摘要
目的: 探讨腹膜透析病人营养不良的发生机制。方法: 采用多中心前瞻性队列研究。对维持腹膜透析治疗的44例病人进行近2年的随访研究。按随访期间膳食蛋白摄入量(DPI)分为两组,即保持在0.78 g/(kg·d)以下者和曾出现0.78g/(kg·d)以上者。将随访期间综合性主观评估(SGA)水平发生动态变化的22例按SGA的变化分为两组,即营养状况好转组和恶化组,比较随访期间营养指标和残余肾功能的变化情况,以及高容量负荷状态和心血管事件的发生状况。结果: 以SGA评定营养状况,较低DPI组病人横断面研究时营养不良发生率为43.5％,而随访后为60.9％;较高DPI病人横断面研究时营养不良发生率为57.1％,而随访后为28.6％。营养状况恶化组病人在随访期间残余肾功能显著下降,高容量负荷状态和新发心血管系统事件的出现率明显高于营养状况好转组病人(P<0.05)。结论:在腹膜透析病人中,单纯低水平的蛋白质摄入并不一定导致营养不良的发生,而残余肾功能的变化、高容量负荷状态和心血管系统疾病与低蛋白质摄入共同作用,可能导致腹膜透析病人营养不良的发生与恶化。
Objective: To study the possible mechanism of malnutrition in peritoneal dialysis patients. Methods: Multicenter prospective cohort study was designed . Forty-four peritoneal dialysis patients who survived two years after a cross-sectional study were included in the present study. We divided our patients into two groups according to the dietary protein intake(DPI) during follow-up period, DPI lower than 0.78 g/( kg·d) or DPI higher than 0.78 g/( kg·d). Patients' nutritional status was evaluated during the cross-sectional study and at the end of follow-up. 22 patients were divided into two groups according to the nutritional status improved or worsened in subjective global assessment (SGA) during the follow-up period. Besides nutritional status, patient's residual renal function, volume status and the incidence of cardiovascular event during the follow-up period were also evaluated. Results: Based on SGA , the incidence of malnutrition in low-DPI group was 60.9% in the cross-sectioned study and 45.5% after the follow-up. In high-DPI group, it decreased from 57.1% to 28.6%. The residual renal function declined significantly in worse nutritional status group, the incidences of volume overload and cardiovascular events during follow-up study were significantly higher in worse nutritional status group than that in improved nutritional status group. Conclusion: Malnutrition in peritoneal dialysis patients may not be simply due to lower protein intake. The changes in residual renal function, fluid overload and cardiovascular disease, accompanied with low dietary protein intake may be the possible cause of malnutrition in peritoneal dialysis patients.
出处
《营养学报》
CAS
CSCD
北大核心
2004年第5期358-361,共4页
Acta Nutrimenta Sinica
基金
985 基金(36-1)
关键词
腹膜透析
营养不良
蛋白质摄入量
残余肾功能
容量负荷
心血管系统疾病
peritoneal dialysis
malnutrition
dietary protein intake
residual renal function
volume overload
cardiovascular disease
