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【目的】探讨个体化营养管理对慢性肾脏病(CKD)4~5期非透析患者生存质量及蛋白质-能量消耗(PEW)的影响。【方法】选择湖南省人民医院肾内科住院部或 CKD 门诊规律随诊的患者75例。随机分为个体化营养管理组(A 组,38例)及对照组(B 组,37例)。A 组接受营养宣教,个体化食谱制定,门诊营养随访及督导等强化管理措施。B 组接受常规营养宣教,管理12个月。采用肾脏病生活质量简表(KDQOL-SFTM1.3)评估患者生存质量。从生化指标、非预期的身体质量降低、肌肉量丢失、饮食蛋白质和(或)热量摄入不足4个方面综合判断 PEW 状况变化。【结果】①管理前期患者 PEW 发生率高(54.6%)。②管理12个月后,A 组健康相关生存质量(SF-36)总评分(68.2±11.6)分,肾脏疾病相关生存质量(KDTA)总评分(66.7±10.2)分及其分支领域评分均高于 B 组(61.1±9.8；60.3±8.4)分,且差异具有显著性(P <0.05)。③A 组患者管理后血红蛋白、总胆固醇、身体质量指数(BMI)较管理前无明显变化。蛋白摄入下降,维持在低蛋白饮食范围。上臂肌围、握力、血清白蛋白、热量摄入量较管理前有增加,PEW 发生率(39.5%)较 B 组(51.3%)下降(P <0.05)。④A 组肾小球滤过率(eGFR)年平均下降速率为(3.04±7.42)mL/(min·1.73 m2)慢于 B 组(5.04±8.28)mL/(min·1.73 m2)。【结论】个体化营养管理能提高非透析 CKD 4~5期患者生存质量,改善患者的 PEW 状态,并延缓 CKD 进展。“,”Objective]To investigate the impact of individual nutritional management on the quality of life and protein en-ergy wasting(PEW)in patients with non dialysis chronic kidney disease(CKD staged4~5).[Methods]75 patients of chronic kidney disease stages 4~5 who were regularly followed up in CKD clinic services were recruited in this study.All of the pa-tients were randomly divided into two groups to receive either individua nutrition management for 12 months(group A)or not (group B).Kidney Disease Quality of Life Short Form (KDQOL-SFTM1.3)which was composed of short-form 36 health sur-vey(SF-36)and kidney disease target areas (KDTA)were used to evaluate the quality of life.Four categories mainly estab-lished are to be recognized for diagnosing PEW,including biochemical indices,unexpected lower body mass,muscle mass loss, lack of dietary protein and/or calorie intake.The scores of KDQOL-SF and clinical indicators before and after receiving indi-vidual nutrition management were compared.[Results](1)The incidence rate of PEW in patients pre-management was rather high(54.6%).(2)After 12 month management,the total scores of SF-36 (68.21±11.6),KDTA(66.7±10.2)and the scores of its several branch dimensions in group A were significantly higher than those in group B(61.1 ±9.8;60.3±8.4),and the difference is significant(P <0.05).(3)After receiving the individual nutrition management,the hemoglobin,total cholesterol levels and Body Mass Index(BMI)showed no significant changes.Protein intake decreased and maintained at a low protein diet. The Arm circumference,hand strength ,serum albumin level and dietary protein and/or calorie intake increased.Incidence of PEW in group A decreased to 39.5% and was significantly lower than that in group B(51.3%)(P <0.05).(4)The average decline rate of glomerular filtration rate (eGFR)in group A was(3.04±7.42)mL/(min·1.73 m2 ),slower than that in the group B (5.04±8.28)mL/(min·1.73 m2 ).[Conclusion]Individual nutrition management can improve the quality of life in patients with non dialysis CKD4-5,ameliorate the PEW status of patients and delay the progress of CKD.