维持性血液透析患者蛋白质能量消耗的调查及对生活质量的影响

发布时间：2018-02-03 23:04

本文关键词： 蛋白质能量消耗维持性血液透析患病率影响因素生活质量　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的随着血液净化技术不断进步和医保政策的大力支持,终末期肾病(End-stage renal disease,ESRD)患者维持性血液透析(Maintainence hemodialysis,MHD)治疗的效果明显提高。但患者预期寿命低于普通人群,生存质量仍然是重要的问题。营养不良是高死亡率的主要原因之一,既往存在多种营养指标和评分工具,2008年国际肾脏营养和代谢协会(ISRNM)提出一套统一标准以识别蛋白质能量消耗(Protein-energy wasting,PEW)在急性或慢性肾脏病患者中的发生,有研究报道PEW是患者死亡率独立危险因素,对于血液透析患者早期PEW的诊断很重要,可以进行相关干预以提高预后。MHD患者的营养状态受到临床医师的重视,也是需要亟待解决的难题。本研究应用人体成分分析、人体测量、生化检查等方法调查MHD患者的营养状况,分析PEW患病率及其相关影响因素,评估PEW对生活质量的影响。对象和方法根据纳入/排除标准,选取每周血液透析3次,透析龄≥3个月,经过知情同意并签署知情同意书的成年MHD患者。对符合条件的所有患者,进行为期6个月三轮随访,2015年6月开始首次随访。随访内容包括收集基本信息,采集周中透析前后血标本进行实验室化验,同时进行透析前人体成分分析(Body composition monitor,BCM)测定和人体测量等检查,并计算标准化蛋白代谢率(nPCR)了解饮食摄入情况,应用肾脏病和生活质量问卷(Kidney disease and quality of life,KDQOLTM-36)评估生活质量。2015年9月和12月进行第二次、第三次随访,内容同第一次随访。根据PEW诊断标准统计PEW患病率,分为PEW组和非PEW组,比较两组间人口学特征、实验室检查、人体成分、人体测量数据、生活质量等的差异;以是否合并PEW为结果变量,应用Logistic回归寻找PEW的影响因素。结果1.对194例MHD患者进行数据处理,女性82例(42.3%),男性112例(57.7%),平均年龄50.84±14.27岁,中位透析龄35(15,60.5)月;PEW四项指标符合3项及以上者40例,即PEW占20.6%。2.PEW组和非PEW组间比较,两组间年龄、血尿素氮、血肌酐、甘油三酯、血磷、单室尿素清除指数(spKt/V)、C反应蛋白(CRP)差异具有统计学意义(P0.05),而性别,透析龄,血红蛋白、原发病为糖尿病肾病、高血压、甲状旁腺素、铁蛋白等两组间无显著差异。3.人体成分数据比较结果显示:PEW组肌肉组织指数(LTI)、人体细胞质量(BCM)低于非PEW组(男性:P=0.019,0.014;女性:P=0.075,0.041);男性与女性两组间脂肪组织如脂肪组织指数(FTI)、脂肪组织质量(ATM)、总脂质质量(FAT)比较差异均无统计学意义。人体测量比较结果显示:PEW组上臂肌肉围径(MAMC)、握力(HGS)均显著低于PEW组(男性:P=0.034,0.048;女性:P=0.004,0.009);PEW组上臂围(MAC)较非PEW组低(男性P=0.118;女性:P=0.008);肱三头肌皮褶厚度(TSF)较非PEW组低,但差异无统计学意义。体液比较结果显示PEW组细胞外液(TBW)、细胞内液(ICW)显著低于非PEW组(P=0.006,0.007);细胞外液/细胞内液(E/I)、过多水分(OH)显著高于非PEW组(P=0.002,0.008)。4.Logistic回归分析显示spKt/V1.2、n PCR0.8g/kg/d为PEW的保护因素(OR=0.64、0.02,P0.029、0.000),CRP为PEW的危险因素[OR:1.06,95%CI(1.02,1.10),P=0.001]。5.KDQOLTM-36评估生活质量,两组间比较发现PEW组在11个维度均低于非PEW组,其中总体健康(30.66±13.57 vs 43.14±16.32,P=0.018)、社会情感(39.67±40.90 vs 59.79±42.34,P=0.012)、精力体力(34.74±24.09 vs 50.35±26.35,P=0.020)、症状影响(67.35±13.74 vs 80.25±15.06,P=0.001)显著低于非PEW患者。结论1.郑州市PEW患病率为20.6%;PEW的特征可能是肌肉组织的消耗;2.Kt/V1.2和nPCR0.8g/kg/d是PEW保护因素,CRP为PEW的危险因素;3.存在PEW的患者的生活质量差于非PEW患者。
[Abstract]:Background and objective with the support of the blood purification technology progress and the health insurance policy, end-stage renal disease (End-stage renal, disease, ESRD) in patients with maintenance hemodialysis (Maintainence hemodialysis MHD) the treatment effect is obviously improved. But life expectancy is lower than the general population, quality of life is still an important problem of malnutrition is one of the main. The reason of high mortality rate, there are many previous nutrition indicators and assessment tools, the 2008 International kidney metabolism and Nutrition Association (ISRNM) proposed a unified set of standards to identify protein energy consumption (Protein-energy wasting, PEW) in patients with acute or chronic kidney disease, studies have reported that PEW is an independent risk factor of mortality is. Important for the early diagnosis of PEW in hemodialysis patients, can be related to intervention to improve the nutritional status of the prognosis of.MHD patients by clinicians Attention also needs a problem urgently to be solved. Based on the analysis, measurement of human body composition, nutritional status and biochemical examination, investigation of MHD patients, the prevalence and related factors of PEW, assessment of the effect of PEW on quality of life. The objects and methods according to the inclusion / exclusion criteria, select weekly hemodialysis 3 times more than 3 months of age, dialysis, after informed consent and signed the informed consent of the adult MHD patients. All patients meet the conditions, for a period of 6 months of follow-up in June 2015 to start the first round, follow-up contents include the collection of