相位角测量评估血液透析患者营养状态的应用价值

Application value of phase angle measurement in assessing the nutritional status of hemodialysis patients

目的探讨相位角(PA)测量评估血液透析(HD)患者营养状态的应用价值。方法选择2019年1月至2020年12月在海南医学院第一附属医院肾内科接受HD治疗的患者98例,年龄23~72(45.5±5.3)岁,男64例,女34例。其中糖尿病肾病36例,慢性肾小球肾炎29例,高血压肾病11例,慢性间质性肾炎2例,狼疮性肾炎2例,成人型多囊肾1例,原因不明17例。以营养不良-炎症评分(MIS)评估HD患者的营养状态。应用InBody770人体成分分析仪在HD结束后20 min内对患者进行PA测量,结果取50 kHz条件下的PA值。以MIS为金标准,采用ROC曲线法分析PA测量评估患者营养状态的效能。分析PA测量值与体重、上臂肌围、血清白蛋白、前白蛋白、血清总铁结合力(TIBC)、转铁蛋白等临床指标的相关性。结果98例患者中,营养正常、轻度营养不良、中度营养不良和重度营养不良的例数分别为9例(9.18%)、34例(34.69%)、45例(45.92%)和10例(10.20%),营养不良发生率为90.82%(89/98)。ROC曲线分析结果显示,PA(50 kHz)可较好地鉴别营养正常-轻度营养不良、轻度-中度营养不良、中度-重度营养不良[AUC(95%CI)=0.902(0.772~0.971),P=0.000;AUC(95%CI)=0.665(0.550~0.767),P=0.016;AUC(95%CI)=0.702(0.564~0.818),P=0.004]。Spearman秩相关分析结果显示,PA(50 kHz)测量值与患者体重、上臂肌围、前白蛋白、TIBC水平呈显著正相关(P<0.05),与年龄、透析时间呈显著负相关(P<0.05)。结论HD患者营养不良发生率高。PA测量可早期发现患者营养不良,有利于临床医师及时予以营养干预,改善患者生存质量。

Objective To explore the application value of phase angle(PA)measurement in assessing the nutritional status of hemodialysis(HD)patients.Methods Ninety-eight patients who received HD treatment in Department of Nephrology,the First Affiliated Hospital of Hainan Medical University from January 2019 to December 2020 were selected.The patients ranged in age from 23 to 72(45.5±5.3)years,including 64 males and 34 females.Among the patients,there were 36 cases of diabetic nephropathy,29 cases of chronic glomerulonephritis,11 cases of hypertensive nephropathy,2 cases of chronic interstitial nephritis,2 cases of lupus nephritis,1 case of adult polycystic kidney disease,and 17 cases of unknown cause.The nutritional status of the HD patients was assessed by malnutrition-inflammation score(MIS).The PA was measured within 20 minutes after HD was completed by using the InBody770 body composition analyzer,and the PA value under the condition of 50 kHz was taken as the result.The receiver operator characteristic(ROC)curve method was used to analyze the efficacy of PA measurement in evaluating the nutritional status of the patients by using MIS as the gold standard.The correlations between PA measurements and the clinical indicators of body weight,upper arm muscle circumference,serum albumin,prealbumin,serum total iron-binding capacity(TIBC)and transferrin were analyzed.Results Among the 98 patients,the cases of normal nutrition,mild malnutrition,moderate malnutrition and severe malnutrition were 9 cases(9.18%),34 cases(34.69%),45 cases(45.92%)and 10 cases(10.20%),respectively,and the incidence of malnutrition was 90.82%(89/98).The results of ROC curve analysis showed that PA(50 kHz)could better distinguish normal nutrition from mild malnutrition,mild malnutrition from moderate malnutrition,and moderate malnutrition from severe malnutrition[area under the curve(AUC)(95%CI)=0.902(0.772-0.971),P=0.000;AUC(95%CI)=0.665(0.550-0.767),P=0.016;AUC(95%CI)=0.702(0.564-0.818),P=0.004].The results of Spearman rank correlation analysis showed that PA(50 kHz)measurements was significantly positively correlated with the patients′body weight,upper arm muscle circumference,prealbumin and TIBC(P<0.05),and was significantly negatively correlated with age and dialysis time(P<0.05).Conclusion The incidence of malnutrition in HD patients is high.PA measurement can detect malnutrition in the patients early,which is beneficial for clinicians to provide nutritional intervention in a timely manner and improve the quality of life of the patients.