CAJ | 학술논문

目的：探讨腹膜透析患者蛋白质-能量消耗（PEW）与腹膜炎发生率的相关性。方法对行维持性腹膜透析（PD）的患者运用改良 SGA 法评分系统（MQSGA）、营养不良-炎症评分（MIS）和血清总蛋白、白蛋白等进行营养评估，采用酶联免疫方法（ELISA）检测血清超敏 C 反应蛋白（Hs - CRP）、白细胞介素-6（IL -6）浓度进行微炎症状态评估，同时检测患者人体学指标、生化指标以及24 h 腹透液蛋白丢失量、瘦素等指标。随后将所有患者依据 PEW 不同分为合并 PEW 组和非 PEW 组，比较两组间腹膜炎的发生率。结果 MQSGA 和 MIS 与 Hs - CRP、IL -6显著正相关。MQSGA 和 MIS 与身体质量指数（BMI）、中臂围（MAC）、肱三头肌皮褶厚度（TSF）、中臂肌围（MAMC）、白蛋白（ALB）、血肌酐（Scr）、血红蛋白（Hb）、尿素氮（BUN）、转铁蛋白（TF）、总铁结合力（TIBC）显著负相关。60例 PD 患者中，PEW 者30例，非 PEW 者30例。与非 PEW 组相比，PEW 组的 MQSGA 分值更高，MIS 分值更高，PEW 组患者 BMI、ALB、Scr 显著降低，hs - CRP、IL -6、24 h 腹透液蛋白丢失量及瘦素显著升高，两组比较差异具有统计学意义（ P <0.05）。PEW 组与非 PEW 组腹膜炎发生率分别为44.7％和10.0％，PEW 组腹膜炎发生率显著高于非 PEW 组（ P <0.01）。结论①MQSGA 和 MIS 可较好评价慢性肾脏病 PD 患者的 PEW，合并 PEW 的 PD 患者，其腹膜炎发生率也较高，PEW 可预测 PD患者发生腹膜炎的风险。②PEW 与瘦素水平、24 h 腹透液蛋白丢失量、微炎症状态等相关。
목적：탐토복막투석환자단백질-능량소모（PEW）여복막염발생솔적상관성。방법대행유지성복막투석（PD）적환자운용개량 SGA 법평분계통（MQSGA）、영양불량-염증평분（MIS）화혈청총단백、백단백등진행영양평고，채용매련면역방법（ELISA）검측혈청초민 C 반응단백（Hs - CRP）、백세포개소-6（IL -6）농도진행미염증상태평고，동시검측환자인체학지표、생화지표이급24 h 복투액단백주실량、수소등지표。수후장소유환자의거 PEW 불동분위합병 PEW 조화비 PEW 조，비교량조간복막염적발생솔。결과 MQSGA 화 MIS 여 Hs - CRP、IL -6현저정상관。MQSGA 화 MIS 여신체질량지수（BMI）、중비위（MAC）、굉삼두기피습후도（TSF）、중비기위（MAMC）、백단백（ALB）、혈기항（Scr）、혈홍단백（Hb）、뇨소담（BUN）、전철단백（TF）、총철결합력（TIBC）현저부상관。60례 PD 환자중，PEW 자30례，비 PEW 자30례。여비 PEW 조상비，PEW 조적 MQSGA 분치경고，MIS 분치경고，PEW 조환자 BMI、ALB、Scr 현저강저，hs - CRP、IL -6、24 h 복투액단백주실량급수소현저승고，량조비교차이구유통계학의의（ P <0.05）。PEW 조여비 PEW 조복막염발생솔분별위44.7％화10.0％，PEW 조복막염발생솔현저고우비 PEW 조（ P <0.01）。결론①MQSGA 화 MIS 가교호평개만성신장병 PD 환자적 PEW，합병 PEW 적 PD 환자，기복막염발생솔야교고，PEW 가예측 PD환자발생복막염적풍험。②PEW 여수소수평、24 h 복투액단백주실량、미염증상태등상관。
Objective To evaluate the correlation of the peritonitis incidence with protein - energy consumption(PEW)in peritoneal di-alysis patients. Methods In the patients with continuous ambulatory peritoneal dialysis,nutritional assessment was applied by the method of im-proved SGA score system(MQSGA),malnutrition - inflammation score(MIS)and serum total protein and albumin. The enzyme - linked immune method(ELISA)was used to detect the concentration of serum hypersensitive c - reactive protein(Hs - CRP)and interleukin - 6(IL - 6)for assessment micro inflammatory condition. At the same time,the somatology,biochemical indicators and 24 hours protein lost of drain fluid a-mount,leptin were detected. Then all of the patients by the protein - based on energy consumption(PEW)divided into merger PEW group and non - PEW group. The incidence of peritonitis of the two groups was compared. Results MQSGA and MIS with Hs CRP,IL - 6 were signifi-cantly positive correlation. MQSGA and MIS and body mass index(BMI),the arm circumference(MAC),triceps skinfold(TSF)and arm mus-cle circumference(MAMC),albumin(ALB),and serum creatinine(Scr),hemoglobin(Hb),urea nitrogen(BUN),transferrin(TF)and total iron binding force(TIBC)were significant negative correlation. In all 60 cases of PD patients,30 cases were the PEW group,other 30 cases of the non - PEW group. Compared with the non - PEW group,the MQSGA score and MIS score of PEW group were higher. Compared with the non- PEW group,the BMI,ALB,Scr of PEW group significantly decreased. The leptin,IL - 6,hs - CRP and protein loss quantity of the PEW group significantly increased. The increasing of these indexes showed significant differences between the two groups( P < 0. 05). The peritonitis rates in PEW group and non - PEW respectively were 44. 7% and 10. 0% ,the peritonitis rates of PEW group was significantly higher than those in non - PEW group( P < 0. 01). Conclusion ①Higher incidence of peritonitis existed at the patient of PD with PEW. PEW increased the risk of peritonitis. ②The PEW and leptin levels,24 hours protein lost of drain fluid amount,micro inflammation may be relevant.