腹膜透析患者透析時間、微炎癥及透析充分性與營養狀態的關系

劉昊虹　劉威　黃麗芳

【摘要】 目的：探討腹膜透析患者透析時間、微炎癥及透析充分性與營養狀態的關系。方法：將2015年8月-2017年12月本院腎病科收治的106例持續性不臥床腹膜透析（CAPD）患者作為研究對象。根據患者透析時間分為透析2年以下組46例、透析2～4年組37例、透析4年以上組23例。選擇同期本院60例健康體檢者臨床資料作為對照組。比較不同透析時間患者微炎癥狀態、透析充分性及營養狀態的差異，分析患者微炎癥及透析充分性與營養狀態關系。結果：透析4年以上組、透析2～4年組、透析2年以下組腹膜透析患者CRP、iPTH、β2-MG、MQSGA均高于對照組，其Kt/V、ALB、MAMC均低于對照組，差異均有統計學意義（P<0.05），上述指標在透析4年以上組、透析2～4年組、透析2年以下組患者，組間兩兩比較差異均有統計學意義（P<0.05）；隨著透析時間的延長，CRP、iPTH、β2-MG、MQSGA水平越高，Kt/V、ALB、MAMC也越低。CRP及iPTH水平與營養狀態中MAC、MAMC均成負相關，與MQSGA成正相關（P<0.05），與TSF、BSF、HGS無明顯相關性；Kt/V、ALB水平與營養狀態中MAC、MAMC均成正相關，與MQSGA呈負相關（P<0.05），與TSF、BSF、HGS無明顯相關性。透析時間、Kt/V、ALB、iPTH、CRP、基礎性疾病是影響腹膜透析患者營養狀態獨立影響因素。結論：透析時間長、微炎癥及透析不充分是腹膜透析患者營養狀態不佳的重要影響因素，也是其獨立影響因素，臨床上應及早干預和治療，以提高患者生存質量及生存期。

【關鍵詞】 腹膜透析； 透析時間； 微炎癥； 透析充分性； 營養狀態

Relationship between Dialysis Time，Micro-inflammation，Dialysis Adequacy and Nutritional Status in Peritoneal Dialysis Patients/LIU Haohong，LIU Wei，HUANG Lifang.//Medical Innovation of China，2018，15（17）：0-018

【Abstract】 Objective：To investigate the relationship between dialysis time，micro-inflammation，dialysis adequacy and nutritional status in peritoneal dialysis patients.Method：106 patients of receiving the continuous ambulatory peritoneal dialysis（CAPD） from August 2015 to December 2017 in our Nephrology Department were selected.The subjects were divided into <2 years group（46 cases），2-4 years group （37 cases） and >4 years group （23 cases） according to the dialysis time.60 health check-ups were selected as control group.The correlation of micro-inflammation and dialysis adequacy with nutritional status was analyzed.Result：The indices of CRP，iPTH， β2-MG and MQSGA for >4 years group，2-4 years group and <2 years group were higher than those in control group（P<0.05）；the indices of Kt/V，ALB and MAMC for >4 years group，2-4 years group and <2 years group were lower than those in control group（P<0.05）；the above indices for >4 years group，2-4 years group and <2 years group were significantly different（P<0.05）；as the dialysis time was extended，the indices of CRP，iPTH，β2-MG and MQSGA were increased while the indices of Kt/V，ALB and MAMC were reduced.The indices of CRP and iPTH were negatively correlated with MAC and MAMC and positively correlated with MQSGA（P<0.05）；the indices of CRP and iPTH had no obvious correlation with TSF，BSF and HGS；the indices of Kt/V and ALB were positively correlated with MAC and MAMC and negatively correlated with MQSGA（P<0.05）；the indices of Kt/V and ALB had no obvious correlation with TSF，BSF and HGS；the independent influence factors of nutritional status included the dialysis time，Kt/V，ALB，iPTH，CRP and basic diseases.Conclusion：The independent influence factors of the poor nutritional status include the long dialysis time，micro-inflammation and dialysis inadequacy，the early intervention and therapy can improve their life quality and survival time.