细胞外液与细胞内液之比的动态变化在腹膜透析患者营养评估中的价值

目的研究细胞内外液分布与营养的关系，探讨细胞外液与细胞内液之比（E／I）在连续不卧床腹膜透析（CAPD）患者临床营养评估中的价值。方法采用前瞻性队列研究方法。使用生物电阻抗测量仪每日测量CAPD患者体内的液体状况，同时进行营养评估。最终观察98名CAPD治疗1个月以上，E／I在一段时间内增加或降低大于5％的患者临床营养指标变化与E／I变化之间的关系，评估E／I在监测CAPD患者营养状态中的价值。结果随着E／I的降低，CAPD患者的营养状况好转；相反，随着E／I的增高，患者的营养状况恶化；血浆白蛋白水平与E／I呈明显负相关（r=-0．656，P=0．000）。结论E／I与患者的营养状态密切相关。通过观察E／I的动态变化．可以较早预测患者营养状况的变化。

Values of Extracellular Water to Intracellular Water Ratio in Evaluating and Monitoring Nutritious Status of Patients under Continuous Ambulatory Peritoneal Dialysis

Objective To investigate the possible role of extracellular water to intracellular water ratio (E/I) in evaluating and monitoring malnutrition of patients under continuous ambulatory peritoneal dialysis (CAPD). Methods A prospective study was conducted in 98 uremic patients who had been on CAPD for at least one month. Bioimpedance analysis (BIA) was employed to assess fluid status monthly. Patients were divided into two groups according to their E/I changes: patients whose E/I increased by greater than 5% compared with baseline were included in group A and those whose E/I decreased by over 5% were divided into group B. Patients' demographic data, nutritious indices, Karnofsky index, and fluid status were parallel between these two groups. Results In group A, with the increase of E/I, patients' serum albumin (ALB), serum hemoglobin (Hb), daily protein intake (DPI), daily energy intake (DEI), and Karnofsky scores decreased while the prevalence of malnutrition (assessed by SGA) increased. In contrast, with the decrease of E/I in group B, ALB, Hb, DPI, DEI, and Karnofsky scores increased and the prevalence of malnutrition decreased. The difference of ALB, Hb, DPI, DEI, Karnofsky index, and incidence of malnutrition between the two groups after treatment was statistically significant (P < 0.05). Spearman correlation analysis showed that E/I was negatively correlated to ALB (r = -0.656, P < 0.001). Conclusions Body fluid distribution as reflected by E/I is closely associated with nutrition status. Observasion of E/I changes may be helpful to predict the changes of nutrition status.