糖尿病肾脏疾病与非糖尿病肾脏疾病血液透析患者容量负荷与营养状况的比较

doi:10.3969/j.issn.1004-583X.2021.04.008

摘要/Abstract

摘要：

目的研究糖尿病肾脏疾病(diabetic kidney disease, DKD)血液透析患者的容量负荷及营养状况。方法选取承德医学院附属医院血液净化中心长期规律行血液透析的患者共92例。按肾脏疾病病因分为DKD血液透析组和非DKD血液透析组。应用人体成分分析仪(body composition monitor, BCM)进行人体成分分析以及生化指标评估两组营养状况以及容量负荷。结果与非DKD血液透析组相比,DKD血液透析组平均动脉血压、水负荷值(overhydration, OH)、细胞外水分(extracellular water, ECW)含量增高(P<0.05)。而血清白蛋白、肌肉组织指数(lean tissue index, LTI)及肌肉组织含量(lean tissue mass, LTM)均降低(P<0.05)。结论相对于非DKD血液透析患者,DKD血液透析患者容量负荷过载及营养不良的风险更高。

关键词: 糖尿病肾病, 人体成分分析仪, 肾透析, 容量负荷

Abstract:

Objective To study the volume load and nutritional status in hemodialysis patients with diabetic kidney disease (DKD). Methods A total of 92 patients with long-term and regular hemodialysis were selected from Blood Purification Center of The Affiliated Hospital of Chengde Medical College. According to the etiology of kidney disease, those patients were divided into DKD hemodialysis group and non-DKD hemodialysis group. The body composition monitor(BCM) was used to analyze human body composition and the biochemical indexes scale was used to evaluate the nutritional status and volume load of the two groups. Results Compared with the non-DKD hemodialysis group, the mean arterial pressure (MAP), overhydration (OH), and extracellular water (ECW) in the DKD hemodialysis group were higher(P<0.05). However, the indexes of albumin, lean tissue index (LTI), and muscle tissue content (LTM) in the DKD hemodialysis group were lower than those in the non-DKD hemodialysis group(P<0.05). Conclusion Compared with non-DKD hemodialysis patients, DKD hemodialysis patients have a higher risk of volume overload and malnutrition.

Key words: diabetic nephropathies, body composition monitor, renal dialysis, capacity load

中图分类号:

R587.24

刘猛, 胡桂才, 杨宗娜, 郭伟伟, 陈万欣. 糖尿病肾脏疾病与非糖尿病肾脏疾病血液透析患者容量负荷与营养状况的比较[J]. 临床荟萃, 2021, 36(4): 332-335.

Liu Meng, Hu Guicai, Yang Zongna, Guo Weiwei, Chen Wanxin. Comparative study on volume load and nutritional status in hemodialysis patients with diabetic kidney disease and non-diabetic kidney disease[J]. Clinical Focus, 2021, 36(4): 332-335.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.04.008

