摘要
目的:明晰国人血透患者透析前后能量代谢变化,揭示静息能量与营养参数、透析充分性及炎性因子的内在联系。方法:应用代谢车对15名血透患者透析前、中、后的能量代谢进行检测,并与匹配的对照组15人比较;患者饮食、与营养相关的人体、生化指标及炎性因子被记录或检测。多元回归分析筛选出与血透患者静息能量密切联系的因素。结果:血透患者蛋白质摄入量(1.02±0.31)g·kg-1·d-1,热卡总量(26.6±5.9)kcal·kg-1·d-1,与NKF-DOQI标准比较有显著差异(P=0.034,P=0.001)。透析前、后能量代谢与对照组无异,血透中能量代谢明显升高;以瘦体纠正后,透析后能量代谢与透前静息能量有差异(P<0.05),多元逐步回归分析显示:它与C反应蛋白、红细胞压积相关,与血透间期增加体重、Kt/V、残余GFR、血清白蛋白、血清总蛋白、血Ph、Hb、血胆固醇、甘油三脂、FTH、IL-6等指标无联系。结论:血透患者静息能量与正常人无异,饮食中热卡和蛋白质摄入明显不足。逐步回归研究表明:红细胞压积、C-反应蛋白与静息能量关系密切。
Objective: To evaluate energy expenditure (EE) and the relationship of it and various energy metabolism and anthropo-metric parameters in maintenance hemodialysis patients.Methods: Energy expenditure was measured by indirect calorimetry using a Sen-sormedics Metabolic Cart and a face mask or mouthpiece in 15 normal individuals and 15 patients undergoing maintenance hemodialysis in the resting state(predialysis), intradialysis and postdialysis. Skinfold thicknesses ,mid - arm muscle circumference were measured by a Harpenden caliper or a rule, lean body mass was measured by Tanita Body Composition Analyzer, body mass index was calculated by equation, and several laboratory values, including serum albumin, serum C - reactive protein, Interleukin - 6(IL - 6), parathyroid hormone (PTH) ,hemoglobin(Hb), hematocrit(Hct) ,et al, were measured. Kt/V and protein equivalence of nitrogen appearance(nPNA) were evaluated by urea kinetic modeling, their diet protein and energy intake were recorded and analysed. Results: The low energy and protein intakes were found in patients. There was no difference between normal individuals and patients undergoing maintenance hemodialysis in REE, the EE was higher in intradialysis than in predialysis. Linear regression showed Hot and CRP were associated with resting energy expediture (REE/FFM) in the patients. Conclusion: There was no difference between normal individuals and patients undergoing maintenance hemodialysis in REE, levels of CRP and Hct seem to be related risk factors of REE in maintenance hemodialysis.
出处
《中国医药导刊》
2004年第4期247-249,251,共4页
Chinese Journal of Medicinal Guide
