应用生物电阻抗评估血液透析患者静息能量代谢及相关因素分析

Resting metabolic rate estimated by bioelectrical impedance analysis and its determinants in maintenance hemodialysis patients

目的了解应用生物电阻抗评估静息能量代谢（REE）的情况，并探讨影响维持性血液透析（MHD）患者静息代谢率（RMR）的相关因素，为改善血液透析患者蛋白质能量消耗（PEW）提供新思路。方法横断面研究。选取2015年7月至2016年9月贵州省11家血液透析中心接受MHD的成年患者765例，利用生物电阻抗分析仪测量MHD患者RMR及人体成分瘦体重、脂肪量和体细胞质量（BCM）等。收集血液透析患者人口学资料、血常规、血生化等资料。依据性别分组比较MHD患者静息能量代谢及人体成分水平。RMR四分位分组、Spearman相关性分析及多重线性回归分析影响血液透析患者RMR的临床相关因素。结果纳入研究的MHD患者年龄（54．96±15．78）岁，透析龄（42．3±9．0）个月，男474例，占61．96％。男性MHD患者RMR水平明显高于女性[1591（1444，1764）kcal／d比1226（1104，1354）kcal／d，P〈0．001]，经瘦体重校正后，不同性别RMR差异无统计学意义（P=0．193）。多重线性回归分析结果显示，RMR与透析患者体表面积（p=0．817）、乳酸脱氢酶（p=0．198）呈正相关，与年龄（β=-0．141）呈负相关（均P〈0．05）。结论乳酸脱氢酶与维持性血液透析患者的RMR相关，可能成为评估能量消耗的新型指标。

Objective To explore the level of resting energy expenditure （REE） estimated by bioelectrical impedance analysis and the association of resting metabolic rate （ RMR ） with clinical related factors, and provide new ideas for improving protein energy wasting （PEW） in maintenance hemodialysis （MHD） patients. Methods Seven hundred and sixty-five subjects receiving MHD between July 2015 and September 2016 in 11 hemodialysis centers in Guizhou province were enrolled in this cross-sectional study. Bioelectrical impedance analysis was used to measure RMR and body composition, such as lean body mass, fat mass and body cell mass （BCM）. Baseline characteristics, routine blood test indexes and biochemical data of hemodialysis patients were collected. The level of RMR and body composition in hemodialysis patients was compared by gender grouping. Then the patients were divided into four groups according to the cutoff value of RMR quartile. Spearman correlation analysis and multiple linear regression analysis were used to analyze the relationships between RMR and clinical related factors. Results The average age of MHD patients was （54.96 ±15.78） years and the duriation of dialysis was （42. 3 ± 9.0） months. The level of RMR in male patients （474 cases, 61.96% ） was significantly higher than that in female patients [ 1 591 （1 444, 1 764） kcal/d vs 1 226 （1 104, 1 354） kcal/d, P 〈0. 001 ]. However, this significant difference of RMR between different genders disappeared after adjusting for lean body mass （ P = 0. 193 ）. Multiple linear regression analysis showed that RMR was positively correlated with body surface area （β = 0. 817 ） and lactate dehydrogenase （LDH） （β =0. 198）, and negatively correlated with age （β = -0. 141 ）, all P 〈 0.05. Conclusion RMR levels in patients with maintenance hemodialysis are associated with lactate dehydrogenase level, which may become a new index to evaluate energy consumption.