CAJ | 학술논문

目的：了解持续性非卧床腹膜透析（CAPD）患者腹透液蛋白质丢失水平及其影响因素，为该类患者的临床营养支持提供理论依据。方法：选择2012年12月-2013年10月在某院腹膜透析中心接受CAPD治疗3个月以上的非糖尿病尿毒症患者72例，完整收集患者的一般资料、实验室检查和主观综合性营养评估等资料。借助食物模型、应用记账法进行连续7 d的膳食调查，获得患者蛋白质摄入量（DPI）及热能摄入量（DEI）。依据患者腹透液蛋白质平均丢失量分为低蛋白丢失组（＜5 g·d-1）和高蛋白丢失组（≥5 g·d-1），比较相关检测指标，应用logistic回归分析患者蛋白质丢失水平的影响因素。结果：CAPD患者腹透液蛋白质丢失量中位数5.0（1.7～21.1）g·d-1，平均占每日蛋白质总摄入量的13.0%（95%CI：10.8%～15.2%），最高达60.3%。腹透液蛋白质高丢失组患者血清白蛋白水平较低（P＜0.05），血肌酐和尿素氮水平较高（P＜0.05）。2组患者的前白蛋白、血红蛋白、转铁蛋白、主观综合性营养评估（SGA）评分、标准化蛋白质呈现率（nPNA）和人体测量指标体质量指数（BMI）、上臂肌围（MAMC）、上臂围（MAC）差别均无统计学意义（P＞0.05）。长期腹透、高腹膜转运、高血尿素氮和男性是腹透液蛋白质高丢失的危险因素。结论：CAPD患者可经腹透液丢失大量蛋白质，其丢失量与腹透时间长短、腹膜转运特性、血尿素氮水平和性别有关。腹透液蛋白质丢失量≥5 g·d-1可导致血清白蛋白降低。对于腹透液蛋白质丢失量≥5 g·d-1的患者，将目前的DPI水平（0.84±0.25）g·kg-1·d-1适当提高是有必要的。
목적：료해지속성비와상복막투석（CAPD）환자복투액단백질주실수평급기영향인소，위해류환자적림상영양지지제공이론의거。방법：선택2012년12월-2013년10월재모원복막투석중심접수CAPD치료3개월이상적비당뇨병뇨독증환자72례，완정수집환자적일반자료、실험실검사화주관종합성영양평고등자료。차조식물모형、응용기장법진행련속7 d적선식조사，획득환자단백질섭입량（DPI）급열능섭입량（DEI）。의거환자복투액단백질평균주실량분위저단백주실조（＜5 g·d-1）화고단백주실조（≥5 g·d-1），비교상관검측지표，응용logistic회귀분석환자단백질주실수평적영향인소。결과：CAPD환자복투액단백질주실량중위수5.0（1.7～21.1）g·d-1，평균점매일단백질총섭입량적13.0%（95%CI：10.8%～15.2%），최고체60.3%。복투액단백질고주실조환자혈청백단백수평교저（P＜0.05），혈기항화뇨소담수평교고（P＜0.05）。2조환자적전백단백、혈홍단백、전철단백、주관종합성영양평고（SGA）평분、표준화단백질정현솔（nPNA）화인체측량지표체질량지수（BMI）、상비기위（MAMC）、상비위（MAC）차별균무통계학의의（P＞0.05）。장기복투、고복막전운、고혈뇨소담화남성시복투액단백질고주실적위험인소。결론：CAPD환자가경복투액주실대량단백질，기주실량여복투시간장단、복막전운특성、혈뇨소담수평화성별유관。복투액단백질주실량≥5 g·d-1가도치혈청백단백강저。대우복투액단백질주실량≥5 g·d-1적환자，장목전적DPI수평（0.84±0.25）g·kg-1·d-1괄당제고시유필요적。
Objective: To explore the daily protein losses via dialysate and its inlfuencing factors in con-tinuous ambulatory peritoneal dialysis (CAPD) patients, to provide theoretical basis for clinical nutrition support. Methods: Seventy two non-diabetic nephropathy patients with uremia and treatment with CAPD for longer than 3 months were recruited during December 2012 to October 2013 from a general hospital. General information, laboratory testing data, and global assessment of nutritional information of the patients were collected. Dietary surveys were conducted for 7 consecutive days to obtain protein and energy intake in patients. According to the amount of protein losses after dialysis, patients were divided into two groups, low protein losses group (<5 g?d-1) and high protein losses group (≥5 g?d-1). Relevant indicators were compared between two groups, logistic re-gression analysis was applied to analyze the factors which affect the level of protein loss in patients.Results: The median of protein losses in CAPD dialysis patients was 5.0 (range: 1.7-21.1) g?d-1, which was about 13.0 per-cent of total daily protein intake (95%CI: 10.8%-15.2%). Patients in high protein losses group showed a lower serum albumin level (P<0.05 ), higher serum creatinine, and higher urea nitrogen levels (P<0.05). There was no statistically signiifcant difference between two groups in prealbumin, hemoglobin, transferrin, SGA score, nPNA and anthropometric measures such as BMI, MAMC, and MAC (P>0.05). Long dialysis duration, high peritoneal transport, high blood urea nitrogen, and male were risk factors of high protein losses by dialysate.Conclusion:CAPD patients may lose substantial amount of protein by dialysis solution, the loss amount is related with dura-tion of dialysis, peritoneal transport characteristics, blood urea nitrogen level, and gender. The protein losses over 5 g?d-1 by dialysate may lead to lower serum albumin level. In terms of patients whose protein loss amounts were higher than 5 g?d-1 by dialysate, it is necessary to improve their current DPI levels (0.84 ± 0.25) g?kg-1?d-1).