肠外营养对维持性血液透析患者营养不良及微炎症状态的影响

目的研究静脉营养治疗是否可以通过逆转营养不良而改善维持性血液透析（MHD）患者的微炎症状态。方法采用营养不良-炎症评分（MIS）法对65例MHD患者进行评分，按照得分分为轻、中、重度营养不良，同时测定与营养不良相关的血生化指标以及血清C反应蛋白（CRP）和白细胞介素6（Ib6）水平，将患者随机分为肠外营养治疗组和对照组，治疗组每周3次在血液透析中给予肠外营养治疗（IDPN），共4周，治疗期结束后再次进行MIS评分及以上指标检测，对照组不接受IDPN治疗。结果治疗期末，治疗组中度和重度营养不良患者比例（17．14％和2．86％）与治疗前比较均显著下降；MIS评分下降治疗前为（13．92±2．18）分，治疗后为（8．48±1．32）分，P〈0．05）]；血白蛋白、前白蛋白升高，铁代谢和贫血指标改善；治疗后CRP和IL-6均较治疗前显著下降，CRP治疗前为（6．82±2．71）mg／L，治疗后为（3．05±1．86）mg／L，治疗前后差异有统计学意义（P〈0．05）；IL-6治疗前为（82．65±22．38）ng／L，治疗后为（33．19±12．50）ng／L，治疗前后差异有统计学意义（P〈0．05）。结论IDPN可改善MHD患者营养状况，减轻患者体内微炎症状态。

Effect of intradialytic parenteral nutrition on malnutrition and microinflammation of patients subject to maintenance hemodialysis

Objective To investigate whether parenteral nutrition （PN） ameliorates microin- flammation through reversing nutrition status in maintenance hemodialysis （MHD） patients. Methods Malnutrition-inflammation score （MIS） was used to evaluate the severity of malnutrition in 65 MHD patients. The malnutrition-associated blood biochemical criteria such as albumin, pre-albumin, blood u- rea nitrogen （BUN）, creatinine, uric acid, total cholesterol, transferrin, ferritin, hemoglobin, red blood cells count, hematocrit（HCT） as well as inflammation-associated biomarkers, c-reactive protein（CRP）, interleukin-6（IL-6） were measured. The patients were then divided into intradialytic parenteral nutri- tion （IDPN） group and control group. The patients in IDPN group were given 3 times of IDPN treat- ment per week for 4 weeks. Four weeks later, MIS and blood test were carried out for a second time in both groups. Results At 4th week after 1DPN treatments,the percentage of both moderate （17. 14%） and severe （2. 86%） malnutrition patients was decreased with a decrease of mean MIS （13. 92± 2. 18 before treatments vs. 8. 48 ± 1.32 after treatments,P〈0. 05）. Blood albumin and pre-albumin were in- creased,and iron metabolism and anemia were ameliorated. CRP （6. 82 ± 2. 7l） mg/L before treat- ments vs. （3. 05 ± 1.86） mg/L after treatments,P〈0. 05] and IL-6 （82. 65± 22. 38） ng/L before treatments vs. （33. 19± 12. 50） ng/L after treatments,P〈0. 05] were decreased, respectively. Conclu- sions IDPN may improve the nutrition status and alleviate microinflammation in MHD oatients.