糖尿病肾病腹膜透析患者的营养状况和相关因素

Nutritious status and related factors in peritoneal dialysis patients with diabetic nephrology

目的探讨糖尿病肾病腹膜透析患者的营养状况及相关因素。方法选择2006年1月~2007年3月北京大学第三医院腹膜透析中心收治的持续不卧床性腹膜透析患者133例,将其分为糖尿病肾病腹膜透析组（33例）和非糖尿病肾病腹膜透析组（100例）。记录患者的一般资料和实验室指标;采用生物电阻抗测定容量状况,采用主观综合性营养评估观察两组患者的营养状况;采用Spearman相关分析营养不良的相关因素。结果糖尿病肾病腹膜透析组男性比例、脉压、细胞外液、总体液、细胞外液/细胞内液、血红蛋白、血糖、每周残肾尿素清除指数（Kt/V）、每周残肾总Kt/V、每周残肾肌酐清除率（Ccr）、每周残肾总Ccr、残余肾功能、营养不良发生率均显著高于非糖尿病肾病腹膜透析组,而透析龄、血白蛋白、尿素氮、血肌酐均低于非糖尿病肾病腹膜透析组,差异均有统计学有意义（P〈0.05或P〈0.01）。相关性分析发现,腹膜透析患者的营养不良与年龄、糖尿病肾病、细胞外液/细胞内液呈正相关,与血白蛋白呈负相关（P〈0.05或P〈0.01）。结论糖尿病肾病腹膜透析患者营养不良的发生率高于非糖尿病肾病腹膜透析患者,与糖尿病肾病、容量超负荷相关。

Objective To investigate the nutritious status and related factor in peritoneal dialysis（PD） patients with diabetic nephrology（DN）. Methods The 133 continuous ambulatory PD patients who came from the PD Center of Peking University Third Hospital were recruited and followed up from January 2006 to March 2007. The patients were divided into the two groups according to the etiology： DNPD group（33 patients） and non-DNPD（100 patients）. The general data and laboratory parameters were recorded. The volume status was measured by bioelectrical impedance analysis; the nutritional status of patients in the two groups was assessed by subjective global assessment（SGA）.Spearman correlation was used to analyze the associated factors for nutritious status. Results The patients in DNPD group showed a higher incidence of male, pulse pressure, extracellular water, total body water, the ratio of extracellular water to intracellular water（E/I）, hemoglobin, serum glucose, renal Kt/V, total Kt/V, renal Ccr, total Ccr, residual renal function, and malnutrition than those in the non-DNPD group, significantly lower duration of dialysis, serum albumin,urea, and creatinine were observed in patients with DNPD group than those in the non-DNPD group, the differences were statistically significant（P〈0.05 or P〈0.01）. Correlation analysis found that the malnutrition was positively associated with age, DN, and E/I ratio, and negatively with serum albumin（P〈0.05 or P〈0.01）. Conclusion DNPD patients has a higher incidence of malnutrition than non-DNPD patients and the malnutrition in PD patients is correlated with DN and volume overload.