basic information, collected during the week before and after dialysis blood samples for laboratory analysis at the same time, body composition before dialysis (Body composition monitor, BCM) were measured and anthropometric examinations, and calculate the normalized protein catabolic rate (nPCR) to understand the dietary intake, with kidney disease and quality of life Questionnaire (Kidney disease and quality of life, KDQOLTM-36) to assess the quality of.2015 in September and December were second times, third times of follow-up, content with the first follow-up. According to the diagnostic criteria of PEW statistical PEW prevalence, divided into PEW group and non PEW group were compared between the two groups in demographic characteristics, laboratory examination, body composition, anthropometric data, differences in quality of life; to whether the merger of PEW as outcome variables, factors affecting the application of Logistic regression for PEW. Results 1. of 194 cases of MHD for data processing, 82 cases were female (42.3%), 112 cases were male (57.7%), mean age 50.84 + 14.27 years old, the median age of dialysis 35 (15,60.5) months; PEW four indicators in line with 40 cases of 3 and above, PEW accounted for between 20.6%.2.PEW group and non PEW group, two groups of age, blood urea nitrogen, serum creatinine, triglycerides, blood phosphorus, single room urea clearance index (spKt/V), C reactive protein (CRP) difference out There was statistical significance (P0.05), and gender, dialysis age, hemoglobin, diabetic nephropathy, primary hypertension, parathyroid hormone, ferritin and no significant difference between the two groups.3. body composition data shows: group PEW muscle index (LTI), body cell mass (BCM) lower than non PEW group (male: P=0.019,0.014; female: P=0.075,0.041); men and women between the two groups in adipose tissues such as adipose tissue index (FTI), fat tissue weight (ATM), total lipid mass (FAT) showed no significant difference. The human body measurement comparison results showed that: PEW group of upper arm muscle circumference (MAMC), grip (HGS) were significantly lower than PEW group (male: P=0.034,0.048; female: P=0.004,0.009); group PEW, upper arm circumference (MAC) compared with non PEW group (low male P=0.118; female: P=0.008); triceps skinfold thickness (TSF) compared with non PEW group, but the difference was not statistically significant. Comparison results showed that the PEW fluid group The extracellular fluid (TBW), intracellular fluid (ICW) was significantly lower than that in non PEW group (P=0.006,0.007); extracellular / intracellular fluid (E/I), too much water (OH) was significantly higher than that of group PEW (P=0.002,0.008).4.Logistic regression analysis showed that spKt/V1.2, N and PCR0.8g/kg/d were protective factors of PEW (OR=0.64,0.02, P0.029,0.000), CRP were the risk factors of PEW [OR:1.06,95%CI (1.02,1.10), P=0.001].5.KDQOLTM-36 assessment of quality of life between the two groups was found in PEW group were lower than non PEW group in 11 dimensions, including general health (30.66 + 13.57 vs 43.14 + 16.32 P, =0.018), social emotion (39.67 + 40.90 vs 59.79 + 42.34, P=0.012) physical energy, (34.74 + 24.09 vs 50.35 + 26.35, P=0.020), symptoms (67.35 + 13.74 vs 80.25 + 15.06, P=0.001) was significantly lower than that of non PEW patients. Conclusion: 1. in Zhengzhou, the prevalence rate of PEW was 20.6%; the characteristics of PEW may be muscle tissue consumption; 2.Kt/V1.2 and nPCR0.8g/kg/d It is a PEW protective factor, and CRP is a risk factor for PEW; 3. the quality of life of patients with PEW is less than that of non PEW patients.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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