维持性血透患者营养不良与炎症的相互关系

目的 探讨维持性血液透析(MHD)患者营养不良、炎症与心血管并发症之间的相互关系。方法 79 例稳定的MHD患者分别运用传统主观全面营养评价法(SGA)、改良SGA、人体学测量进行营养评估;分析营养 不良、炎症以及心功能之间的联系。结果 营养不良组的理想体重％、体重指数(BMI)、三头肌皮褶厚度(TSF)、 血球压积(HCT)、血清白蛋白(ALB)值均明显低于营养正常组;改良SGA值、CRP、SF明显高于正常组。高CRP 组营养不良发生率和改良SGA评分明显高于正常组;生化指标方面,高CRP组的总蛋白(TP)、球蛋白(GLB)较 正常组高,ALB则低于正常组;高CRP组心功能检查E／A<1的比例高于CRP正常组。CRP与ALB存在负相 关,与改良SGA值、ALB、白细胞(WBC)、GLB存在正相关,但进行多因素分析后,CRP仅与ALB、改良SGA值存 在相关。营养不良患者中Ⅱ型约占60％。结论MHD患者中相当一部分存在Ⅱ型营养不良,该型营养不良与 炎症关系密切;炎症尚与心功能受损(尤其是左心舒张功能受损)有关。

Relationship between Malnutrition and Inflammation in Maintenance Hemodialysis Patients

Purpose To study the relationship between malnutrition,inflammation and cardiac function in maintenance hemodialysis patients (MHD). Methods Seventy-nine stable MHD patients were recruited. Subjective global assessment (SGA), modified SGA and anthropometric measurements were used to assess nutritional status. Meanwhile, biochemical parameters, echocardiogram and adequacy of dialysis were examined. The relationship between malnutrition, inflammation and cardiac function were analyzed. Results Malnourished patients had significantly lower percentage of ideal body weight,body mass index (BMI), triceps skin-fold thickness (TSF), haematocrit(HCT), serum albumin(ALB), higher modified SGA score, C-reactive protein(CRP), plasma ferritin (SF). Prevalence of malnutrition, modified SGA score, white blood cell count(WBC), total protein(TP) and globulin (GLB) were significantly higher in those with higher CRP level, while ALB was lower. E/A ratio less than 1, a parameter correspecting to damage of left cardiac ventricle, was more frequent in higher CRP group. CRP was correlated with ALB negatively, while with SGA, modified SGA,WBC and GLB positively. After controlling the variables of age,weight,height,partial correlation analysis showed a significant correlation only between CRP and modified SGA. Conclusions Type II malnutrition, which seems strongly associated with inflammation, is popular in MHD population. Prevalence of left cardiac ventricle damage correlates with inflammation but not with malnutrition.