摘要
目的探讨腹膜透析患者标准蛋白分解率(Npcr)的影响因素,及其对患者预后的影响。方法对在上海交通大学医学院附属仁济医院肾脏科随访的86例稳定的腹膜透析患者,进行透析充分性检查,计算nPCR,并检测相关营养指标。对这些患者进行为期(32±13)个月的随访。结果入选患者平均nPCR(0.90±0.19)g/(kg·d)。Pearson相关分析显示,nPCR与年龄呈负相关,与白蛋白和高密度脂蛋白水平呈正相关,与IL-6和CRP水平呈负相关。nPCR与总Ccr,残肾Ccr,总Kt/V和残肾Kt/V均呈正相关。多元逐步回归分析显示,总Kt/V是影响腹膜透析患者nPCR水平的独立因素,总Kt/V较低的患者nPCR水平较低。根据入选时的nPCR水平将患者等分为三组,Kaplan-Meier生存分析显示,nPCR水平最低组0.82g/(kg·d)的生存率明显低于另两组(P<0.05)。结论透析充分性较低的患者nPCR水平较低。腹膜透析患者nPCR水平过低与患者的不良预后相关。
Objective Malnutrition is closely related to the outcome of peritoneal dialysis patient. In the clinically stable patient, nPCR provides a valid estimate of protein intake. The present research was to evaluate the influence factors of nPCR and examine its predictive power of clinical outcomes in peritoneal dialysis patients. Methods A prospective observational cohort study was performed in 86 clinically stable peritoneal dialysis patients followed-up in hemodialysis center. The routine biochemical tests including albumin, prealbumin, glucose, lipid, calcium and phosphorus, and the levels of C-reaction protein （CRP） and interleukin-6 （IL-6） were estimated. The nPCR was calculated by Baxter PD Adquest, version 2.0 for Windows. The stepwise regression method was enrolled to estimate the independent parameters of nPCR. Patients were followed up for a mean ± SD duration of （32 ± 13） mo. Results The mean level of nPCR was 0.90±0.19 [g/（kg. d）]. The level of nPCR was inversely related to age, and directly related to albumin and HDL. It was inversely related to the levels of CRP and IL-6. There were inverse correlations between nPCR and total Ccr, residual renal Ccr, total Kt/V and residual renal Kt/V. While the relationships between nPCR and peritoneal Ccr and peritoneal Kt/V were not significant. The multiple stepwise regression analysis showed the independent effect of total Kt/V on the level of nPCR. Patients in the lower tertiles of nPCR [〈 0.82g/（kg· d）] were in higher risk of subsequent mortality. Conclusion A lower nPCR is associated with increased mortality. Dialysis adequacy has independent effect on the level of nPCR.
出处
《中国血液净化》
2008年第9期468-470,共3页
Chinese Journal of Blood Purification
关键词
标准蛋白分解率
透析充分性
微炎症状态
饮食蛋白摄入
生存率
Normalized protein catabolic rate
Dialysis adequacy
Micro-inflammation status
Protein intake
Mortality risk
