老龄维持性血液透析患者营养不良及炎症状态的临床分析

目的：营养不良是维持性血液透析（MHD）患者主要并发症,老龄血透患者一般预后更差,死亡风险更高,其原因是否与老龄患者具有更严重的营养不良和炎症状态有关。本课题研究对象为年龄≥65周岁的老龄MHD患者,临床观察其MIS,MQSGA,人体测量学指标,生化指标及炎症因子水平,并与非老龄MHD患者进行比较研究。方法：选取2007年11月～2008年4月在我院门诊行MHD的36例老龄患者（年龄≥65周岁）为研究对象,64例非老龄（年龄〈65周岁）MHD患者为对照。观察指标：（1）营养不良指标：包括营养不良-炎症评分、改良SGA评分和白蛋白水平。（2）人体测量学指标：包括体重指数（BMI）、肱三头肌皮褶厚度（TSF）、上臂围（MAC）、上臂肌围（MAMC）等。（3）生化指标和血常规：包括血浆总蛋白（TPRO）、白蛋白（Alb）、转铁蛋白（TF）、总胆固醇（TC）、肾功能、铁蛋白（Ft）、未饱和铁（UIBC）等,及血红蛋白（Hb）、红细胞（RBC）等。（4）炎症指标：包括血清超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）等。结果：老龄组平均年龄（75.19±8.26）岁。以MQSGA标准：老龄组中营养不良者为91.67%,非老龄组为70.31%。老龄组MIS评分（9.19±5.73）高于非老龄组（6.38±4.51）;按照MIS营养不良程度划分：老龄组55.56%为轻度营养不良,36.11%为中度营养不良,8.33%为重度营养不良。老龄组血浆白蛋白、转铁蛋白、肌酐、未饱和铁和总铁结合力低于非老龄组（P〈0.05）,而铁蛋白水平显著高于非老龄组。两组总胆固醇、血常规（Hb、RBC和红细胞压积）水平,差异无统计学意义。两组的中臂围、中臂肌围、TSF均较健康对照组明显下降,但组间差异无统计学意义。两组CRP、IL-6、和TNF-α水平均显著高于正常人群。老龄组透析前后IL-6和透前TNF-α均高于非老龄组（P〈0.05）。结论：老龄MHD患者具有较高的营养不良发生率,且营养不良程度更重;MHD患者具有较高的炎症因子水平,与非老龄患者比较,老龄患者具有较高水平血清IL-6。

Clinical Observation of Malnutrition and Inflammation Status in Elderly Patients on Maintenance Hemodialysis

Objective:Malnutrition is a prevalent complication in patients with maintenance hemodialysis (MHD). There is a poor outcome in dderly MIlD patients who have extremely high risk of death compared with that of the younger. A severe malnu-trition and inflammatory status might be one important reason. In this study, we compared the MIS,7 - point SGA score,biochemical assays,and anthropometry in the dderly MHD patients to the younger. Methods:Thirty-six dderly MHD patients with age≥65 y were named as Observed group. Sixty- four MHD patients with age< 65 y were named as Compared group. All the patients came from Hemo- purified Center of The 455th Hospital of PLA,who took hemodialysis from Nov. 2007 to Apr. 2008. We detected the following parameters: (1)nutritional parameters: including MIS, 7- point SGA, and serum albumin. (2)Anthropometry: including body mass index (BMI),triceps skinfold (TSF),mid- arm circumference (MAC) and mid-arm muscle circumference (MAMC).(3)Biochemical assays: including serum total protein,albumin, transferrin, ferritin, total iron binding capacity,serum creatinine, uric acid, urea nitrogen and haernoglobin. (4) Inflammatory parameters, including high sensitive C reactive protein ( hs - CRP ), interleukin -6(IL-6) and turaor necrosis factor alpha (TNF-α). Parameters in the two groups were compared. Results:The average age is (75.19 ± 8.26)y. The morbidity of malnutrition was 91.67% in the Observed group according to the MQSGA, but that was 70.31% in the Compared group. IS of Observed group(9.19±5.73) was higher than that of Compared group(6.38 ± 4.51);In Observed group:55.56% were mild in malnutrition,36.11% were median,and 8.33% were severe. The anthropometric was lower in two group compared to health people, but there was no difference between the two groups. The serum albumin, transferrin, creati-nine,UIBC and TIBC were significantly lower,but the Ft was higher in Observed group than that of Compared group(P<0.05).The concentration of in ks- CRP, TNF - α, IL- 6 which were detected with blood gotten before hemodialysis were higher than the health people's. In both groups there were no significant difference in Ks- CRP,TNF- a concentration of which were detected with blood gotten before and after hemodialysis. But there was significant difference in ooncentration of IL- 6 before and after hemolialy-sis(P<0.05). Conclusion:The elderly MHD patients were in worse status of nutritional and inflammatory compared the younger ones.