个体化营养管理对非透析慢性肾脏病患者生存质量及蛋白质-能量消耗的影响

Impact of Individual Nutritional Management on the Quality of Life and Protein Energy Wasting in Patients with Non Dialysis Chronic Kidney Disease

【目的】探讨个体化营养管理对慢性肾脏病（CKD）4-5期非透析患者生存质量及蛋白质-能量消耗（PEW）的影响。【方法】选择湖南省人民医院肾内科住院部或CKD门诊规律随诊的患者75例。随机分为个体化营养管理组（A组，38例）及对照组（B组，37例）。A组接受营养宣教，个体化食谱制定，门诊营养随访及督导等强化管理措施。B组接受常规营养宣教，管理12个月。采用肾脏病生活质量简表（KDQOL-SFTM1.3）评估患者生存质量。从生化指标、非预期的身体质量降低、肌肉量丢失、饮食蛋白质和（或）热量摄入不足4个方面综合判断PEW状况变化。【结果】①管理前期患者PEW发生率高（54．6%）。②管理12个月后，A组健康相关生存质量（SF-36）总评分（68．2±11．6）分，肾脏疾病相关生存质量（KDTA）总评分（66．7±10．2）分及其分支领域评分均高于B组（61．1±9．8；60．3±8．4）分，且差异具有显著性（P〈0．05）。③A组患者管理后血红蛋白、总胆固醇、身体质量指数（BMI）较管理前无明显变化。蛋白摄入下降，维持在低蛋白饮食范围。上臂肌围、握力、血清白蛋白、热量摄入量较管理前有增加，PEW发生率（39．5％）较B组（51．3％）下降（P〈0．05）。④A组肾小球滤过率（eGFR）年平均下降速率为（3．04±7．42）mL／（min·1．73m^2）慢于B组（5．04±8．28）mL／（min·1．73m^2）。【结论】个体化营养管理能提高非透析CKD4～5期患者生存质量，改善患者的PEW状态，并延缓CKD进展。

[Objective]To investigate the impact of individual nutritional management on the quality of life and protein energy wasting（PEW） in patients with non dialysis chronic kidney disease（CKD staged4 - 5）.[Methods]75 patients of chronic kidney disease stages 4-5 who were regularly followed up in CKD clinic services were recruited in this study.All of the patients were randomly divided into two groups to receive either individua nutrition management for 12 months（group A） or not （group B）.Kidney Disease Quality of Life Short Form （KDQOL-SFTM1.3）which was composed of short-form 36 health s urvey（SF-36） and kidney disease target areas （KDTA） were used to evaluate the quality of life. Four categories mainly established are to be recognized for diagnosing PEW, including biochemical indices, unexpected lower body mass, muscle mass loss, lack of dietary protein and/or calorie intake. The scores of KDQOL-SF and clinical indicators before and after receiving individual nutrition management were compared.[Results]（1） The incidence rate of PEW in patients pre-management was rather high（54.6%）.（2） After 12 month management, the total scores of SF-36 （68.21±11.6）, KDTA（66.7±10.2） and the scores of its several branch dimensions in group A were significantly higher than those in group B（61.1±9.8;60.3±8.4）, and the difference is significant（ P 〈0.05）.（3） After receiving the individual nutrition management, the hemoglobin, total cholesterol levels and Body Mass Index（BMI）showed no significant changes. Protein intake decreased and maintained at a low protein diet. The Arm circumference, hand strength , serum albumin level and dietary protein and/or calorie intake increased. Incidence of PEW in group A decreased to 39.5% and was significantly lower than that in group B（51.3%）（ P 〈0.05）. （4） The average decline rate of glomerular filtration rate （eGFR） in group A was（3.04 ± 7.42）mL/（min · 1.73 m^2）, slower than that in the group B （5.04±8.28）mL/（min ·1.73 m^2 ）. [Conclusion] Individual nutrition management can improve the quality of life in patients with non dialysis CKD4-5, ameliorate the PEW status of patients and delay the progress of CKD.