复方α酮酸对透析患者状况及代谢的影响

The effect of compound α- ketoacids on the nutritional status and metabolism of dialysis patients

目的采用微营养评定简表法(mini nutritional assessment-Short form,MNA-SF),探讨复方α酮酸对透析患者营养不良的改善作用。方法调查在150家医院的透析中心接受血液透析(HD)或持续非卧床腹膜透析(CAPD)的终末期肾衰竭(ESRD)患者共2252例,透析时间均在3个月以上,所有患者均口服开同6个月,以服用开同前营养状况作为对照。营养监测采用MNA-SF方法结合客观指标测量:体质量指数(BMI)、三头肌皮褶厚度(TSF)、上臂围(AMC)、血清白蛋白(ALB),统计采用Frideman检验和配对秩和检验的方法。结果服用复方α酮酸制剂6个月后,MNA-SF评分由11.13±2.35升至12.44±1.58,有显著差异;营养不良和营养不良风险例数分别由181例(8.04%)和952例(42.27%)降至33例(1.48%)和474例(21.24%)。体质指数从(21.86±3.38)kg/m2升至(22.18±3.32)kg/m2,血清白蛋白由(35.93±5.31)g/L升至(38.27±5.04)g/L,有显著差异。三头肌皮褶厚度、上臂围和淋巴细胞计数等指标亦有明显上升。结论复方α酮酸制剂能够提高透析患者血白蛋白水平和体质指数,改善营养不良状况。

Objective This study aimed to explore the effect of compound α-ketoacids on the dialysis patients with malnutrition assessed by Mini Nutritional Assessment- short form（MNA-SF）. Methods We investigated 2,252 patients who suffered from end- stage renal disease（ESRD） in the dialysis centers of 150 hospitals. These patients were treated with hemodialysis（HD） or continuous ambulatory peritoneal dialysis（CAPD） for more than 3 months and compound α-ketoacids tablets orally for 6 months. The nutrition status before taking compound α-ketoacids tablets was used as control group. MNA-SF method combined with objective indexes including body mass index（BMI）, triceps skinfold（TSF）, mid-arm circumference（AMC）, serum albumin（ALB） were used for monitoring nutrition status. Frideman test and paired rank test were used for statistical analyses. Results After 6 months of oral compound α-ketoacids treatment, MNA-SF score increased from 11.13±2.35 to 12.44±1.58（P〈0.001）, and the number of malnutrition and risk of malnutrition cases decreased from 181 patients（8.04%） and 952 cases（42.27%） to 33 patients（1.48%） and 474 cases（21.24%）, respectively. BMI rose from 21.86±3.38 kg/m2 to 22.18±3.32 kg/m2 and serum ALB from 35.93±5.31 g/L to 38.27±5.04 g/L, with statistical differences. TSF, AMC and lymphocyte count also increased obviously. Conclusion Compound α- ketoacids supplement could increase serum ALB and BMI and improve malnutrition status in dialysis patients.