蛋白质能量消耗与维持性血液透析患者预后的关系

Relationship between Protein Energy Wasting and Prognosis in Maintenance Hemodialysis Patients

目的探索维持性血液透析(maintenance hemodialysis,MHD)患者并发蛋白质能量消耗(protein energy wasting,PEW)的患病情况、PEW及其评估指标与预后的关系。方法选取在笔者医院规律血液透析3个月以上、资料完整的MHD患者125例,进行队列研究,根据国际肾脏营养和代谢学会(International Society of Renal Nutrition and Metabolism,ISRNM)2008年提出的PEW诊断标准确定MHD患者是否存在PEW,分为PEW组与非PEW组,共随访64个月,以全因死亡为终点事件,应用Kaplan-Meier生存曲线和COX回归模型评估PEW及其评估指标对预后的影响。结果125例患者中全因死亡32例。基线资料中29.60%(37/125)的MHD患者合并PEW,PEW组的病死率高于非PEW组(χ^(2)=18.299,P=0.000)。Kaplan-Meier生存曲线提示非PEW组的累积生存率高于PEW组(χ^(2)=19.595,P=0.000),多因素COX回归模型分析显示,PEW是MHD患者全因死亡的独立危险因素(HR=2.837,95%CI:1.109~7.258,P=0.030)。结论约1/3的MHD患者合并PEW,PEW是MHD患者全因死亡的独立危险因素,ISRNM2008的PEW诊断标准中各个评估指标未发现是MHD患者全因死亡的独立危险因素,临床中应使用综合指标评估MHD患者的营养状况。

Objective To explore the incidence of protein energy wasting(PEW)and the relationship between PEW and prognosis in maintenance hemodialysis(MHD)patients.Methods Totally 125 stable MHD patients whose dialysis time more than 3 months in our hospital were enrolled in the prospective study followed up 64 months.The MHD patients were divided into PEW group and non-PEW group according to the International Society of Renal Nutrition and Metabolism(ISRNM)criterion of PEW.The endpoint is all-cause death.Kaplan-Meier analysis was used to evaluate the influence of PEW on MHD patients'all-cause mortality.COX regression analysis was used to to assess the independent risk factors of all-cause mortality.Results A total of 32 patients died during the 64-month follow-up.The prevalence of PEW was 29.6%(37/125)in MHD patients.The all-cause mortality was significantly higher in PEW group than that of non-PEW group(χ^(2)=18.299,P=0.000).Kaplan-Meier survival curve indicated that the survival rate of non-PEW group was higher than that of PEW group(χ^(2)=19.595,P=0.000).Multivariate COX regression analysis showed that PEW was the independent risk factor of all-cause death in MHD patients(HR=2.837,95%CI:1.109-7.258,P=0.030).Conclusion About 1/3 of MHD patients are accompanied with PEW,which is an independent risk factor of all-cause death in MHD patients.According the PEW diagnostic criteria of ISRNM2008,none of the component evaluation indexes were found to be independent risk factors for all-cause mortality in MHD patients.Therefore,the nutritional status of MHD patients should be comprehensively evaluated.