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I4/332

图/表 2

参考文献 21

[1]	孙晓丹, 刁宗礼, 刘旭, 等. 糖尿病肾病维持性血液透析患者死亡危险因素分析[J]. 临床和实验医学杂志, 2017,16(7):633-636.
[2]	Pinter J, Chazot C, Stuard S, et al. Sodium, volume and pressure control in haemodialysis patients for improved cardiovascular outcomes[J]. Nephrol Dial Transplant, 2020;35(Suppl 2):ii23-ii30. doi: 10.1093/ndt/gfaa017 URL
[3]	Oliveira EA, Zheng R, Carter CE, et al. Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment[J]. Semin Dial, 2019,32(6):493-499. doi: 10.1111/sdi.12832 pmid: 31286575
[4]	丁嘉祥, 王梅. 人体成分监测仪在透析患者中的应用[J]. 临床内科杂志, 2018,35(2):81-83.
[5]	国勤, 徐彩棉, 李狄, 等. 主观综合评分联合生物电阻抗法评估血液透析患者的营养状况[J]. 中国血液净化, 2016,15(1):14-17.
[6]	中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏疾病防治临床指南[J]. 中华糖尿病杂志, 2019,11(1):15-28.
[7]	穆立芹, 李明明, 孙利军, 等. 血清N端脑钠肽对维持性血液透析患者血压、超滤量及容量负荷的诊断价值[J]. 中国实验诊断学, 2017,21(2):233-235.
[8]	Wu B, Yan C, Zhang S, et al. Comparative performance of body composition parameters in prediction of death in hospitalized patients on maintenance hemodialysis: A cohort Study[J]. Sci Rep, 2020,10(1):10199. doi: 10.1038/s41598-020-67019-0 URL
[9]	孙晓, 张昭强, 杨洪垒, 等. 生物电阻抗评估调整干体重对血液透析患者血压和心功能的影响[J]. 中华临床医师杂志(电子版), 2018,12(07):371-376.
[10]	Park JH, Jo YI, Lee JH, et al. Clinical usefulness of bioimpedance analysis for assessing volume status in patients receiving maintenance dialysis[J]. Korean J Intern Med, 2018,33(4):660-669. doi: 10.3904/kjim.2018.197 URL
[11]	Liu L, Sun Y, Chen Y, et al. The effect of BCM guided dry weight assessment on short-term survival in Chinese hemodialysis patients : Primary results of a randomized trial - BOdy COmposition MOnitor (BOCOMO) study[J]. BMC Nephrol, 2020,21(1):135. doi: 10.1186/s12882-020-01793-x pmid: 32295531
[12]	Raza SH, Hashmi MN, Elairon P, et al. Improvement in dialysis-related adverse events with use of body composition monitoring[J]. Saudi J Kidney Dis Transpl, 2018,29(3):518-523. doi: 10.4103/1319-2442.235203 URL
[13]	敖广宇, 周树录, 吴蓉, 等传统方式评估维持性血液透析患者干体质量准确度的影响因素[J]. 山东医药, 2019,59(33):79-81.
[14]	徐缘钊, 祁爱蓉, 徐彩, 等. 糖尿病肾脏疾病血液透析患者与非糖尿病肾脏疾病血液透析患者人体成分测定分析[J]. 临床肾脏病杂志, 2019,19(6):392-395.
[15]	李玉金. 维持性血液透析患者营养状况与动脉钙化进展的相关性及危险因素分析[J]. 中国中西医结合肾病杂志, 2019,20(2):131-133.
[16]	章海芬, 陶幸娟, 施翎, 等. 维持性血液透析患者营养评估和人体成分分析[J]. 中国血液净化, 2018,17(2):114-117.
[17]	王婷立, 柳园, 胡雯, 等. 应用生物电阻抗法评估44例维持性血液透析患者的营养状况[J]. 中国血液净化, 2015,14(11):640-643.
[18]	Bakkal H, Dizdar OS, Erdem S, et al. The relationship between hand grip strength and nutritional status determined by malnutrition inflammation score and biochemical parameters in hemodialysis patients[J]. J Ren Nutr, 2020,30(6):548-555. doi: 10.1053/j.jrn.2020.01.026 URL
[19]	Rymarz A, Gibińska J, Zajbt M, et al. Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients[J]. Ren Fail, 2018,40(1):231-237. doi: 10.1080/0886022X.2018.1456451 URL
[20]	Yajima T, Arao M, Yajima K, et al. The associations of fat tissue and muscle mass indices with all-cause mortality in patients undergoing hemodialysis[J]. PLoS ONE, 2019,14(2):e0211988. doi: 10.1371/journal.pone.0211988 URL
[21]	Caetano C, Valente A, Oliveira T, et al. Body composition and mortality predictors in hemodialysis patients[J]. J Ren Nutr, 2016,26(2):81-86. doi: 10.1053/j.jrn.2015.10.005 URL

