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目的探讨血液透析(HD)对新诊断终末期肾脏疾病(ESRD)患者营养状况及体内水分布的影响。方法选择2006年10月至2007年10月上海交通大学医学院附属新华医院血液净化中心进行HD的ESRD患者30例。HD前及后3、6个月使用生物电阻抗分析方法(BIA)评估体内水分布状况,应用BIA、人体测量、血液生化指标评估营养状况。结果新诊断ESRD患者总体液量、细胞外液、细胞内液、标化总体液量、标化细胞外液、标化细胞内液在HD后3、6个月较HD前明显下降(P<0.05),HD后3、6个月比较差异无统计学意义;机体蛋白质、无机盐、体脂肪、瘦体重、骨骼肌在HD后3个月较HD前明显增加(P<0.05),HD后6个月较3个月进一步增加(P<0.05),去脂体重、肱三头肌皮褶厚度在HD后3、6个月较HD前明显增加(P<0.05),HD后3、6个月比较差异无统计学意义,体重指数在HD后6个月较HD前明显增加(P<0.05),HD后3个月和HD前比较差异无统计学意义;血白蛋白、转铁蛋白在HD后3、6个月较HD前明显增加(P<0.05),HD后3、6个月比较差异无统计学意义,前白蛋白在HD后6个月较HD前和HD后3个月明显增加(P<0.05),血红蛋白在HD后3个月较HD前明显增加(P<0.05),HD后6个月较3个月进一步增加(P<0.05),超敏C-反应蛋白在HD后6个月较HD前明显增加(P<0.05)。结论及时HD可纠正新诊断ESRD患者体内水负荷过多,改善营养状况,提示有严重营养不良,体内水负荷过多的ESRD患者应尽早行HD。
Objective To investigate the effect of hemodialysis (HD) on nutritional status and body water distribution in patients with newly diagnosed end-stage renal disease (ESRD). Methods From October 2006 to October 2007, 30 patients with ESRD undergoing HD in the Blood Purification Center of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected. The bioelectric impedance analysis (BIA) was used to assess the water distribution in the body before and after 3 months and 6 months of HD. The nutritional status was evaluated by BIA, anthropometric and blood biochemical indexes. Results The total volume of fluid, extracellular fluid, intracellular fluid, normalized total fluid volume, standardized extracellular fluid and standardized intracellular fluid in newly diagnosed ESRD patients were significantly lower than those before HD 3 months and 6 months after HD (P < 0.05), but there was no significant difference at 3 and 6 months after HD (P> 0.05). The levels of protein, inorganic salts, body fat, lean body mass and skeletal muscle in HD after 3 months were significantly higher than HD before 3 months (P <0.05). The thickness of trichoderma skinfold and lean body weight increased significantly at 3 and 6 months after HD compared with that before HD (P <0.05). After HD There was no significant difference between the three months after HD and before HD. The body mass index increased significantly at 6 months after HD compared with that before HD (P <0.05), and there was no significant difference between HD after 3 months and before HD. Serum albumin, transferrin (P <0.05) at 3 and 6 months after HD, and there was no significant difference at 3 and 6 months after HD compared with pre-albumin at 6 months after HD compared with before HD and after HD (P <0.05). Hemoglobin increased significantly at 3 months after HD compared with that before HD (P <0.05), and increased at 6 months after HD (P <0.05) 6 months after HD than before HD increased significantly (P <0.05). Conclusions Timely HD can correct newly diagnosed ESRD patients with excessive water load and improve nutritional status, suggesting that severe malnutrition, excessive water load in patients with ESRD should be HD as soon as possible.