维持性透析患者的营养状况与糖尿病、炎症的关系

目的：通过对维持性透析患者营养状况影响因素的分析，以期进一步提高患者生活质量。方法：调查2003年9月1日至2004年3月31日在本科进行透析的终末期肾病患者的临床资料，包括性别、年龄、透析龄和糖尿病发病情况。采用主观综合评估（subjective global assessment,SGA）来评价患者的营养状况，采用karnofsky指数评估患者活动能力，采用ICED（index of co-existence disease）系统来评估患者合并症情况。自动生化检测仪检测患者血清白蛋白、胆固醇、甘油三酯、低密度脂蛋白。结果：有45例入选本研究，糖尿病患者占42．2296（19／45）。轻一中度营养不良发生率为44．44％（20／45），严重营养不良发生率为2．22％，血清CRP与血清白蛋白呈负相关（r=-0．44，P〈0．01）；在糖尿病组，尽管患者年龄、血液透析龄及每日残余尿量与非糖尿病组无差别，但营养不良发生率和血清CRP水平明显高于后者，而血清白蛋白水平则明显低于后者。结论：糖尿病、炎症是影响维持性透析患者营养状况的重要因素。

Relationship between diabetes/inflammation and nutritional status in patients with maintenance hemodialysis

Objective: To further improve the life quality of patients with maintenance hemodialysis through analyses of the contributing factors of malnutrition in patients with maintenance hemodialysis. Methods: Following methods were used in the investigation: to investigate the clinical data(including sex,age,duration of hemodialysis and onset of diabetes) of patients with end-period nephropathy receiving maintenance hemodialysis in the hospital from Sept.1st 2003 to Mar.31st 2004;to evaluate the nutritional status of patients with subjective global assessment(SGA);to evaluate the physical activity of patients with Karnofsky index;to assess the occurrence of complication of patients with index of co-existence disease(ICED);to measure serum albumin,cholesterol,triglyceride,low density lipoprotein with auto biochemical instruments.Results: 45 cases were selected for the present study,of which patients with diabetes accounted for 42.22 %(19/45).Of the total,incidence rate of mild and medium malnutrition accounted for 44.44 %(20/45),while rate of severe malnutrition accounted for 2.22 %.Serum CRP and serum albumin were inversely correlated(r=-0.44,P<0.01).For the patient group with diabetes,the occurrence rate of malnutrition and the level of serum albumin were significantly higher than the non-diabetes group,in spite of the fact that there was no difference in the age,the age of hemodialysis,and daily amount of residual urine,when compared with those of the non-diabetes group.However,the level of serum albumin was significantly lower than that of the latter.Conclusions: Diabetes and inflammation are the main contributing factors affecting the nutritional status of patients with maintenance hemodialysis.