持续不卧床腹膜透析患者食欲不良的影响因素及相关性分析

Influencing factors and correlation analysis of poor appetite in continuous ambulatory peritoneal dialysis patients

目的 探讨持续不卧床腹膜透析（CAPD）患者食欲不良的相关临床特征与影响因素,以便改善CAPD患者的营养不良.方法 使用透析症状指数问卷评估192例CAPD患者的食欲不良的状况,分析食欲不良与营养状态、临床特征、社会人口统计学资料及实验室指标的关系.Beck抑郁量表（BDI）与主观综合性营养评估表（SGA）分别用于抑郁与营养状态的评估.将BDI得分≥15分判断为抑郁,SGA得分≤5分定为营养不良.结果 37.9%的CAPD患者出现营养不良.与食欲良好的患者比较,食欲下降的患者有低的血白蛋白水平（36.9±4.5 vs.38.8±3.8,P＜0.01）,高营养不良发生率（43.1% vs.25.4%,P＜0.01）,高抑郁患病率（50.0%vs.21.2%,P＜0.01）,高舒张压水平（86.6±10.5 vs.81.9±11.0,P＜0.01）.在相关性分析中食欲不良与白蛋白（r=-0.24,P＜0.01）及SGA得分（r=-0.31,P＜0.01）、舒张压水平（r=-0.19,P＜0.05）呈负相关,与二氧化碳结合力（CO2CP）（r=0.19,P＜0.05）、抑郁（r=0.38,P＜0.01）呈正相关关系.在二元逻辑回归分析中,血白蛋白水平（OR=0.92,P＜0.05）、舒张压水平（OR=1.04,P＜0.01）和抑郁（OR=1.04,P＜0.05）是食欲不良的独立影响因素.结论 食欲不良与营养不良、抑郁、高血压及酸中毒之间有显著相关性,加强对患者抑郁及高血压的管理有助于提高患者的食欲改善患者的营养状态.

Objective To identify CAPD patient＇ s clinical characteristics and psychological problems associated with poor appetite and to improve the nutrition of patients. Methods Nutrition status of 192 CAPD patients was investigated by dialysis symptom index questionnaire. The relationships between poor appetite and nutrition, clinical characteristics, sociodemographic data and laboratory index were also investigated. The Beck Depression Inventory （BDI） and the Subjective Global Assessment （SGA） were used to assess the presence of depression and nutrition status, respectively. Depression was diagnosed in the current study based on BDI score ≥ 15. SGA score≤5 was defined as malnutrition. Results 37.9% of patients were poor appetite. Compared to patients with good appetite, poor appetite patients had lower serum albumin level （36.9 ±4.5 vs. 38.8 ±3.8,（50% vs. 21.2%, P 〈 0. 001 ） and higher diastolic blood pressure （ 86.6 ± 10. 5 vs. 81.9 ± 11.0, P =0. 005 ）. Poor appetite was negatively correlated with serum albumin level （ r = - 0. 24, P = 0. 003 ）, SGA score （r = -0. 31, P = 0. 001 ）, and positively correlated with CO2 combining power （ CO2 CP） （ r = 0. 19, P =0. 012）, diastolic blood pressure （ r = - 0. 19, P = 0. 01 ） and depression （ r = 0. 38, P 〈 0. 001 ）. In multiple logistic regression analysis, serum albumin level （ OR = 0. 92, P = 0. 031 ）, diastolic blood pressure （ OR =1.04, P = 0. 007 ） and depression （ OR = 1. 04, P = 0. 035 ） were independent predictors for the lack of appetite. Conclusions Lack of appetite significantly related to poor nutritional status, depression, hypertension and metabolic acidosis. It suggested that depression and hypertension management in CAPD patients may be helpful to improve patient＇ s appetite and beneficial to nutritional status.