不同年龄组血液透析患者蛋白质能量消耗评估及比较

Assessment and comparison of protein-energy wasting in hemodialysis patients of different age groups

目的评估不同年龄组维持性血液透析(MHD)患者蛋白质能量消耗(PEW),并比较其异同,为临床工作提供依据。方法横断面及回顾性研究。运用透析营养客观评分法(OSND)、改良定量主观整体评估法(MQSGA)结合问卷调查、人体测量、血生化检测等对成年组(年龄<65岁)242例和老年组(年龄≥65岁)106例患者进行PEW评估、比较。分别以OSND评分≤22分、MQSGA评分≥21~35分、肱三头肌皮褶厚度(TSF)男<12.5 mm、女<16.5 mm,上臂围(MAC)男<25.3 cm、女<23.2 cm,白蛋白(ALB)<38 g/L,体质量指数(BMI)<18.5 kg/m2诊断为PEW;分别以OSND、MQSGA、TSF、MAC的不同积分及百分比将PEW区分为轻、中、重3个等级。结果按照上述六个标准诊断的MHD患者PEW发生率分别为79.3%、67.8%、43.9%、23.0%、43.1%、19.5%,其中成年组PEW的发生率分别为74.0%、62.2%、39.7%、19.0%、25.6%、17.8%,老年组PEW的发生率分别为91.5%、81.4%、53.8%、32.1%、40.6%、23.5%;按照其中四项标准诊断,重度PEW分别为13.5%、6.9%、15.5%、3.7%;两组PEW发生率、基线多项营养相关指标比较差异有统计学意义(P<0.05),老年组超敏C反应蛋白(hs-CRP)显著高于成年组(P<0.05)。结论 MHD患者老年组较成年组PEW发生率高,营养指标普遍偏低,炎症状态更重,临床工作中应更加关注老年透析人群PEW状况。

Objective Assessment and comparison of protein-energy wasting（ PEW） in maintenance hemodialysis（ MHD） patients of different age groups in order to provide basis for clinical work.Methods A cross-sectional and retrospective study was performed. Assessment and comparison of PEW were made by means of objective score of nutrition on dialysis（ OSND） and modified quantitative subjective global assessment（ MQSGA） combining questionnaires,anthropometrics,blood biochemistry,and other indicators in the 242 patients of the adult group（ aged 65 years） and the 106 patients of the elderly group（ aged ≥65 years）. The PEW diagnosis criteria were as follows： the OSND score ≤22 points,the MQSGA score 21 to 35 points,the triceps skinfold thickness（ TSF） 12. 5 mm for males and 16. 5 mm for females,the mid-upper arm circumference（ MAC） 25. 3 cm for males and 23. 2 cm for females,albumin（ ALB） 38 g/L,and the body mass index（ BMI） 18. 5 kg/m2. The PEW was divided into mild,medium and severe grades according to the different scores and percentages of OSND,MQSGA,TSF,and MAC. Results The incidence of PEW diagnosed by the OSND score,MQSGA score,TSF,MAC,ALB,and BMI was 79. 3%,67. 8%,43. 9%,23. 0%,43. 1%,and 19. 5%,respectively in all,but was74. 0%,62. 2%,39. 7%,19. 0%,25. 6%,and 17. 8%,respectively in the adult group,and was91. 5%,81. 4%,53. 8%,32. 1%,40. 6%,and 23. 5%,respectively in the elderly group. The incidence of severe PEW diagnosed by OSND,MQSGA,TSF,and MAC was 13. 5%,6. 9%,15. 5%,and 3. 7%,respectively. There were statistically significant differences in the incidence of PEW,and multiple baseline nutrition-related indicators between the two groups（ P〈0. 05）. The high-sensitivity C-reactive protein（ hs-CRP） in the elderly group was significantly higher than in the adult group（ P〈0. 05）.Conclusion Compared with the ones of the adult group,the MHD patients of the elderly group had higher incidence of PEW,lower levels of nutritional indicators,and severer inflammatory status,indicating that PEW status of elderly dialysis patients should be more concerned in clinical work.