应用生物电阻抗分析维持性血液透析患者体液分布特点

The characteristics of body fluid distribution in maintenance hemodialysis patients by using bioelectrical impedance

目的应用多频生物电阻抗分析法研究维持性血液透析(MHD)患者透析前后体液分布特点。方法选取临床干体质量达标的MHD患者86例,并选取同质的健康人群258例作为对照组,运用多频人体成分分析仪测量透析前后体质量(W)、身体总水(TBW)、细胞内液(ICW)、细胞外液(ECW),计算透析前后ICW/W、ICW/TBW、ICW/H2、ECW/W、ECW/TBW、ECW/H2以及ICW/ECW。结果 MHD患者透析前ECW/H2明显高于对照组[男(4.77±0.58 vs.4.52±0.36),P<0.01;女(4.16±0.47 vs.3.97±0.32),P<0.01],透后接近对照组透析前后ICW/TBW,ICW/ECW及ECW/TBW之间,以及与对照组比较均无明显差别。ICW/H2表现不完全一致,男性患者透析前ICW/H2高于对照组[男(9.42±1.26 vs.9.03±0.75,(P<0.05)],透后接近对照组[男(8.83±1.15 vs.9.03±0.75,(P>0.05)],女性患者透析前明显高于透后[女(8.07±0.79 vs.7.52±1.49,P<0.05]。结论 1维持性血液透析患者体内潴留的水分并非主要分布于细胞外液,而是同时分布于细胞内液和细胞外液;透析超滤脱水不仅影细胞外液,同时影响细胞内液。2 ECW/H2和ICW/H2透析后明显下降,接近正常人,有可能成为评价维持性血液透析患者水负荷状态的一个指标,需要进一步研究。

Objective of this study was to study the characteristics of fluid distribution by using multifrequency bioelectrical impedance in maintenance hemodialysis（MHD） patients before and after dialysis.Methods A total of 86 MHD patients who reached the target of clinical dry weight were selected as the experiment group. Meanwhile, a total of 258 healthy cases were recruited as the control group. Body weight（W）, total body water（TBW）, intracellular water（ICW） and extracellular water（ECW） before and after a dialysis session were measured by using a multi-frequency body composition analyzer. ICW/W, ICW/TBW, ICW/H2, ECW/W, ECW/TBW, ECW/H2 and ICW/ECW before and after a dialysis session were then calculated.Results Before dialysis, ECW/H2 was significantly higher in experiment group than in control group（4.77±0.58 vs. 4.52±0.36 in males, P〈0.01; 4.16±0.47 vs. 3.97±0.32 in females, P〈0.01）. After dialysis in experiment group, ECW/H2 approximated to that of control group. Before and after a dialysis session in experiment group, there were no significant differences in ICW/TBW, ICW/ECW and ECW/TBW. Between experiment group and control group. For ICW/H2 in males, the level in experiment group before dialysis was higher than that in control group（9.42±1.26 vs. 9.03±0.75, P〈0.05）, and the level after dialysis approximated to that of control group（8.83±1.15 vs. 9.03±0.75, P〉0.05）. For ICW/H2 in females, the level before dialysis was significantly higher than that after dialysis（8.07 ± 0.79 vs. 7.52 ± 1.49, P〈0.05）. Conclusion （1） In MHD patients, water was retained not mainly in extracellular space but in both extracellular and intracellular spaces.Dialysis by ultrafiltration decreased the water retention in both extracellular and intracellular spaces. （2）ECW/H2 and ICW/H2 decreased closely to those of normal persons after dialysis. Therefore, ECW/H2 and ICW/H2 may represent water load status in MHD patients, and need to be further studied.