生物电阻抗法在血液透析患者营养状况评估中的(3)
蛋白质是人体一切细胞、组织的重要组成成分,本研究发现蛋白质亦为骨骼肌的影响因素,与既往研究[19]结果相符。PAB是反映蛋白质储存情况的传统营养指标,本研究根据PAB得出的营养不良检出率为3.70%(2/54), 相较BIA测得的骨骼肌不足的检出率显著较低,分析PAB正常患者的BIA测量数据,仍有35.29%(18/51)患者存在骨骼肌不足情况,且PAB与骨骼肌无显著相关性(P>0.05), 原因可能与血清蛋白质易受感染、炎症、水肿、酸中毒等非营养因素影响有关。血清ALB水平控制达标(靶目标)的患者中,有50.00%(8/16)患者存在骨骼肌减少,研究[20]表明, ALB水平对病死率产生影响可能是因为炎症而不是营养摄入不足,因此采用PAB、ALB指标来评估营养状况时会受到一定限制。临床评估营养状况时,应采用实验室指标联合BIA检测或其他营养评估方法进行综合评估,弥补单一指标的局限性,提供更准确的营养状况评估结果。
综上所述, MHD患者营养不良发生率较高,骨骼肌减少问题突出,血清磷、蛋白质水平是MHD患者骨骼肌含量的影响因素,临床应加强对患者血清磷水平的控制,以减缓骨骼肌萎缩进程。BIA是一种简单、廉价、快速、无创、可重复的人体成分评估技术,建议将其联合实验室指标检测用于MHD患者营养状况的综合评估与定期随访中。
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