摘要
目的：了解持续性非卧床腹膜透析（CAPD）患者腹透液蛋白质丢失水平及其影响因素，为该类患者的临床营养支持提供理论依据。方法：选择2012年12月-2013年10月在某院腹膜透析中心接受CAPD治疗3个月以上的非糖尿病尿毒症患者72例，完整收集患者的一般资料、实验室检查和主观综合性营养评估等资料。借助食物模型、应用记账法进行连续7 d的膳食调查，获得患者蛋白质摄入量（DPI）及热能摄入量（DEI）。依据患者腹透液蛋白质平均丢失量分为低蛋白丢失组（＜5 g·d^-1）和高蛋白丢失组（≥5 g·d^-1），比较相关检测指标，应用logistic回归分析患者蛋白质丢失水平的影响因素。结果：CAPD患者腹透液蛋白质丢失量中位数5.0（1.7～21.1）g·d^-1，平均占每日蛋白质总摄入量的13.0%（95%CI：10.8%～15.2%），最高达60.3%。腹透液蛋白质高丢失组患者血清白蛋白水平较低（P＜0.05），血肌酐和尿素氮水平较高（P＜0.05）。2组患者的前白蛋白、血红蛋白、转铁蛋白、主观综合性营养评估（SGA）评分、标准化蛋白质呈现率（nPNA）和人体测量指标体质量指数（BMI）、上臂肌围（MAMC）、上臂围（MAC）差别均无统计学意义（P＞0.05）。长期腹透、高腹膜转运、高血尿素氮和男性是腹透液蛋白质高丢失的危险因素。结论：CAPD患者可经腹透液丢失大量蛋白质，其丢失量与腹透时间长短、腹膜转运特性、血尿素氮水平和性别有关。腹透液蛋白质丢失量≥5 g·d^-1可导致血清白蛋白降低。对于腹透液蛋白质丢失量≥5 g·d^-1的患者，将目前的DPI水平（0.84±0.25）g·kg^-1·d^-1适当提高是有必要的。
Objective： To explore the daily protein losses via dialysate and its inlfuencing factors in con-tinuous ambulatory peritoneal dialysis （CAPD） patients, to provide theoretical basis for clinical nutrition support. Methods： Seventy two non-diabetic nephropathy patients with uremia and treatment with CAPD for longer than 3 months were recruited during December 2012 to October 2013 from a general hospital. General information, laboratory testing data, and global assessment of nutritional information of the patients were collected. Dietary surveys were conducted for 7 consecutive days to obtain protein and energy intake in patients. According to the amount of protein losses after dialysis, patients were divided into two groups, low protein losses group （〈5 g·d-1） and high protein losses group （≥5 g·d^-1）. Relevant indicators were compared between two groups, logistic re-gression analysis was applied to analyze the factors which affect the level of protein loss in patients.Results： The median of protein losses in CAPD dialysis patients was 5.0 （range： 1.7-21.1） g·d^-1, which was about 13.0 per-cent of total daily protein intake （95%CI： 10.8%-15.2%）. Patients in high protein losses group showed a lower serum albumin level （P〈0.05 ）, higher serum creatinine, and higher urea nitrogen levels （P〈0.05）. There was no statistically signiifcant difference between two groups in prealbumin, hemoglobin, transferrin, SGA score, nPNA and anthropometric measures such as BMI, MAMC, and MAC （P〈0.05）. Long dialysis duration, high peritoneal transport, high blood urea nitrogen, and male were risk factors of high protein losses by dialysate.Conclusion：CAPD patients may lose substantial amount of protein by dialysis solution, the loss amount is related with dura-tion of dialysis, peritoneal transport characteristics, blood urea nitrogen level, and gender. The protein losses over 5 g？d-1 by dialysate may lead to lower serum albumin level. In terms of patients whose protein loss amou
出处
《温州医学院学报》
CAS
2015年第1期18-21,共4页
Journal of Wenzhou Medical College
基金
国家自然科学基金资助项目(81273060)
关键词
腹膜透析
尿毒症
蛋白质丢失
营养状况
peritoneal dialysis
uremia
protein losses
nutritional status
