血液透析和腹膜透析患者蛋白质能量消耗危险因素分析

Analysis of risk factors for protein-energy wasting in patients with maintenance hemodialysis and peritoneal dialysis

目的了解血液透析(HD)和腹膜透析(PD)患者蛋白质能量消耗(PEW)状况,探讨不同透析人群中PEW的相关危险因素。方法纳入2018年12月至2019年6月在浙江大学医学院附属第一医院规律HD患者357例和腹膜透析中心管理的PD患者324例为研究对象,根据国际肾脏营养和代谢学会(ISRNM)的诊断标准调查HD和PD患者PEW发生率,用生物电阻抗法(BIA)、生化检查、人体学测量等方法评估透析患者的营养状况,并进一步分析不同透析人群PEW的危险因素。结果与非PEW患者相比,诊断PEW透析患者人体成分分析指标水分比率(ECW/TBW)、体细胞质量(BCM)、骨骼肌(SMM)差异有统计学意义(P<0.001)。HD患者PEW发生率明显低于PD患者,两组差异有统计学意义(P<0.001)。对HD患者进行二元Logistic回归分析显示,炎症状态[C反应蛋白(CRP)≥8 mg/L,OR=2.695,95%CI 1.429~5.026]是预测PEW发生的危险因素,而Kt/v(OR=0.182,95%CI 0.062~0.508)是预测HD患者发生PEW的保护性因素。对PD患者进行二元Logistic回归分析显示,高龄(OR=1.04,95%CI 1.021~1.059)、低BMI(OR=0.671,95%CI 0.563~0.794)及低血红蛋白(OR=0.962,0.944~0.979)是PEW发生的危险因素。结论 HD患者PEW发生率低于PD患者,使用人体成分分析可辅助诊断PEW的发生,炎症状态是血液透析患者PEW发生的危险因素,提高透析充分性是血透患者PEW的保护因素。高龄、低BMI及低血红蛋白是腹透患者发生PEW的危险因素。

Objective To evaluat the clinical characteristics of protein-energy wasting(PEW),to determine the risk factors of PEW in maintenance hemodialysis(HD)and peritoneal dialysis(PD). Method Totally 357 HD patients and 324 PD patients were recruited in one top three hospital in Zhejiang Province,from December 2018 to June 2019,as the study cohort. PEW diagnosed via ISRNM criteria. Nourishment states of the patients were evaluated via BIA method,biochemical indexes and anthropomorphic parameters. The risk factors of PEW in these patients were determined via statistical strategy.Results The following factors,including ECW/TBW,BCM,and SMM,had significantly difference between PEW and nonPEW patients(P<0.01). The incidence of PEW in HD patients was lower than in PD individuals(P<0.01). Logistic regression analysis indicated that inflammation state(CRP≥8 mg/L)(OR=2.695,95%CI 1.429-5.026) and Kt/V(OR=0.182,95%CI 0.062-0.508) were independently associated with PEW respectively in HD patients. Age(OR=1.040,95%CI1.021-1.059),BMI(OR=0.671,95% CI 0.563-0.794),and hemoglobin level(OR=0.962,95% CI 0.944-0.979)were independently associated with PEW respectively in PD patients. Conclusion The incidence of PEW in HD patients is lower than in PD individuals. Human body component analysis might be useful for the PEW prediction. Inflammation stateand Kt/V are dependently associated with PEW in HD patients,as well as age,BMI and hemoglobin level in PD patients.