200例慢性肾脏疾病患者营养状况与病程进展的关系

目的探讨主观综合营养评估法（subjective global assessment of nutrition，SGA）评价慢性肾脏疾病（chronic kidney disease，CKD）2～4期患者营养状态并分析其与病程进展的关系。方法对200例CKD患者进行分组：①根据肾小球滤过率（estimated glomerular filtration rate，eG-FR）分为CKD2期组、3期组、4期组；②根据SGA评估分为营养正常组、轻一中度营养不良组和重度营养不良组；③根据病程进展分为进展1组、进展2组、进展3组。于随访第1天、第12个月、第24个月分别检测血红蛋白（hemoglobin，Hb），白蛋白（albumin，Alb），前白蛋白（prealbumin，PA），血清钙（Ca），血清磷（P），分析CKD患者的营养状况与病程进展的关系。结果在随访第1天、第12个月、第24个月，CKD4期组与2期组Hb比较有显著性差异；4期组与3期组比较，差异有统计学意义（P〈0．05），但2期组与3期组比较无统计学差异；CKD2期组第1天与12个月Hb比较差异有统计学意义（P〈O．05）。CKD4期组随访第1天、第12个月、第24个月PA比较，均有统计学差异（P〈0．05）。在第1天、12个月，营养正常组、轻一中度营养不良组、重度营养不良组Alb组间比较，差异有统计学意义；轻一中度营养不良组随访第1天、第12个月、第24个月比较，均有统计学差异（P〈0．05）。重度营养不良组随访第1天、第12个月、第24个月PA比较，均有统计学差异（P〈0．05）。CKD患者不同营养状况与病程进展发生率差异有统计学意义（P〈0．05），且重度营养不良患者进展3组发生率为92．6％。结论Alb可作为营养状况的评价指标之一。CKD患者PA随着肾功能下降及病程的延长而升高。重度营养不良对CKD患者病程进展影响较大，SGA评估CKD患者的营养状态具有一定临床参考价值。

Relationship between nutrition status and disease progress in 200 CKD patients

Objective To investigate the nutrition status by the subjective global assessment of nutrition（SGA）in 200 patients with chronic kidney disease （CKD）at stages 2,3 and 4 and analyze the relationship between nutrition status and disease progress. Methods 200 CKD patients were divided into three groups according to estimated glomerular filtration rate（eGFR） ：CKD stage 2, CKD stage 3 and CKD stage 4. Nutrition status was analyzed by SGA and the patients were also divided into three groups：normal nutrition,mild and moderate malnutrition grade and serious malnutrition grade. There were three disease progress conditions. Clinical and laboratory indexes were detected, including hemo globin （Hb）, albumin（Alb）, prealbumin（PA）, Ca, and P. The data were recorded respectively at three time points：0 month, 12 th month and 24 th month. Due to the conditions of disease progress, three groups were set up：progress I, progress 2, and progress 3. Results There was statistically significant difference in Hb between CKD stage 4 and CKD stage 3 groups and between CKD stage 4 and CKDstage 2 groups （P〈0. 05 for both）, but there was no significant difference between CKD stage 2 and CKD stage 3 groups. In addition, when compared at the time points of 0 month and 12 th month in CKD stage 2 group, there exited statistically significant difference in Hb. There was significant difference in PA in CKD stage 4 group among three time points. The comparison of Alb at 0 month and 12 th month, showed statistical significant difference among normal nutrition, mild and moderate malnutri- tion grade and serious malnutrition grade（P〈0. 05 for all）. PA in the serious malnutrition grade showed remarkable difference among the three time points（P〈0. 05）. The occurrence of disease progress in different nutrition status groups showed statistically significant difference （P〈0. 05）, and that of progress 3 in serious malnutrition grade was 92. 6%. Conclusions Alb can be used as one of indicators in the evalu