蛋白质摄入水平对腹膜透析患者早期营养状况的影响

Influence of protein intake levels on early nutritional status in peritoneal dialysis patients

目的观察每日蛋白质摄入（DPI）分别为0．8≤DPI≤1．0g·kg^-1·d^-1和1．0〈DPI≤1．2g·kg^-1·d^-1对新进入腹膜透析患者的营养状况的影响。方法选取2004年6月至2005年6个月期间进入腹膜透析且透析后1个月DPI水平在0．8≤DPI≤1．2g·kg^-1·d^-1范围的腹膜透析患者进入研究。分别于透析后1、3、6个月分别评估患者营养状况。血生化测定仪检测血红蛋白（Hh）、血白蛋白（Alb）、尿素氮（BUN）和血肌酐（Scr）水平。人体测量法测量上臂围（AC）、三头肌皮褶厚度（TSF）和上臂肌围（AMC）。肌酐动力学方法测定瘦体质量。同时监测影响营养状况的一些重要因素并进行评价，包括DPI和每日能量摄入（DEI）水平、透析充分性[总的和残肾尿素清除指数（tKt／V和rKt／V）；总的和残肾的标准化肌酐清除率，（tCcr和rCcr）1、代谢性酸中毒（血CO2CP）、炎性反应状态[血C反应蛋白（CRP）]、容量指标[生物电阻抗法测定并计算细胞外液／总体水（ECW／TBW）；身高标化的细胞外液（nECW）]。结果82例腹透患者进入本研究，其中39例为0．8≤DPI≤1．0g·kg^-1·d^-1，DEI（108．24±17．99）kJ·kg^-1·d^-1；43例为1．0〈DPI≤1．2g·kg^-1·d^-1，DEI（126．82±19．92）kJ·kg^-1·d^-1。两组患者基础的DPI和DEI水平，3个月时DPI，6个月时DPI和DEI值差异有统计学意义（P〈0．01或0．05）。透析后半年内两组平均tKt／V和rKt／V、tCer和rCcr、CRP、CO2CP、ECW／TBW、nECW差异均无统计学意义（P〉0．05）。两组患者透析半年内均保持营养状况稳定，分别于1、3及6个月时比较各项营养指标，两组患者血Alb、BUN、Scr、Hb、AC、AMC、TSF和LBM水平差异均无统计学意义（P〉0．05）。结论新入的腹透患者不论其0．8≤DPI≤1．0g·kg^-1·d^-1,或1．0〈DPI≤1．2g·kg^-1·d^-1，均可保持透析早期的营养状况稳定，且不同DPI水平的患者透析半年内各项营养指标差异均无统计学意义。

Objective To observe the influence of daily protein intake （DPI） （0.8 ≤ DPI≤1.0 g·kg^-1·d^-1 or 1.0〈DPI≤ 1.2 g·kg^-1·d^-1） on early nutritional status in peritoneal dialysis （PD） patients. Methods New PD patients from June 2004 to June 2005 with DPI level between 0.8 g·kg^-1·d^-1 and 1.2 g·kg^-1·d^-1 on the first month of peritoneal dialysis were enrolled in the study. Nutritional status and nutrition-related factors were assessed on the month 1,3 and 6 after PD. Hemoglobin（Hb）, serum albumin（Alb）, urea nitrogen （BUN） and serum creatinine （Scr）, direct anthropometry [arm circumference （AC）, triceps skin-fold thickness （TSF）, arm muscle ciucumference （AMC）] and lean body mass （LBM） were examined as nutritional indices. Nutritionrelated factors including DPI and daily energy intake （DEI）, dialysis adequacy （total and renal Kt/V, total and renal Ccr）, metabolic acidosis （CO2CP）, inflammation （serum CRP）, volume status [extracellular water（ECW）, intracellular water（ICW）, total body water（TBW）, calculated ECW/TBW and normalized ECW] were analyzed respectively. Results Eighty-two PD patients were included in the study. Thirty-nine patients were 0.8 g·kg^-1·d^-1 ≤DPI ≤1.0 g·kg^-1·d^-1 and the other 43 patients were 1.0 g·kg^-1·d^-1≤DPI≤1.2 g·kg^-1·d^-1 There were significant differences of baseline DPI and DEI levels, DPI on the 3rd month, DPI and DEI on the 6th month between two groups （P〈0.05）. The average tKt/V, rKt/V, tCcr, rCcr, CRP, CO2CP, ECW/TBW and nECW were not significantly different between two groups during the six months of PD （P〉0.05）. All the patients maintained good nutritional status. Serum levels of Alb, BUN, Scr, Hb, AC, AMC, TSF and LBM in patients on the 1st, 3rd and 6th month of PD were not significantly different between two groups（P〉0.05）. Conclusions New PD patients can maintain good nutrition on the early stage of dialysis whether their DPI levels are 0.8 g·kg^-1·d^-1≤DPI≤l.0 g·kg^-1·d^-1 or 1.0 g·kg^-1·d^-1〈DPI ≤ 1.2 g ·kg^-1·d^-1. All nutritional indices are not significantly different between two groups in the first six months.