应用生物电阻抗分析法检测营养不良病人的人体组成

目的 :应用生物电阻抗分析法 ,检测营养不良病人人体组成的改变。　方法 :中等程度以上营养不良住院病人 6 8例 ,其中男 4 0例 ,女 2 8例 ,年龄为 5 3± 16 (37～ 6 8)岁作为研究对象。 78名健康志愿者 (男 4 4 ,女 34)为对照者 ,年龄为 5 2± 11(38～ 6 2 )岁。人体组成测定应用HYDRAECF/ICF 4 2 0 0多频率生物电阻抗分析仪。　结果 :营养不良病人实际平均体重是理想体重的 6 8.8% ,其体质指数、肱三头肌皮皱厚度、臂肌围、白蛋白、转铁蛋白、前白蛋白及淋巴细胞总数均明显低于正常值 ,属中、重度营养不良范围。营养不良病人的体脂、瘦组织群、体细胞群及细胞内液含量均明显低于健康志愿者 (P <0 .0 5 )。细胞外液含量比例高于健康志愿者 (5 8.5 %vs 4 8.5 % ) (P <0 .0 5 )。　结论 :营养不良时人体体脂、瘦组织群和体细胞群存在不同程度的消耗 ,机体细胞内液丢失 ,而细胞外液增加。     

Evaluation of body composition: why and how?

Evaluation of human body composition in vivo remains a critical component in the assessment of nutritional status of an individual. Whereas traditional measurements of standing height and body weight provide information on body mass index and, hence, the risk of some chronic diseases, advanced technologies, such as dual X-ray absorptiometry, air displacement plethysmography and various forms of bioelectrical impedance analysis enable the determination of soft tissue composition (fat and lean) as well as bone. This review summarises the physical bases of these methods and critically evaluates their accuracy in observational and interventional studies. It also discusses a new approach, bioelectrical impedance vector analysis, which assesses the hydration status of an individual, and includes pertinent examples of its novel applications in clinical nutrition. Mention of a trademark or proprietary product does not constitute a guarantee of the product by the United States Department of Agriculture and does not imply its approval to the exclusion of other products that may also be suitable. US Department of Agriculture, Agricultural Research, Northern Plains Area is an equal opportunity/affirmative action employer and all agency services are available without discrimination.     

急性白血病患儿治疗期人体组成成分的变化

目的 探讨不同治疗阶段的急性白血病患儿人体组成成分变化的特点,为其营养支持提供依据.方法 前瞻性观察2009年1月至2010年4月在上海儿童医学中心住院接受化疗的急性白血病患儿56例,同时选择同年龄同性别健康儿童56名作为正常对照组.使用节段多频生物电阻抗分析法对正常对照组儿童及在各个治疗期的第1个疗程结束时的白血病患儿进行人体组成成分测定.人体各组成成分的分布情况使用各成分占体重的百分比表示.结果 56例急性白血病患儿中,急性淋巴细胞性白血病41例,急性非淋巴细胞性白血病15例;处于诱导缓解期23例,巩固强化期15例,维持治疗期18例.56例白血病患儿与正常对照组儿童人体组成成分比较后发现,白血病患儿细胞内液(P=0.000)、细胞外液(P=0.005)、蛋白质(P=0.000)、无机盐(P=0.001)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童,而体脂肪含量高于对照组[(26.2±8.3)%比(20.3 ±3.8)%,P=0.000].诱导缓解期患儿的人体组成与正常对照组儿童相比,表现为体重下降(P=0.001),细胞内液(P=0.005)、蛋白质(P=0.004)、体细胞群(P=0.001)和活动细胞群(P=0.020)明显减少.进入巩固强化期的患儿,细胞内液(P=0.000)、细胞外液(P=0.000)、蛋白质(P=0.000)、无机盐(P=0.001)、体脂肪(P=0.000)、去脂体重(P=0.000)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童.而维持治疗期的患儿与正常对照组儿童相比,除体重指数(P=0.127)和细胞外液占体重的百分比(P=0.097)差异无统计学意义外,其余各项指标差异仍具有统计学意义(P均<0.05).结论 急性白血病患儿经化疗后人体组成成分发生明显改变.应尽早监测白血病患儿营养状况变化,及时予以营养支持,以改善患儿预后.

Abstract：

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

Body Composition Measurement in Bronchiectasis: Comparison between Bioelectrical Impedance Analysis,Skinfold Thickness Measurement,and Dual-Energy X-ray Absorptiometry before and after Pulmonary Rehabilitation

Background

In individuals with bronchiectasis, fat-free mass depletion may be common despite a low prevalence of underweight and is considered a risk factor for increased morbidity and mortality. Techniques to adequately estimate fat-free mass and its changes over time are needed.

应用生物电阻抗法测定部队士兵人体成分

应用生物电阻抗（BIA）法测定314名部队士兵的人体成分。年龄（20．3±1．5）岁，身高（171．2±5．7）cm，体重（61．8±6．9）kg，体质指数（BMI）21．1±2．1，瘦体（L）（55．2±5．8）kg，L占体重（89．6±7．1）％，脂肪（F）（6．6±4．9）kg，F占体重（10．4±7．1）％；BIA、理想体重和BMI三种方法对肥胖的检出率分别为8．3％，36．2％和6．7％，BIA法与理想体重法有非常显著性差异，BIA法与BMI法差异不显著，但两者一致性较差；年龄、体重、电阻抗（Z）、BMI、F与F％为非常显著性正相关。结果提示：（1）部队士兵随着年龄的增高，F有增多的趋势；（2）受试人群营养状况良好，锻炼强度适宜；（3）理想体重法与BMI法判断肥胖，不适用于全训部队士兵。     

