摘要
目的:观察中医脾肾两虚证候的慢性肾脏病患者蛋白质能量消耗(PEW)状态的临床特征。方法:根据中医脾肾两虚证候标准,选取2017年6月-2018年10月我院肾内科住院患者及门诊透析患者,其中慢性肾脏病维持性血液透析(CKD 5期)及非透析患者(CKD 4~5期)各40名。对两组患者分别进行改良主观营养评分(MQSGA);比较两组脾肾两虚中医症候、体重指数(BMI)、中臂围(MAC)、肱三头肌皮褶厚度(TSF)、中臂肌围(MAMC)、脂肪重量、瘦体重等人体测量学指标;血浆中白蛋白、铁蛋白、肌酐、尿素氮、尿酸及脑钠肽(BNP)水平;并检测患者的蛋白水解诱导因子(PIF)水平。结果:透析组SGA评分显著高于非透析组(P<0.05);透析组倦怠乏力、气短懒言等脾肾两虚中医症候明显加重;BMI、MAC、TSF、MAMC、瘦体重指标明显低于非透析组(P<0.05,P<0.01)且脂肪重量高于非透析组(P<0.05);血浆白蛋白、铁蛋白水平及BNP显著低于非透析组(P<0.05);肾功能明显差于非透析组(P<0.05);并且透析组患者血清及尿液中蛋白水解诱导因子(PIF)水平显著高于非透析组患者(P<0.05)。结论:维持性血液透析脾肾两虚型慢性肾脏病患者及非透析患者均存在不同程度的蛋白质能量消耗异常的现象,并且血液透析后患者蛋白质能量消耗更为明显,提示蛋白质能量消耗随着患者病情的进展不可避免,且PIF表达与蛋白质能量消耗的肌肉消耗有关。
Objective:To observe the clinical characteristics of protein energy expenditure(PEW)status in patients with chronic kidney disease with syndrome of spleen and kidney deficiency. Methods:According to the syndrome standard of spleen and kidney deficiency syndrome of Chinese medicine,the inpatients and outpatient dialysis patients of our hospital from June 2017 to October 2018 were selected,including 40 patients on chronic kidney disease maintenance hemodialysis(stage 5 CKD)and 40 patients on non-dialysis(stage 4-5 CKD). Modified subjective nutritional scores(MQSGA)were performed in the two groups;the two groups were compared with the spleen and kidney deficiency syndrome,body mass index(BMI),middle arm circumference(MAC),triceps skinfold thickness(TSF),and middle arm muscle circumference(MAMC),fat or lean weight and other anthropometric indicators;Levels of albumin,ferritin,creatinine,urea nitrogen,uric acid,and brain natriuretic peptide(BNP)in plasma;and detecting proteolytic inducing factor(PIF)levels in patients. Results:The SGA score of the dialysis group was significantly higher than that of the non-dialysis group(P<0.05);In the dialysis group,the symptoms of fatigue,shortness of breath,shortness of laziness,and other symptoms of spleen and kidney deficiency were significantly aggravated;BMI,MAC,TSF,MAMC and lean weight was significantly lower than that of the non-dialysis group(P<0.05,P<0.01),and fat weight was higher than non-dialysis group(P<0.05);Plasma albumin,ferritin levels and BNP were significantly lower than those in the non-dialysis group(P<0.05);the renal function was significantly worse than the non-dialysis group(P<0.05);And the level of pro-protease-inducing factor(PIF)in serum and urine of patients in the dialysis group was significantly higher than that in the non-dialysis group(P<0.05). Conclusion:Maintenance hemodialysis patients with chronic kidney disease and non-dialysis patients with both spleen and kidney deficiency have different degrees of abnormal protein energy consumption,and the p
作者
许烨
远方
岳媛
XU Ye;YUAN Fang;YUE Yuan(Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China)
出处
《辽宁中医药大学学报》
CAS
2019年第12期137-140,共4页
Journal of Liaoning University of Traditional Chinese Medicine
基金
辽宁省科技厅自然基金项目（20170540607）
关键词
脾肾两虚
慢性肾脏病
蛋白质能量消耗
营养不良
蛋白水解诱导因子
spleen and kidney deficiency
chronic kidney disease
protein energy consumption
malnutrition
proteolytic inducing factor
