慢性肾脏病3～5期患儿37例营养及生长发育状况回顾

A retrospective study on nutritional status and growth and development of 37 children with chronic kidney disease stage 3 to 5

目的 分析慢性肾脏病3～5期患儿首次确诊时营养及生长发育情况.方法 应用医院电子病历检索系统检索2007年1月至2015年9月期间首都儿科研究所附属儿童医院肾脏内科收治的符合慢性肾脏病3～5期诊断标准且临床资料齐备者共37例,统计其首次确诊时年龄、身高、体重、体质指数、白蛋白、血脂、酸中毒等情况,对其营养状态和生长发育情况进行分析、总结.结果 37例中男24例,女13例.身高低于同年龄同性别儿童身高值第3百分位者23例（62％）;体重低于同年龄同性别儿童体重值第3百分位者18例（49％）;经身高-年龄校正后体质指数低于相应年龄同性别儿童第3百分位者5例（14％）;肥胖症5例（14％）.3～5期患儿血白蛋白水平为（37.0±8.7）g/L,各期间差异无统计学意义,低白蛋白血症10例（27％）,3～4期与5期相比其出现比例差异无统计学意义;甘油三酯水平为（2.2±1.1） mmol/L,均值高于正常范围,各期间差异无统计学意义,高甘油三酯血症者共21例（62％）,较高胆固醇血症（32％）、低密度脂蛋白升高（26％）及高密度脂蛋白降低（12％）等其他血脂异常发生比例高;5期患儿失代偿性代谢性酸中毒出现比例为69％,显著高于3～4期38％的出现比例（P =0.036 6）.结论 在慢性肾脏病3～5期患儿中普遍存在生长落后,且随分期加重呈现比例升高,程度加重趋势;体重低下和肥胖均可存在于此类患儿中;低白蛋白血症并非慢性肾脏病患儿营养不良的敏感指标;慢性肾脏病患儿平均甘油三酯水平高于正常范围,高甘油三酯血症是此类儿童最常见的脂代谢异常.

Objective To retrospectively analyze the nutritional status and growth and development situation of the children with chronic kidney disease stage 3 to 5 when they were diagnosed at the first visit.Method After searching for the data of all the hospitalized cases during January 2007 to September 2015 in the Department of Nephrology of Children＇s Hospital Affiliated to the Capital Institute of Pediatrics from the medical record system,data of 37 cases with complete clinical data were collected;all these cases were diagnosed as chronic kidney disease stage 3 to 5 according to the diagnostic criteria.We recorded these children＇s age,height,weight,body mass index,albumin,blood lipids and acidosis situation when they were first diagnosed,and then,analyzed and summarized their nutritional status and growth and development situation.Result In these 37 cases,24 cases were boys and 13 cases were girls;23 cases （62%） were shorter than the third percentile of age-sex-specific height;18 cases （49%） exhibited lower weight than the third percentile of age-sex-specific weight;5 cases （13.5%） showed lower BMI than the third percentile of height-age BMI,and 5 cases （13.5%） had obesity.The level of albumin was （37.0 ± 8.7） g/L,and no statistically significant difference was observed within each stage.In all of these cases,10 cases were hypoalbuminemia （27%）,and the difference of its frequency between stage 3-4 and stage 5 was not statistically significant.Triglyceride was （2.2 ± 1.1） mmol/L.The mean level was higher than the normal range,but with no statistically significant difference within each stage;21 cases （62%） were diagnosed as hypertriglyceridemia,which were more frequent compared with the occurrence of the hypercholesterolemia （32%）,the high low density lipoprotein （26%） and the low high density lipoprotein（12%）.And the occurrence of decompensated metabolic acidosis in stage 5 （69%） was significantly higher than that in stage 3-4 （38%） （P =0.036 6,〈 0.05）.Conclusion Growth retardation is highly prevalent among the children with chronic kidney disease stage 3 to 5.It would become more frequent and more serious as the stage worsening.Both underweight and obesity could be observed in this kind of children.Low serum albumin level is not a sensitive indicator of malnutrition in these children.The mean value of triglyceride in the children with chronic kidney disease was higher than the normal range.And hypertriglyceridemia is the most common abnormal lipid metabolism in our study.