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。     

Body composition in underweight elderly subjects: reliability of bioelectrical impedance analysis

BACKGROUND AND AIMS: In underweight elderly subjects it is important to estimate body composition and particularly fat-free mass (FFM). Bioelectrical impedance analysis (BIA) is a non-invasive method in determining FFM, but its usefulness in these frail subjects should be verified. The aim of this study is to verify in underweight elderly people the reliability of previously published BIA formulas in detecting FFM. METHODS: Fifty-seven hospitalized elderly subjects (27 males and 30 females) with body mass index <20 kg/m(2) were selected. In all subjects, FFM was detected by dual energy X-ray absorptiometry. Moreover, BIA measurements were performed at standard frequency (50 kHz and 800 microA) and FFM was derived using the main previous published BIA equations. Results: In men, Kyle and Rising equations gave acceptable estimates of FFM with a mean error, respectively, of 1+/-1.9 and 1.4+/-1.7 kg. Also RJL formula could be used after adjusting for a correction factor. In women, no equation seemed sufficiently reliable to estimate FFM. CONCLUSIONS: BIA method seems useful to evaluate body composition in underweight elderly men but it seems to have intrinsic limits in women. Nevertheless, the variability in behavior of the different equations suggests to be careful in adopting BIA equations.     

Bioelectrical impedance analysis-part II: utilization in clinical practice

BIA is easy, non-invasive, relatively inexpensive and can be performed in almost any subject because it is portable. Part II of these ESPEN guidelines reports results for fat-free mass (FFM), body fat (BF), body cell mass (BCM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) from various studies in healthy and ill subjects. The data suggests that BIA works well in healthy subjects and in patients with stable water and electrolytes balance with a validated BIA equation that is appropriate with regard to age, sex and race. Clinical use of BIA in subjects at extremes of BMI ranges or with abnormal hydration cannot be recommended for routine assessment of patients until further validation has proven for BIA algorithm to be accurate in such conditions. Multi-frequency- and segmental-BIA may have advantages over single-frequency BIA in these conditions, but further validation is necessary. Longitudinal follow-up of body composition by BIA is possible in subjects with BMI 16-34 kg/m(2) without abnormal hydration, but must be interpreted with caution. Further validation of BIA is necessary to understand the mechanisms for the changes observed in acute illness, altered fat/lean mass ratios, extreme heights and body shape abnormalities.     

生物电阻抗技术临床应用现状及探讨

生物电阻抗技术是利用细胞外液、细胞内液的电学性质测量人体成分及其变化。因其有无创、操作简便、测量数据精确等优点,在流行病学研究和临床疾病动态检测中广泛应用。我们通过综述生物电阻抗技术在临床应用开展情况的优点和缺陷,试图探讨其可能的应用潜力。     

高原环境对驻训官兵人体成分的影响

目的:观察高原环境对驻训官兵人体成分的影响。方法:对120例男性高原驻训官兵进行健康体检。采用生物电阻抗法测量受试者的人体成分,主要指标有体重指数(BMI)、体脂肪量等33项。结果:与进驻高原前相比,进入高原后官兵的人体成分指标中除左下肢肌肉分布、右上肢细胞外水分/细胞内水分(ECW/TBW)无显著性差异外,其他31项均明显降低。结论:高原环境下官兵人体成分水平明显降低,需引起高度关注,给予针对性的干预,科学安排官兵膳食和训练强度。     

一种阻抗法人体脂肪总量测量仪的研制及初步应用

本文介绍一种利用人体阻抗来测量人体脂肪总量的新仪器。它是根据当交流电信号通过人体时人体体内电阻与体内脂肪总量的相关性，将一标准电阻与被测人体串联，微型计算机系统通过比较交流电通过人体和标准电阻时所产生的电压降计算出人体体内的电阻值，然后结合被测者的身高、体重和年龄计算出入体的脂肪总量。本仪的准确性误差为３．２４％，重复性误差为２．７５％。     

应用生物电阻抗法分析人体组成

目的：通过应用生物电阻抗法测定人体组成,探讨其对营养评价的临床意义。方法：利用生物电阻抗法测定７６例健康志愿者的人体组成。结果：男性体脂占体重的（１４．８１±４．８９）％,女性体脂则占体重的（２２．３３±５．５８）％,女性体脂含量明显大于男性（Ｐ＜０．０５）。随年龄增长,可出现体脂增加而瘦组织群减少的趋势。应用生物电阻抗法测定体脂含量,其肥胖检出率明显低于按理想体重法和体质指数（ＢＭＩ）法的检出率。结论：生物电阻抗法测定人体组成简便、准确,有助于临床客观地评价机体营养状况。     

母体生物电阻抗分析与新生儿出生体质量关系的研究

目的:探讨孕期母体体质量增加及人体成分的改变与新生儿出生体质量间的关系.方法:选择来我院建保健卡的单胎健康孕妇70例,分别于孕中期(24～25周)和孕晚期(37～38周)测人体成分,同时监测同期胎儿生长发育状况.结果:共有63例孕妇完成所有的测量项目.孕中期和孕晚期的体质指数(BMI)、蛋白质、无机盐、肌肉量、脂肪量(FM)等与新生儿出生体质量间无相关性(P>0.05);孕中期和晚期的基础代谢率(BMR)、细胞内液(ICW),细胞外液(ECW),总体水(TBW),去脂体质(FFM),体细胞群(BCM)、上臂肌围(AMC)等与母亲体质量的增加有关,且与胎儿出生体质量呈显著相关(P<0.05).结论:孕期母体体质量的增加与母亲人体成分的组成和改变有关,并且能影响胎儿的生长发育及出生体质量,FFM是新生儿出生体质量的一个预测因素.