维持性血液透析患者血钠水平与营养状态的相关性研究

Correlation of serum sodium level with malnutrition in maintenance hemodialysis patients

目的探讨维持性血液透析患者透析前血清钠水平与营养状况的关系。方法选取2015年4月-2015年8月浙江省温州市中心医院终末期肾病接受维持型血液透析治疗患者94例,用标准技术测量患者的肱三头肌皮褶厚度厚度、上臂中部肌周长、上臂中点肌肉周长、握力以及采用改良主观综合评估法评估患者的营养状态,检测透析间期体重增长、干体重、透析前后血压以及实验室指标。其根据血清钠水平分两组:低钠组(Na<137 mmol/L)和对照组(Na≥137mmol/L),分别比较两组的上述指标。结果低钠组患者上臂肌围、握力、血清白蛋白水平更低,营养评分、透析间期体重增长占干体重的平均百分数更高,差异有统计学意义(P<0.05)。两组的肱三头肌皮褶厚度、上臂围、干体重、血透前后血压、前白蛋白、血红蛋白、转铁蛋白、血脂、血钾、血钙及CRP差异无统计学意义(P>0.05)。透析前血清钠浓度与上臂肌围呈正相关(r=0.266,P=0.009),与握力呈正相关(r=0.401,P=0.001),与营养评分呈负相关(r=-0.46,P=0.001),与血清白蛋白水平呈正相关(r=0.309,P=0.002),与血CRP和透析间期体重增长占干体重的平均百分数不相关。结论维持性血液透析患者透析前血钠水平偏低与蛋白质能量消耗和透析间期体重增加有关。

Objective To explore the relationship between serum sodium level and malnutrition in maintenance hemodialysis patients. Methods Ninety-four patients with the end-stage renal diseases requiring maintenance hemodialysis between April 2015 and August 2015 were selected. Triceps skinfold thickness （TSF）, mid-arm circumference （MAC）, mid-arm muscle circumference （MAMC） and hand grip strength （HGS） were measuered using standard techniques. And modified quantitative subjective global assessment （MQSGA） was used to evaluate their nutritional status. The dry weight （DW）, inter-dialysis weight growth （IDWG）, blood pressure data and laboratory indexes were also measured. According to serum sodium level, the patients were divided into two groups： low-sodium group （Na 〈 137 mmol/L） and control group （Na ≥ 137 mmol/L）. The above indexes of the two groups were compared. Results The patients in the low-sodium group had significantly lower MAMC, HGS and albumin levels, but significantly higher MQSGA and IDWG% （P 〈 0.05）; while there was no statistically significant difference in TSF, MAC, DW, BP, ALB, HB, TF, TC, TG, K＋, Ca2＋ or CRP （P 〉 0.05）. Pre-dialysis serum Na＋ correlated positively with MAMC （r = 0.266, P = 0.009）, HGS （r = 0.401, P = 0.001） and albumin level （r = 0.309, P = 0.002）, and negatively with MQSGA （r = -0.46, P = 0.001）. Pre-dialysis serum Na＋ was uncorrelated with CRP or IDWG%.Conclusions This study demonstrates that low serum sodium is associated with protein energy wasting and increased inter-dialysis weight gain in maintenance hemodialysis patients.