PDF(934 KB)
PDF(934 KB)
PDF(934 KB)
慢性肾脏病5期维持性血液透析患儿营养状态的评估
An assessment of nutritional status in children on maintenance hemodialysis due to stage 5 chronic kidney disease
目的 研究儿童慢性肾脏病（CKD）5期维持性血液透析患者营养状态，探讨各营养评估指标的临床意义。方法 对21例CKD 5期维持性血液透析患儿按体重指数进行分组，根据人体测量指标、生物化学指标、炎症指标、残存肾功能及透析充分性指标、静息能量消耗指标等进行营养状态评估，分析营养不良患儿与营养正常患儿相关指标的差异。结果 21例患儿中，营养不良10例，营养正常11例。营养不良组与营养正常组人体测量指标之间差异有统计学意义（P < 0.05）；两组间瘦素、胰岛素样生长因子1的比较差异有统计学意义（P < 0.05）；两组间IL-1、IL-6、TNF-α的比较差异有统计学意义（P < 0.05）；两组间平均24 h残余尿量的比较差异有统计学意义（P < 0.05）。而两组间白蛋白、前白蛋白、胆固醇的比较差异无统计学意义；两组间尿素清除指数（Kt/V）及实测静息能量消耗值的比较差异亦无统计学意义。结论 人体测量指标、生物化学指标、残存肾功能、炎症因子对CKD 5期维持性血液透析患儿营养状况评估具有重要的价值，而静息能量消耗测定对于CKD 5期维持性血液透析患儿营养状况评估和监测的应用价值有待研究。
Objective To investigate the nutritional status of children on maintenance hemodialysis due to stage 5 chronic kidney disease (CKD) and the clinical significance of nutritional assessment indices. Methods A total of 21 children on maintenance hemodialysis due to stage 5 CKD were grouped according to body mass index. The nutritional status was assessed based on anthropometric parameters, biochemical parameters, inflammatory factors, residual renal function, indices of dialysis adequacy, and resting energy expenditure. Related indices were compared between the children with malnutrition and those with normal nutritional status. Results Of the 21 children, 10 had malnutrition and 11 had normal nutritional status. There were significant differences between the two groups in anthropometric parameters, levels of leptin, insulin-like growth factor-1, interleukin-1, interleukin-6, and tumor necrosis factor-α, and mean 24-hour residual urine volume (P < 0.05), while there were no significant differences in albumin, prealbumin, cholesterol, urea clearance index (Kt/V), and measured resting energy expenditure. Conclusions Anthropometric parameters, biochemical parameters, residual renal function, and inflammatory factors have an important value in evaluating the nutritional status of children with stage 5 CKD on maintenance hemodialysis. Further studies are needed to investigate the value of the measurement of resting energy expenditure in the evaluation and monitoring of nutritional status in children with stage 5 CKD on maintenance hemodialysis.
[1] National Kidney Foundation Kidney Disease Quality Outcome Initiative (K/DOQI). Clinical practice guideline for nutrition in children with CKD:2008 update[J]. Am J Kidney Dis, 2009, 53(3 Suppl 2):S1-S123.
[2] 全国儿童常见肾脏病诊治现状调研工作组. 慢性肾衰竭肾脏替代治疗现状调查多中心研究[J]. 中华儿科杂志, 2013, 51(7):491-494.
[3] 李辉, 季成叶, 宗心南, 等. 中国0~18岁儿童、青少年身高、体重的标准化生长曲线[J]. 中华儿科杂志, 2009, 47(7):487-492.
[4] 李辉, 季成叶, 宗心南, 等. 中国0~18岁儿童、青少年体块指数的生长曲线[J]. 中华儿科杂志, 2009, 47(7):493-498.
[5] Becherucci F, Roperto RM, Materassi M, et al. Chronic kidney disease in children[J]. Clin Kidney J, 2016, 9(4):583-591.
[6] Mastrangelo A, Paglialonga F, Edefonti A. Assessment of nutritional status in children with chronic kidney disease and on dialysis[J]. Pediatr Nephrol, 2014, 29(8):1349-1358.
[7] Zha Y, Qian Q. Protein nutrition and malnutrition in CKD and ESRD[J]. Nutrients, 2017, 9(3). pii:E208.
[8] Nehus E, Furth S, Warady B, et al. Correlates of leptin in children with chronic kidney disease[J]. J Pediatr, 2014, 165(4):825-829.
[9] Bach LA, Hale LJ. Insulin-like growth factors and kidney disease[J]. Am J Kidney Dis, 2015, 65(2):327-336.
[10] Tu J, Cheung WW, Mak RH. Inflammation and nutrition in children with chronic kidney disease[J]. World J Nephrol, 2016, 5(3):274-282.
[11] Lee BT, Ahmed FA, Hamm LL, et al. Association of C-reactive protein, tumor necrosis factor-alpha and interleukin-6 with chronic kidney disease[J]. BMC Nephrol, 2015, 16:77.
[12] Beberashvili I, Erlich A, Azar A, et al. Longitudinal study of serum uric acid, nutritional status, and mortality in maintenance hemodialysis patients[J]. Clin J Am Soc Nephrol, 2016, 11(6):1015-1023.
[13] den Hoedt CH, Bots ML, Grooteman MP, et al. Clinical predictors of decline in nutritional parameters over time in ESRD[J]. Clin J Am Soc Nephrol, 2014, 9(2):318-325.
[14] Shah A, Bross R, Shapiro BB, et al. Dietary energy requirements in relatively healthy maintenance hemodialysis patients estimated from long-term metabolic studies[J]. Am J Clin Nutr, 2016, 103(3):757-765.
[15] Avesani CM, Kamimura MA, Cuppari L. Energy expenditure in chronic kidney disease patients[J]. J Ren Nutr, 2011, 2(1):27-30.
