维持性血液透析患者蛋白质能量消耗的调查及对生活质量的影响

Investigation of protein-energy wasting and its effect on quality of life in maintenance hemodialysis patients

目的调查维持性血液透析(maintenance hemodialysis,MHD)患者蛋白质能量消耗(protein-energy wasting,PEW)状况及PEW对生活质量的影响。方法选取多个中心MHD患者205例随访,通过实验室检查、人体测量、人体成分分析、标准化蛋白代谢率(nomalized protein catabolic rate,nPCR)评价PEW状态,应用肾病及生活质量问卷(kidney disease and quality of life^(TM),KDQOL^(TM)-36)评估患者生活质量,分为PEW组和非PEW组进行统计分析。结果 194例MHD患者,40例诊断为PEW;PEW组患者肌肉组织指数、人体细胞质量、上臂肌肉围径、握力均低于非PEW组;Logistic回归分析示C反应蛋白(C-reactive protein,CRP)为PEW的危险因素[OR=1.064,95%CI(1.023,1.109),P=0.001],sp Kt/V>1.2、nPCR>0.8g/(kg·d)为PEW的保护因素[OR=0.638,95%CI(0.430,0.954),P=0.029;OR=0.017,95%CI(0.005,0.059),P<0.001];PEW组KDQOL^(TM)-36 11个维度得分均低于非PEW组,其中总体健康(t=2.432,P=0.018)、社会情感(t=2.510,P=0.012)、精力体力(t=2.361,P=0.020)、症状影响(t=3.337,P=0.001)4个维度得分显著低于非PEW组。结论郑州市MHD患者PEW患病率为20.6%,PEW的特征可能是肌肉组织的消耗,饮食摄入、透析充分性、炎症状态是PEW的影响因素,PEW影响患者的生活质量。

Objective To investigate the protein-energy wasting （PEW） and its impact on quality of life in maintenance hemodialysis （MHD） patients. Methods A total of 205 MHD patients treated in our hospitals were enrolled in this study. They were followed up. Laboratory examinations, body measurements, body composition monitor, and normalized protein catabolic rate （nPCR） to evaluate PEW, and kidney disease and quality of life （KDQOLTM-36） were conducted. They were then divided into PEW group and non-PEW group for statistical analyses. Results In the 194 MHD patients 40 cases were diagnosed as PEW. Lean tissue index, body cell mass, mid-arm circumference and hand-grips were lower in PEW group than in non-PEW group. Logistic regression showed that C- reactive protein was the risk factor for PEW （OR=1.064, 95% CI 1.023～1.109, P=0.001）, while spKt/V〉1.2 and nPCR〉0.8g/（kg·d） were the protect factors for PEW （OR=0.638, 95% CI 0.430-0.954, P=0.029 for spKt/V; OR=0.017, 95% CI 0.005～0.059, P〈0.001 for nPCR）. The scores of all dimensions in the KDQOLTM- 36 were lower in PEW group than in non-PEW group, especially the scores of general health （t=2.432, P=0.018）, social emotions （t=2.510, P=0.012）, energy/fatigue （t=2.361, P=0.020） and symptoms/problems （t=3.337, P=0.001）. Conclusion The incidence of PEW in MHD patients was 20.6% in Zhengzhou city. Wasting of muscle tissue was the characteristic of PEW. Dietary intake, dialysis adequacy and inflammatory state were the influence factors for PEW. PEW affected the quality of life in MHD patients.