=42）：依诺肝素40mg,皮下注射,每早1次以及依诺肝素20mg,皮下注射,每晚1次。观察各组出血及支架内血栓发生率。结果在服用同样剂量阿司匹林和氯吡格雷的情况下,3组患者均无大出血及支架内血栓发生,但A组患者皮下出血、牙龈出血发生率明显高于其他两组。结论老年冠心病合并肾功能不全患者介入治疗围术期给予依诺肝素,40mg皮下注射,每早1次,20mg皮下注射,每晚1次,共5～7d,是安全和有效的。     

Pancreatic insufficiency in celiac disease is not dependent on nutritional status

To determine the relationship between pancreatic secretory capacity and nutritional status in celiac patients, we studied 52 patients with celiac disease (24 males, 28 females; age range 6–36 months) and 30 healthy control subjects (14 males, 16 females; age range 6–42 months). A secretin-cerulein test was performed on all patients, and levels of serum albumin and plasma fibronectin were assayed. In addition, weight/height ratios were calculated in the celiacs, who were then divided into three groups on this basis, as follows: celiacs with weight/height ratio3rd percentile; those with weight/height ratio between the 4th and 10th percentiles; and those with weight/height ratio>10th percentile. There was no significant difference in the duodenal output of chymotrypsin, phospholipase and lipase between these groups. When the total celiac group was compared to control subjects, only lipase levels were significantly lower (P<0.009). However, subnormal values in one or more pancreatic enzymes were observed in 15/52 celiacs (29%). A residual enzyme activity<10% of normal secretory capacity, was also found in 4/52 patients. There was no correlation between the output of the various pancreatic enzymes and levels of albumin, fibronectin, and weight/height ratios in the patients. Furthermore, there was no difference in weight/height ratio and levels of albumin and fibronectin between the celiac subjects with pancreatic deficiency and those with normal pancreatic function. We conclude that a mild/moderate pancreatic insufficiency is quite frequent in celiacs, but that it may be completely independent of nutritional status; further studies are therefore required to shed light on its pathogenesis.     

波替单抗治疗伴或不伴有肾功能不全的老年多发性骨髓瘤

目的：通过回顾性分析波替单抗（硼替佐米）为主的化疗方案治疗老年多发性骨髓瘤（MM）患者的治疗结果,探讨其治疗效果、不良反应及对合并肾功能不全患者的疗效。方法对2007年1月至2012年12月在解放军总医院第一附属医院住院治疗的46例老年MM患者进行回顾性分析,依据肾功能是否正常将患者分为肾功能不全组14例,肾功能正常组32例;依据是否初治分为初治组25例,复治组21例。分别采用波替单抗为主的化疗方案治疗,比较各组患者治疗2个疗程及4个疗程后的总反应率（ORR）,并统计治疗后的相关不良反应。结果46例患者中,治疗2个疗程后初治组ORR为88.0%（22/25）,复治组ORR为76.2%（16/21）,但差异无统计学意义（P＞0.05）。4个疗程后初治组ORR为90.0%（9/10）,复治组ORR为75.0%（15/20）,两组间差异有统计学意义（P＜0.01）。完成4个疗程时肾功能不全组ORR为90.9%（10/11）,肾功能正常组ORR为73.7%（14/19）,两组间差异无统计学意义（P＞0.05）。治疗相关的不良反应包括末梢神经炎、胃肠道反应、血小板减少等,对症处理后均可控制。结论波替单抗为主的化疗方案治疗老年MM患者疗效显著,疗效随疗程增加逐渐提高。对于合并肾功能不全老年患者,尽早使用波替单抗为主的化疗方案,可纠正肾功能不全,改善患者生活质量。含波替单抗的化疗方案在该组老年患者治疗中有较好的安全性。     

Assessing nutritional status in children with chronic liver disease

The metabolic changes compounded by anorexia associated with chronic liver disease adversely affect growth in children. In many cases, this requires the administration of artificial nutritional support. It is important in this group of patients that those who are becoming nutritionally depleted are identified quickly and in those receiving artificial nutritional support, the effectiveness is monitored. The current review is an examination of methods available to assess nutritional status. These include anthropometry, methods available in the laboratory and a selection of less commonly used methods undergoing evaluation at research level. A brief discussion accompanies each technique, outlining the limitations of its use in children with chronic liver disease. The review concludes with an outline of how nutritional status should be assessed in this group of children, and suggests further research.     

The nutritional status of 250 older Australian recipients of domiciliary care services and its association with outcomes at 12 months

OBJECTIVES: To identify predictors and consequences of nutritional risk, as determined by the Mini Nutritional Assessment (MNA), in older recipients of domiciliary care services living at home. DESIGN: Baseline analysis of subject characteristics with low MNA scores (<24) and follow-up of the consequences of these low scores. SETTING: South Australia. PARTICIPANTS: Two hundred fifty domiciliary care clients (aged 67-99, 173 women). MEASUREMENTS: Baseline history and nutritional status were determined. Information about hospitalization was obtained at follow-up 12 months later. INTERVENTION: Letters suggesting nutritional intervention were sent to general practitioners of subjects not well nourished. RESULTS: At baseline, 56.8% were well nourished, 38.4% were at risk of malnutrition, and 4.8% were malnourished (43.2% not well nourished). Independent predictors of low MNA scores (<24) were living alone, and the physical and mental component scales of the 36-item Short Form Health Survey. Follow-up information was obtained for 240 subjects (96%). In the ensuing year not well-nourished subjects were more likely than well-nourished subjects to have been admitted to the hospital (risk ratio (RR) = 1.51, 95% confidence interval (CI) = 1.07-2.14), have two or more emergency hospital admissions (RR = 2.96, 95% CI = 1.15-7.59), spend more than 4 weeks in the hospital (RR = 3.22, 95% CI = 1.29-8.07), fall (RR = 1.65, 95% CI = 1.13-2.41), and report weight loss (RR = 2.63, 95% CI = 1.67-4.15). CONCLUSION: The MNA identified a large number of subjects with impaired nutrition who did significantly worse than well-nourished subjects during the following year. Studies are needed to determine whether nutritional or other interventions in people with low MNA scores can improve clinical outcomes.