营养支持对维持性血液透析患者营养状态及钙磷代谢的影响

    Effects of nutritional support on nutritional status and calcium and phosphorus metabolism in maintenance hemodialysis patients

      摘要
    • 摘要:
      目的  观察营养支持对维持性血液透析（maintenance hemodialysis，MHD）患者营养状态及钙磷代谢的影响。
      方法  选取2023年6～8月在荆门市人民医院接受MHD治疗的终末期肾病患者70例，按数字表法随机分为营养支持组和常规治疗组，各组均为35例。常规治疗组给予常规治疗，营养支持组在常规治疗的基础上给予膳食营养摄入干预治疗。比较两组患者的营养不良发生率、营养指标、炎症因子指标、钙磷代谢指标及并发症发生率。
      结果  干预3个月、6个月后营养支持组的营养不良发生率（31.43%比57.14%，11.43%比34.29%）均低于常规治疗组（P＜0.05）。干预3个月后，两组患者血红蛋白（126.78 ± 11.22）g/L比（115.39 ± 10.04）g/L、前白蛋白（316.44 ± 25.26）g/L比（287.54 ± 26.10）g/L、白蛋白（46.08 ± 8.15）g/L比（38.73 ± 8.11）g/L水平均升高，且营养支持组高于常规治疗组（P＜0.05）。干预3个月后，两组患者血清肿瘤坏死因子α（89.52 ± 9.13）ng/L比（101.64 ± 9.44）ng/L、白细胞介素6（10.83 ± 2.61）ng/L比（13.43 ± 2.42）ng/L和C反应蛋白（2.16 ± 0.45）mg/L比（2.61 ± 0.51）mg/L水平均下降，且营养支持组低于常规治疗组（P＜0.05）。干预3个月后，两组患者血钙（2.06 ± 0.20）mmol/L比（2.25 ± 0.19）mmol/L、血磷（2.20 ± 0.23）mmol/L比（2.42 ± 0.26）mmol/L、全段甲状旁腺激素（180.38 ± 44.82）mmol/L比（216.54 ± 48.44）mmol/L水平及血钙磷乘积（4.53 ± 0.49）mmol/L比（5.45 ± 0.51）mmol/L均降低，且营养支持组低于常规治疗组（P＜0.05）；营养支持组并发症总发生率低于常规治疗组（χ2 = 4.629，P = 0.031）。
      结论  营养支持能够减轻MHD患者的炎症反应，改善患者的营养状况和钙磷代谢紊乱。

       

      Abstract:
      Objective  To observe the effects of nutritional support on nutritional status and calcium and phosphorus metabolism in maintenance hemodialysis （MHD） patients.
      Methods  From June 2023 to August 2023, patients with end-stage renal disease （ESRD） on MHD were randomized into two groups of nutritional-support and conventional-treatment （n = 35 each）. Conventional-treatment group received routine treatment while nutritional-support group had dietary and nutritional intervention on the basis of routine treatment in control group. The incidence of malnutrition, nutritional parameters, inflammatory factors, calcium and phosphorus metabolism parameters and complications were compared between two groups.
      Results  After 3/6-month intervention, the incidence of malnutritionwas lower in nutritional-support group than that in conventional-treatment group （31.43% vs 57.14%, 11.43% vs 34.29%, P＜0.05）; after 3-month intervention, the levels of hemoglobin （Hb）（126.78 ± 11.22）g/L vs （115.39 ± 10.04）g/L, prealbumin （PA）（316.44 ± 25.26）g/L vs （287.54 ± 26.10）g/L and albumin （Alb）（46.08 ± 8.15）g/L vs （38.73 ± 8.11）g/L increased in both groups and nutritional-support group was higher than conventional-treatment group（P＜0.05）; after 3-month intervention, serum levels of C-reactive protein （CRP）（2.16 ± 0.45）mg/L vs （2.61 ± 0.51）mg/L, interleukin-6 （IL-6）（10.83 ± 2.61）ng/L vs （13.43 ± 2.42）ng/L and tumor necrosis factor-α （TNF-α）（89.52 ± 9.13）ng/L vs （101.64 ± 9.44）ng/L decreased in both groups and the nutritional-support group was lower than conventional-treatment group （P＜0.05）; after 3-month intervention, serum levels of calcium （S-Ca）（2.06 ± 0.20）mmol/L vs （2.25 ± 0.19）mmol/L, phosphorus （S-P）（2.20 ± 0.23）mmol/L vs （2.42 ± 0.26）mmol/L, intact parathyroid hormone （iPTH）（180.38 ± 44.82）mmol/L vs （216.54 ± 48.44）mmol/L and Ca×P （4.53 ± 0.49）mmol/L vs （5.45 ± 0.51）mmol/L decreased in both groups and nutritional-support group was lower than conventional-treatment group （P＜0.05）; overall incidence of complications was lower in nutritional-support group than that in conventional-treatment group（χ2 = 4.629, P = 0.031）.
      Conclusion  Nutritional support may alleviate the inflammatory response, improve their nutritional status and disrupt calcium and phosphorus metabolism in MHD patients.

       

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