相位角在评估腹膜透析患者营养状况中的应用

Application of phase angle in evaluating nutritional status of peritoneal dialysis patients

目的分析生物电阻抗测量的相位角(phase angle,PA)在评估腹膜透析(peritoneal dialysis,PD)患者营养状态中的应用价值。方法纳入于2020年4月至2021年12月在同济大学附属第十人民医院肾脏内科接受腹膜透析的患者271例。使用InBody S10(韩国Biospace公司)检测50kHz频率下的PA,分为正常PA组和低PA组。比较两组患者一般资料及实验室指标,并用Pearson相关分析及多元线性回归分析PA与各指标的关系。结果271例PD患者中正常PA组108例(39.9%),低PA组163例(60.1%)。低PA组糖尿病肾病患者比例高于正常PA组。Pearson相关性分析结果显示,PA与年龄、糖化血红蛋白、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、体脂肪率、浮肿指数和内脏脂肪面积(visceral fat area,VFA)呈负相关,与肌酐、前白蛋白、白蛋白、预后营养指数、25-羟维生素D[25-hydroxyvitamin D_(3),25(OH)D_(3)]、血清铁、去脂体质量、骨骼肌质量、上臂肌围(arm muscle circumference,AMC)、骨矿物质含量、VFA、基础代谢率和骨骼肌质量指数(skeletal muscle mass index,SMI)呈正相关(P<0.05)。多元线性回归分析结果显示肌酐、NLR、AMC、SMI与PA独立相关。结论应用生物电阻抗分析(bioelectrical impedance analysis,BIA)技术测量PA值来评估患者的营养状态,具有无创、快速等优点。早期识别患者营养状态并实施个体化营养干预是提高肾衰竭患者生活质量和生存率的重要途径。

Objective To analyze the value of phase angle(PA)measured by bioelectrical impedance analysis in evaluating nutritional status of peritoneal dialysis(PD)patients.Methods Totally 271 patients admitted to the Department of Nephrology,Tenth People's Hospital Affiliated to Tongji University from April 2020 to December 2021 were selected.InBody S10(Korean Biospace)was used to detect PA at 50kHz,which was divided into normal PA group and low PA group.The differences of general data and laboratory indexes between the two groups were compared,and the relationship between PA and each index was analyzed by Pearson correlation analysis and multiple linear regression analysis.Results Among 271 PD patients,108(39.9%)were in the normal PA group and 163(60.1%)were in the low PA group.The proportion of diabetic nephropathy patients in low PA group was significantly higher than that in normal PA group.Pearson correlation analysis showed that PA was negatively correlated with age,glycated hemoglobin,neutrophil to lymphocyte ratio(NLR),percent body fat(PBF),edema index and visceral fat area(VFA).It was positively correlated with creatinine,prealbumin,albumin,predictive nutritional index(PNI),25-hydroxyvitamin D_(3)[25(OH)D_(3)],serum iron,fat free mass,skeletal muscle mass,arm muscle circumference(AMC),bone mineral content,VFA,basal metabolic rate and skeletal muscle mass index(SMI)(P<0.05).Multiple linear regression analysis showed that creatinine,NLR,AMC,SMI were independently correlated with PA.Conclusions Bioelectrical impedance analysis(BIA)is non-invasive and rapid to evaluate the nutritional status of patients.Early identification of patients’nutritional status and implementation of individualised nutritional interventions are important ways to improve the quality of life and survival of patients with renal failure.