摘要
目的:运用双能X线法(DEXA)探讨慢性肾脏病(CKD)患者营养不良的临床特点,评估DEXA的临床应用价值。方法:143例CKD4～5期的非透析CKD患者通过主观综合营养评估法(SGA)将分为营养良好组和营养不良组,测定人体学指标和生化营养指标,同时应用DEXA法测定所有患者全身肌肉组织及脂肪组织含量,探讨二者之间的相关性。结果:营养不良组(SGA评分≥2)的前白蛋白水平较低(P<0.05)而C反应蛋白水平明显偏高(P<0.01),血清白蛋白水平无统计学差异。无论男性或女性组,营养不良患者均相对高龄(P<0.05),表现为更低的相对体重(P<0.01)、体重指数(P<0.05)和肾小球滤过率(P<0.01)。男性营养不良组三头肌皮褶厚度(TSFT)、上臂周径(AC)、上臂中部肌肉周径(AMC)、LBM-DXA、FM-DXA均较营养正常组有显著性降低。女性营养不良组表现为TSFT、AC和FM-DXA的显著降低,而AMC和LBM-DXA无统计学差异。DXA-LBM值与AMC之间存在显著相关性(r=0.864,P<0.001);DXA-FM值与TSFT存在显著相关性(r=0.799,P<0.001);Logistic回归分析显示:低FMDXA百分比、高血清C反应蛋白水平和低肾小球滤过率是营养不良的独立危险因素。结论:低DXA-FM百分比、高血清C反应蛋白水平和低肾小球滤过率对预测营养不良的发生具有较高价值。双能X线测定脂肪及肌肉组织含量与传统人体学测量指标有良好的相关性,尤其DEXA-FM百分比评价CKD患者营养状况精确度高,重复性好,可早期发现CKD患者的营养不良,值得推广。
To evaluate the value of assessing the nutritional characters of CKD patients without dialysis with dual -energy X-ray absorptiometry （DEXA）. Methyls： One hundred and forty-three CKD patients in stage 4--5 without dialysis were enrolled and they were classified as well- nourished and malnourished groups by SGA. Biochemical and anthropometric measurements were performed. At the same time, body composition including lean body mass （LBM） and fat mass （FM） were evaluated by dual- energy X- ray absorptiometry. Results：Compared to well - nourished patients, malnourished patients showed lower prealbumin levels but higher CRP levels. There was no difference in serum albumin between both groups. For men or women, body weight,BMI and GFR were lower in the malnourished group. For the men, triceps skin - fold thickness, mid- ann circumference, mid-arm muscle circumference, LBM - DEXA and FM - DEXA were significantly lower in the malnourished patients. For the women, triceps skin - fold thickness, mid - ann circumference and FM- DEXA, but not mid- arm muscle circumference and LBM-DEX, were significantly lower in the malnourished patients. There was a significant correlation between LBM- DEXA and mid - arm muscle circumference. There was a significant correlation between FM - DEXA and triceps skin - fold thickness. The result of multi- ple logistic regression showed that low percentage of FM, high serum CRP level and low glomerular filtration rate were independent risk factors for malnutrition. Conclusion： Low percentage of FM, high serum CRP and low glomerular filtration rate （GFR） were independent risk factors for malnutrition. Estimation of LBM and FM by DXA correlated well with traditional anthropometric measurements. Especially,DEXA is a reliable and easy- to- perform assessment method, which can sensitively indicate early malnutrition and may be useful in monitoring nutrition changes in CKD patients.
出处
《中国中西医结合肾病杂志》
2009年第2期140-143,共4页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
上海市自然科学基金资助项目(No.05ZR14086)
上海市医苑新星基金资助项目(No.02xx46)
