氨基酸腹膜透析对腹透患者营养状况的影响

A short term study of nutritional effect of intraperitoneal amino acid in CAPD patients

目的 :观察氨基酸腹膜透析液对腹膜透析患者营养状况的影响。 方法 :2 4例不卧床腹膜透析(CAPD)患者随机进入治疗组、对照组。治疗组每日使用 1次 0 4 91%的氨基酸透析液 ,留腹 4～ 7h ,每 3个月随访 1次 ,观察期为 6个月。研究期间观察的营养观察指标包括白蛋白、标准化蛋白氮呈现率 (normalizedproteinequivalentofnitrogenappearance,nPNA)、瘦体重百分比 (%leanbodymass,%LBM )、前臂肌围 (mid armmusclecircumference ,MAMC)、三头肌皮皱厚度 (tricepsskinfold ,TSF) ;同时观察了前白蛋白 (prealbumin)、转铁蛋白 (transferrin)的变化及透析充分性指标的改变。 结果 :治疗组氨基酸透析 3个月后白蛋白 [(38 6 7± 6 81)g/Lvs(42 4 4± 3 6 0 )g/L ,P <0 0 5 ]、转铁蛋白 [(2 74± 0 37)g/Lvs(2 93± 0 16 )g/L ,P <0 0 5 ]、前白蛋白 [(46 1 38± 330 2 9)g/Lvs(6 4 1 5 7±6 73 91)g/L ,P <0 0 5 ]呈明显上升 ,之后保持在稳定水平 ;对照组上述指标则逐步下降。治疗组nPNA、%LBM、MAMC在研究期间始终稳定 ,对照组则随透析时间的延长降低明显。两组患者透析充分性指标在氨基酸透析期间始终保持充分状态。 结论 :氨基酸腹膜透析可以预防及纠正CAPD患者营养不良的发生及发展。

Objective:Nutritional complications is an important prognosis factor for continuous ambulatory peritoneal dialysis (CAPD) patients. In this study, we investigated the short term effects of intraperitoneal amino acid solution in CAPD patients for six months. Methodology:Twenty-four CAPD patients were enrolled in this study, and randomly divided into the treatment group and the control group(12 in each). In the treatment group, during the day-time exchange of dialysate, each patient recieved a bag of dialysate(1.5% Dianeal) enriched with 100ml branch-chain amino acid. The control group, patients continued their CAPD with the same dialysate(1.5% Dianeal) as usual. All the patients were followed-up in this study for six months. Serum levels of albumin, transferrin, prealbumin were determined monthly. Nutritional parameters as nPNA(the normalized protein equivalent of nitrogen appearance), %LMB(percentage of lean body mass), MAMC(middle-arm muscle circumference) and TSF(triceps skinfold)were assessed during the study. Results:In the treatment group, serum level of albumin increased significantly as compared with the baseline level[(38.67±6.81)g/L vs (42.44±3.60)g/L, P<0.05] after three months of treatment. Serum levels of transferrin[(2.74±0.37)g/L vs (2.93±0.16)g/L, P<0.05] and prealbumin [(461.38±330.29)g/L vs (641.57±673.91)g/L,P<0.05] were also found increased after three months of treatment and being stable thereafter. While in the control group, serum levels of transferrin [baseline vs 6-month:(2.51±0.47)g/L vs (2.41±0.53)g/L] and prealbumin [baseline vs 6-month: (450.12±286.31)g/L vs (351.58±172.36)g/L] declined singnificantly. Nutritional parameters as nPNA?%LBM and MAMC were stable throughout the study in the treatment group, while reduced singificantly in the control group (nPNA: 0.9612±0.13 vs 0.9426±0.17, P>0.05; %LBM: 0.6849±0.02 vs 0.6452±0.04,P>0.05) after the study. No significant difference in adequcy parameters of dialysis were found during the study. Triglycerides [baseline vs 6-month: (1.58±0.95)mmol/L vs (2.17±0.78)mmol/L,P<0.05] and total cholesterol [baseline vs 6-month: (5.78±2.10)mmol/L vs (6.12±1.05)mmol/L,P<0.05] increased significantly in the control group, while in the treatment group triglycerides decreased at the end of study[(1.66±0.94)mmol/L vs (1.52±0.56)mmol/L,P>0.05]. No side effect and discomfirt complains were found in any patient of the treatment group during the dwelling of the amino acid enriched dialysate. Conclusion:Administration of amino acid enriched dialysate (1.5% dextrose) is a safe maneuver and a effective means to improve nutritional status in CAPD patients.