静息能量代谢评价公式预测血液透析患者能量消耗的效能评估

Accuracy of prediction equations for resting energy expenditure in hemodialysis patients

目的通过Bland-Altman分析法证实8个静息能量代谢评价公式在终末期肾脏病(end-stage of renal disease,ESRD)维持性血液透析(maintenance hemodialysis,MHD)患者中使用的准确性。方法研究入选53例行MHD的ESRD患者,采用呼吸间接测热法测量患者实际的静息能量代谢(resting energy expenditure,REE)值,同时使用8个国内外常用的REE评价公式计算该患者的REE值,使用Spearman相关、配对t检验、Bland-Altman分析法以及吻合比例分析两种结果的一致性。结果实测REE值是(1460±398)kcal/d。8个评价公式的预测值与实测值均呈正相关,其中Mifflin公式、Liu公式、贾虹公式的预测值与实测值差异有统计学意义(P<0.05),贾虹公式的偏倚最大[(240±321)kcal/d]。而Schofield公式、FAO/WHO/UNU公式、Owen公式、Harris-Benedict公式、Cunningham公式的预测值与实测值差异无统计学意义(P>0.05),Schofield公式偏倚最小[(6±293)kcal/d]。然而,使用Bland-Altman分析法计算95%一致性界限(limits of agreement)时,即使是偏倚最小的Schofield公式,其一致性界限也相当大,低限为-(580±137)kcal/d,高限为(592±137)kcal/d,且吻合比例仅41.5%。结论在评估ESRD的MHD患者的能量代谢时,评价公式预测法并不可靠,建议直接使用呼吸间接测热法进行实测。如无相关条件而必须使用公式预测时,推荐选择Schofield公式,因该公式相较其他公式将更可靠。

Objective Equations are frequently used to predict resting energy expenditure（REE） in clinical settings.This study aimed to evaluate the accuracy of the eight prediction equations for REE by using Bland-Altman method in a population of end-stage renal disease（ESRD） patients on maintenance hemodialysis（MHD）.Methods In a total of 53 ESRD patients on MHD,REE was measured by indirect calorimetry,and then compared with the values calculated from the eight prediction equations suggested by the Food and Agriculture Organization/World Health Organization/United Nations University（FAO/WHO/UNU）,Schofield,Harris-Benedict,Owen,Mifflin,Cunningham,Liu,and Hong Jia.Agreement between the REE from indirect calorimetry and the values calculated from the prediction equations was assessed by Spearman correlation,paired t-test,Bland-Altman method and the percentage of individual coincidence.Results The measured REE was 1460±398kcal/day.There were significant discrepancies between the measured REE and the values predicted from Mifflin,Liu,and Hong Jia equations（P〈0.05）,among which that predicted from Hong Jia equation（240±321kcal/day） was found to have the maximal deviation from the measured REE.There were no significant discrepancies between the measured REE and the values predicted from FAO/WHO/UNU,Schofield,Harris-Benedict,Owen and Cunningham equations（P〉0.05）,among which the value from Schofield equation（6±293kcal/day） showed the minimal deviation from the measured REE.When Bland-Altman method was used to calculate the 95% limits of agreement,however,the agreement between the measured REE and the values predicted from the 8 equations was very weak.The REE predicted from Schofield equation showed the smallest bias（the low limit was-580±137kcal/day,and the high limit was 592±137kcal/day） and the greatest percentage of individual coincidence（41.5%）.Conclusion No equation can be used to accurately predict REE.We therefore recommend indirect calorimetry as the method for determining REE in MHD patients.Schofield equation appears to be the most reliable one among the eight equations.We can use this equation when indirect calorimetry is unavailable.