腹膜透析病人营养状况的临床观察

目的　前瞻性观察终末期肾衰 (ESRD)病人的营养状况及影响因素。方法　对 84例持续性非卧床式腹膜透析 (CAPD)病人进行主观综合性营养评估 (SGA)、人体测量、生化指标的测定。结果　 84例病人中A组(营养良好组 ) 2 6例 (30 95 % ) ;B组 (轻中度营养不良组 ) 4 5例 (5 3 5 7% ) ;C组 (重度营养不良组 ) 13例(15 4 8% )。测量指标平均每日每公斤体重蛋白质摄入 (DPI)、血清白蛋白 (ALB)、前清白蛋白 (Pre -A)、转铁蛋白 (TF)、氮出现率相当蛋白 (nPNA)、血肌酐 (Scr) ,3组间均有明显差异 (P <0 0 1或P <0 0 5 )。肌酐清除率 (Ccr)和尿素清除指数 (KT/V) ,C组低于A组与B组 (P <0 0 1或P <0 0 5 )。上臂围 (AC) ,三头肌皮褶厚度 (TSF)及上臂肌围 (AMC)、尿素氮 (BUN)及血胆固醇 (CH) ,3组间均未见明显差别 (P >0 0 5 )。结论　ESRD的CAPD病人营养不良发生率较高 ,可能与蛋白质摄入不足、透析前营养状况、残余肾功能、酸中毒、糖尿病、心理因素及经济状况等因素有关。

Clinical Study of the Nutritional Status in Patients with Eternal State Renal Diseases

Objective A prospective study was made to observe the nutritional status and its effective factors in patients with eternal state renal failure (ESRD). Methods We examined the nutritional status in 84 clinially stable continuous ambulatory peritoneal dialysis (CAPD) patients , including subjective global assessment (SGA), anthropometry, biochemistry and so on. Results Of 84 patients investigated, 26 patients (30.95%) were graded as good nutrition (group A), 45(53.57%) mild malnutrition (group B) and 13(15.48%) severe malnutrition (group C). There were magnificent differences for the three groups about DPI, ALB, Pre-A, TF, nPNA, Ccr(P<0.05 or P<0.01). Both KT/V and Ccr were much lower for group C than those for group A and group B (P<0.05 or P<0.01). There were no magnificent difference for the three groups about AC, TSF, AMC, BUN and CHOL (P>0.05). Conclusions There was a high morbidity of malnutrition in patients with ESRD who underwent peritoneal dialysis. The morbidity may have something to do with low protein intake, deterioration of digestive and absorptive functions of gastrointestional system, duration of dialysis, nutrition status before peritoneal dialysis, residual renal fuction, acidosis, diabetes, anxiety and depression.