Teixidó J, Bayés B, Johnston S, Fernandez-Crespo P, Romero R
Nephrology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Adv Perit Dial. 1998;14:209-13.
To define protein anabolism or catabolism in our patients we retrospectively studied the 24-hour balances (B24 h), dietary protein intake (DPI), anthropometric parameters [body mass index (BMI), tricipital skin fold thickness (TF), and muscular arm circumference (MAC), using the rating scheme: undernourished (U): percentile (pc) < 15; normal (N): pc > 15 to pc < 85; obese (O): pc > 85], and urea kinetics (protein equivalent of nitrogen appearance) [PNA = PCR according to the Gotch-Borah (G), Blumenkrantz (B), and Randerson (R) formulas]. Nitrogen-balance [N-B = DPI(N)-PNA(N)], metabolic ratio (MR = DPI/PNA), and metabolic index (MI = IDPI/nPNA) were calculated as metabolic indicators. There were 215 evaluations (B24 h) in 44 patients, of whom 29 were male and 15 female, 35 on continuous ambulatory peritoneal dialysis (PD), 9 on automated PD, age 58.2 +/- 15.6 years, followed-up for 15.3 +/- 10.2 months. Undernourished patients (BMI) showed higher N-B, MR, and MI irrespective of the formula used, but MR was only significant using the Blumenkrantz formula. For N-balance and metabolic index, analysis of variance (ANOVA) was significant with all formulas. The mean metabolic index (Randerson) in subgroups was: U: 1.09 +/- 0.27, n = 54; N: 0.90 +/- 0.25, n = 135; O: 0.87 +/- 0.27, n = 26 (ANOVA: P < 0.0001). The U-N and U-O subgroup comparison was significant (Newman-Keuls P < 0.01). We concluded that: (1) The metabolic index is more discriminating for protein metabolism than N-balance or metabolic ratio. (2) Most of the undernourished patients (BMI) are anabolic according to metabolic index and N-balance, and this indicates recovery. (3) Undernourished (low BMI) patients with metabolic index < 1 deserve special attention due to the risk of remaining malnourished.
为了确定我们患者的蛋白质合成代谢或分解代谢情况，我们回顾性研究了24小时平衡（B24 h）、膳食蛋白质摄入量（DPI）、人体测量参数[体重指数（BMI）、三头肌皮褶厚度（TF）和上臂围（MAC），使用以下评级方案：营养不良（U）：百分位数（pc）<15；正常（N）：pc>15至pc<85；肥胖（O）：pc>85]以及尿素动力学（氮出现的蛋白质当量）[根据Gotch-Borah（G）、Blumenkrantz（B）和Randerson（R）公式计算的PNA = PCR]。计算氮平衡[N-B = DPI（N）-PNA（N）]、代谢率（MR = DPI/PNA）和代谢指数（MI = IDPI/nPNA）作为代谢指标。对44例患者进行了215次评估（B24 h），其中男性29例，女性15例，35例接受持续性非卧床腹膜透析（PD），9例接受自动化腹膜透析，年龄58.2±15.6岁，随访15.3±10.2个月。无论使用何种公式，营养不良患者（BMI）的氮平衡、代谢率和代谢指数均较高，但仅使用Blumenkrantz公式时代谢率才有统计学意义。对于氮平衡和代谢指数，所有公式的方差分析（ANOVA）均有统计学意义。亚组中的平均代谢指数（Randerson）为：U：1.09±0.27，n = 54；N：0.90±0.25，n = 135；O：0.87±0.27，n = 26（ANOVA：P<0.0001）。U-N和U-O亚组比较有统计学意义（Newman-Keuls检验P<0.01）。我们得出以下结论：（1）代谢指数比氮平衡或代谢率对蛋白质代谢的区分度更高。（2）根据代谢指数和氮平衡，大多数营养不良患者（BMI）处于合成代谢状态，这表明正在恢复。（3）代谢指数<1的营养不良（低BMI）患者因有持续营养不良的风险而值得特别关注。
