维持性血液透析患者代谢性酸中毒和营养不良之间相关性分析

Correlation between metabolic acidosis and malnutrition in haemodialysis patients

目的评估维持性血液透析患者(MHD)代谢性酸中毒与营养不良之间的相关性。方法按照患者透析前血浆碳酸氢根浓度(PHCO3)和动脉血pH值将病例分为3组,分析不同程度代谢性酸中毒以及酸中毒纠正情况对营养指标的影响。结果甲组(n=13)平均PHCO3为(19．1±0．9)mmol／L,乙组(n=22)平均PHCO3为(24．0±1．3)mmol／L,丙组(n=9)平均PHCO3为(27．1±0．1)mmol／L。3组透析充分性指标无显著性差异。与乙组比较,甲组体重指数(BMI)、肱三头肌皮褶厚度(TSF)、膳食蛋白摄入量(DPI)、标准化蛋白代谢率(nPCR)和Scr、血消K+、血清甲状旁腺激素(PTH)水平均显著增高。与乙组比较,丙组DPI、nPCR、Scr和白蛋白(Alb)显著降低。3组血清炎性指标C反应蛋白(CRP)无显著性差异。参试病例平均PHCO3和nPCR、DPI及Scr水平均存在显著负相关(P<0．01)。在3个月的随访后,参试病例代谢性酸中毒纠正后其营养指标并无显著性变化。结论由于高蛋白膳食摄入增加导致的代谢性酸中毒在中短期对患者综合营养状态无明显负性影响。

Objective To examine the correlation between metabolic acidosis and malnutrition in maintenance haemndialysis （MHD） patients. Methods Forty-four MHD patients were divided into 3 groups according to plasma bicarbonate concentrations （PHCO3） and pH values. The correlation between metabolic acidosis and nutritional parameters was studied. Results The mean PHCO3 was （19.1±0.9） mmoL/L in group A （n=13）, （24.0±1.3） mmol/L in group B （n=22） and （27.1±0.1） mmol/L in group C （n=9）. The adequacy of dialysis （Kt/V） was comparable in three groups. As compared with group B, group A had significantly higher body mass index （BMI）, triceps skin fold thickness （TSF）, dietary protein intake （DPI）, normalized protein catabolic rate （nPCR）, Scr, serum K＋ and parathyroid hormone （PTH）, meanwhile, group C had significantly lower DPI, nPCR, Ser and albumin. There was no significant difference in plasma inflammatory markers C-reactive protein （CRP） among three groups. There was significant negative correlation of PHCO3 to nPCR （P 〈 0.01）, DPI （P 〈 0.01） and Scr （P 〈 0.01）. After 3 months, the correction of metabolic acidosis did not affect nutritional parameters. Conclusion Metabolic acidosis as a result of higher protein intake does not detrimentally affect nutritional status.