成年与老年维持性血液透析患者营养状况的比较研究

Comparison of Nutritional Status Between Young and Middle Aged Patients and Elderly Patients With Maintenance Hemodialysis

目的评价并比较成年与老年维持性血液透析(MHD)患者的营养状况,为针对性营养干预提供依据。方法选择2013年7—12月在第二军医大学附属长海医院血液净化中心行MHD的非住院患者121例,根据年龄将患者分为成年组(年龄<65岁)72例和老年组(年龄≥65岁)49例。采用主观综合性营养评估法(SGA)、人体测量、实验室检查等综合评估并比较患者的营养状况。结果按照SGA(B/C)、清蛋白(Alb)<35 g/L、前清蛋白(PA)<200 mg/L、肱三头肌皮褶厚度(TSF)实测值/参考值≤90%、中臂肌围(MAMC)实测值/参考值≤90%这几种不同的营养不良评价标准,121例MHD患者营养不良的发生率分别为45.5%(55/121)、17.4%(21/121)、11.6%(14/121)、66.1%(80/121)、43.0%(52/121),成年组分别为37.5%(27/72)、12.5%(9/72)、5.6%(4/72)、62.5%(45/72)、29.2%(21/72),老年组分别为57.1%(28/49)、24.5%(12/49)、20.4%(10/49)、71.4%(35/49)、63.3%(31/49)。采用SGA(B/C)、PA<200 mg/L、MAMC实测值/参考值≤90%评价标准时,成年组与老年组MHD患者的营养不良发生率比较,差异均有统计学意义(P<0.05)。成年组与老年组的血PA、磷(P)、甲状旁腺素(PTH)、肌酐(SCr)、尿素氮(BUN)比较,差异均有统计学意义(P<0.05)。结论老年MHD患者的营养不良发生率较成年患者高,营养状况较成年患者差。应采用综合方法定期、规范地评估老年MHD患者的营养状况。

Objective To evaluate and compare the nutritional status of young and middle aged patients and elderly patients With maintenance hemodialysis in order to provide a preference for targeted nutrition intervention. Methods We enrolled 121 patients With maintenance hemodialysis Who received treatment in the blood purification center of Changhai Hospital affiliated to Second Military Medical University from July to December in 2013. According to age,72 subjects Were assigned into the younger group（ 〈65 years old）,and 49 subjects Were assigned into the elderly group（≥65 years old）. The nutritional status of the subjects Was evaluated comprehensively and compared using subjective global assessment of nutritional status （ SGA ）, somatometry,laboratory examinations. Results The prevalence of malnutrition measured by SGA（ B/C）,Alb 〈35 g/L,PA〈200 mg/L, TSF measured value/reference value ≤90%, MAMC measured value/reference value of ≤90% Was 45. 5%（55/121）,17. 4%（21/121）,11. 6%（14/121）,66. 1%（80/121） and 43. 0%（52/121） respectively for all subjects, 37. 5%（27/72）,12. 5%（9/72）,5. 6%（4/72）,62. 5%（45/72） and 29. 2%（21/72） for the younger group and 57. 1%（ 28/49 ）, 24. 5% （ 12/49 ）, 20. 4% （ 10/49 ）, 71. 4% （ 35/49 ） and 63. 3% （ 31/49 ） for the elderly group. When measured by SGA（ B/C）,PA〈200 mg/L and MAMC measured value/reference value of≤90%,the adult group and the elderly group Were significantly different（P〈0. 05）in the prevalence of malnutrition. The tWo groups Were significantly different（P〈0. 05）in blood PA,phosphorus（P）,parathyroid hormone（PTH）,serum creatinine（SCr）,blood urea nitrogen（ BUN ） . Conclusion The elderly patients With MHD are higher in the prevalence of malnutrition and Worse in nutritional status than young and middle aged patients With MHD. We suggest a comprehensive method be adopted on a regular basis and in a standard manner to evaluate the nutritional status in elderly patients With MHD.