维持血液透析患者骨骼肌减少症发生率和危险因(3)
透析时间在肌少症组明显长于无肌少症组,这可能是患者随着透析时间的延长,依赖医师和护士进行治疗,产生抑郁的精神症状,许多患者有意识的运动明显减少。有研究表明,抑郁是尿毒症患者发生肌少症的独立危险因素【17-18】。
但在我们的研究中,传统的营养评估指标(如BMI、血清白蛋白)在有或无肌少症患者中无显著性差异。还有研究发现,BMI与三头肌皮皱厚度和体脂肪呈正相关,而与握力和瘦体重无关【10】。这个研究可以解释BMI为什么在有或无肌少症两组患者中无差异。此外,血清白蛋白由于其半衰期长(20d左右),而且它还受微炎症状态的影响,所以血清白蛋白也不是反映患者营养状态的可靠指标【19】。
肌少症在MHD患者中发生率高,男性、微炎症状态和营养不良是MHD患者发生肌少症的危险因素。因此,在临床工作中应对MHD患者定期的进行营养评估,对存在营养不良者予以营养教育。必要时,添加口服营养补充(ONS),及时纠正营养不良和微炎症状态,同时进行个体化的运动教育非常重要。
本研究作为一个横断面研究,而且观察病例数有限,有少肌症的患者未进行肌肉功能的评价。希望在今后的研究中对有少肌症的MHD患者不仅要进行肌肉功能的评价,而且要进行营养支持疗法。
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