维持性血液透析患者体液分布情况与营养状况的关系

The relationship between body fluid distribution and nutritional status in maintenance hemodialysis patients

目的:研究维持性血液透析(MHD)患者体液分布及其与营养状况之间的关系。方法:选择MHD患者80例,并选择同期健康体检人群48名作为对照组,进行人体测量[身高(H)、体重(Wt)等]、血生化检测,采用生物电阻抗法测定全身总液体量(TBF)、细胞外液(ECF)、细胞内液(ICF),计算ICF/Wt、ICF/TBF、ICF/H2、ECF/Wt、ECF/TBF、ECF/H2、ICF/ECF,采用透析营养客观评分法进行营养评估,根据评估结果将患者分为营养正常组、轻中度营养不良组和重度营养不良组,比较3组间的体液分布,并分析体液分布与血生化相关指标的关系。结果:MHD患者75%存在营养不良,其中轻中度营养不良28例(35%),重度营养不良32例(40%)。MHD营养不良患者ICF/TBF、ICF/H2、ICF/ECF低于营养正常组和对照组(F=5.81、3.222、4.876,均P<0.05),而ECF/Wt、ECF/TBF明显高于营养正常组和对照组(F=4.037、6.173,均P<0.05),均以重度营养不良组尤为显著。MHD患者ICF/ECF比值与营养状况呈负相关(r=-0.452,P<0.05),而与血清总蛋白、白蛋白、血红蛋白、血钠、血钾浓度呈明显正相关(r=0.451、0.617、0.357、0.330、0.688,均P<0.05)。结论:MHD患者体液分布异常,体内水分潴留大多存在于细胞外液及一些细胞内液。其与患者的营养不良程度相关,随着营养不良程度加重,细胞内外液分布异常情况逐渐加重。

Objective:To study the relationship between body fluid distribution and nutritional status in patients with maintenance hemodialysis(MHD),so as to provide basis for early nutritional intervention and reasonable clinical treatment.Methods:A total of 80 patients with MHD undergoing maintenance dialysis were selected and 48 healthy people were recruited as the control group.Anthropometry[height(H),weight(Wt),etc]and blood biochemical test were measured.Total body fluid volume(TBF),extracellular fluid(ECF)and intracellular fluid(ICF)were measured by bioelectrical impedance method.Then ICF/Wt,ICF/TBF,ICF/H2,ECF/Wt,ECF/TBF,ECF/H2 and ICF/ECF were calculated.Objective score of nutrition on dialysis(OSND)was used to evaluate the patients′nutrtitional status.According to the OSND score,the patients were divided into normal nutrition group,mild to moderate malnutrition group and severe malnutrition group.The body fluid distribution among different groups was compared,and the relationship between body fluid distribution and blood biochemical parameters was analyzed.Results:75%of patients with MHD had malnutrition.Among them,28 cases were mild to moderate malnutrition(35%)and 32 cases of severe malnutrition(40%).ICF/TBF,ICF/H2 and ICF/ECF in MHD malnutrition patients were lower than those in normal nutrition group and control group(F=5.81,3.222,4.876,all P<0.05),while ECF/Wt and ECF/TBF were significantly higher in MHD malnutrition group than those in normal nutrition group and control group(F=4.037,6.173,both P<0.05),especially in severe malnutrition group.The ICF/ECF ratio was negatively correlated with nutritional status(r=-0.452,P<0.05),while it was positively correlated with serum total protein,albumin,hemoglobin,sodium and potassium(r=0.451,0.617,0.357,0.330,0.688,all P<0.05).Conclusions:Patients with MHD have abnormal body fluid distribution,which is characterized by the excess fluid distributing in extracellular fluid and some in intracellular fluid.It is related to the degree of malnutrition.With the aggravation of malnutrition,the abnormal distribution of intracellular and extracellular fluid is gradually increased.