不同腹膜转运特性对持续性非卧床腹膜透析患者营养状态的影响

目的评价腹膜转运特性与持续性非卧床腹膜透析(CAPD))患者营养状况之间的关系。方法按照腹膜平衡试验(PET)计算结果,将62例稳定的CAPD患者分为高转运(H)组和低转运(L)组。测定血浆和腹透透出液营养指标:总蛋白、白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TF),并计算蛋白质分解率(nPCR)、标准化总氮出现率相当蛋白(nPNA)、瘦体质量%(LBM%)。同时观察透析充分性指标:每周总肌酐清除率(TCcr/W)与每周尿素清除指数Kt/(v.W)],进行主观综合性营养评估(SGA)。比较两组营养状态及分析相关因素。结果两组患者一般资料比较:H组患者腹透液与血中肌酐比值(D/Pcr)和TCcr显著高于L组(P<0.05),而血肌酐(Scr)水平较L组显著降低(P<0.01),H组每日经腹透液丢失的总蛋白质、Alb均显著高于L组(P<0.05)。两组患者营养状况指标比较:H组的Alb、TF水平和SGA评分显著低于L组(P<0.05),其他营养指标也低于L组,但差异无统计学意义(P>0.05)。血中及经腹透透出液丢失的白蛋白与转运类型相关。结论高转运腹膜透析患者营养状态较低转运者差,故应加强对高转运CAPD患者的营养管理及饮食指导。

Effect of different peritoneal transport status on the nutritional status of continuous ambulatory peritoneal dialysis patients

Objective To observe the effect of peritoneal transport status on nutritional status of continuous ambulatory peritoneal dialysis(CAPD) patients.Methods According to peritoneal equilibrium test(PET),62 stable CAPD patients were divided into high transport group and low transport group.Total protein,albumin(Alb),prealbumin(PA) and transferrin(TF) in plasma or peritoneal effusive dialysate were measured,and nPNA,LBM% and nPCR were calculated synchronously.Adequacy parameters including Kt/v.W and TCcr/W were also measured.SGA was also evaluated.Nutritional status was compared between the two groups and correlated factors were analyzed.Results D/Pcr and TCcr were significantly higher in the high transport group than in the low transport group(P<0.05),while Scr decreased significantly(P<0.01).Total protein and Alb loss from daily effusive dialysate were significantly more in the high transport group than in the low transport group(P<0.05),and nutritional indexes were poorer in the high transport group than in the low transport group(P<0.05),including significant decreases in serum Alb,TF and SGA.Levels of Alb in blood and effusive dialysate were correlated with peritoneal transport characteristics(P>0.05).Conclusion The nutritional status of peritoneal high transport patients is worse as compared to low transport ones.Nutritional management and guidance should be strengthened on the patients undergoing CAPD.