组别	例数		性别(例)			身高 (cm)		体重 (kg)		年龄 (岁)		BMI (kg/m²)		平均动脉压 (mmHg)
组别	例数		男		女	身高 (cm)		体重 (kg)		年龄 (岁)		BMI (kg/m²)		平均动脉压 (mmHg)
DKD血液透析组	41		25		16	165.17±8.53		63.50±14.44		56.80±11.92		22.97±3.49		116.48±12.91
非DKD血液透析组	51		30		21	166.43±7.97		64.45±10.87		55.04±12.30		23.20±2.97		108.44±13.68
t/χ²值			0.044			-0.731		-0.361		0.694		-0.350		2.871
P值			0.834			0.467		0.719		0.490		0.727		0.005
组别		例数		超滤量 (L)			血红蛋白 (g/L)		白蛋白 (g/L)		透析前肌酐 (μmol/L)		透析前尿素氮 (mmol/L)
DKD血液透析组		41		2.51±0.85			107.49±19.37		39.08±3.93		886.45±242.20		23.91±6.15
非DKD血液透析组		51		2.40±0.67			111.02±14.15		40.97±3.36		956.07±216.70		24.64±6.71
t值				0.692			-1.010		-2.494		-1.453		-0.541
P值				0.491			0.315		0.014		0.150		0.590

组别	例数		性别(例)			身高 (cm)		体重 (kg)		年龄 (岁)		BMI (kg/m²)		平均动脉压 (mmHg)
组别	例数		男		女	身高 (cm)		体重 (kg)		年龄 (岁)		BMI (kg/m²)		平均动脉压 (mmHg)
DKD血液透析组	41		25		16	165.17±8.53		63.50±14.44		56.80±11.92		22.97±3.49		116.48±12.91
非DKD血液透析组	51		30		21	166.43±7.97		64.45±10.87		55.04±12.30		23.20±2.97		108.44±13.68
t/χ²值			0.044			-0.731		-0.361		0.694		-0.350		2.871
P值			0.834			0.467		0.719		0.490		0.727		0.005
组别		例数		超滤量 (L)			血红蛋白 (g/L)		白蛋白 (g/L)		透析前肌酐 (μmol/L)		透析前尿素氮 (mmol/L)
DKD血液透析组		41		2.51±0.85			107.49±19.37		39.08±3.93		886.45±242.20		23.91±6.15
非DKD血液透析组		51		2.40±0.67			111.02±14.15		40.97±3.36		956.07±216.70		24.64±6.71
t值				0.692			-1.010		-2.494		-1.453		-0.541
P值				0.491			0.315		0.014		0.150		0.590

组别	例数	OH (L)	ECW (L)	ICW (L)	LTI (kg/m²)	FTI (kg/m²)	LTM (kg)	ATM (kg)
DKD血液透析组	41	2.15±1.41	16.26±3.44	16.35±3.63	12.03±2.33	10.11±3.59	33.28±7.97	27.91±11.00
非DKD血液透析组	51	1.58±1.26	14.90±2.84	17.63±3.30	13.15±2.17	9.34±3.43	36.64±7.48	25.70±9.38
t值		2.042	2.074	-1.769	-2.392	1.046	-2.079	1.042
P值		0.044	0.041	0.080	0.019	0.299	0.040	0.300

组别	例数	OH (L)	ECW (L)	ICW (L)	LTI (kg/m²)	FTI (kg/m²)	LTM (kg)	ATM (kg)
DKD血液透析组	41	2.15±1.41	16.26±3.44	16.35±3.63	12.03±2.33	10.11±3.59	33.28±7.97	27.91±11.00
非DKD血液透析组	51	1.58±1.26	14.90±2.84	17.63±3.30	13.15±2.17	9.34±3.43	36.64±7.48	25.70±9.38
t值		2.042	2.074	-1.769	-2.392	1.046	-2.079	1.042
P值		0.044	0.041	0.080	0.019	0.299	0.040	0.300