液体状态对腹膜透析患者身体成分评估技术的影响。

Influence of fluid status on techniques used to assess body composition in peritoneal dialysis patients.

作者信息

Konings Constantijn J A M, Kooman Jeroen P, Schonck Marc, van Kreel Bernardus, Heidendal Guido A K, Cheriex Emile C, van der Sande Frank M, Leunissen Karel M L

机构信息

Department of Internal Medicine, University Hospital Maastricht, The Netherlands.

出版信息

Perit Dial Int. 2003 Mar-Apr;23(2):184-90.

PMID:12713087

Abstract

OBJECTIVE

A reliable assessment of nutritional state in peritoneal dialysis (PD) patients is of great importance. Nevertheless, techniques used to assess body composition in patients on PD may be affected by abnormalities in fluid status. The primary aim of the present study was to compare different techniques used to evaluate body composition and to assess the influence of fluid status on the assessment of body composition. The secondary aim was to assess the relevance of handgrip muscle strength in the nutritional evaluation of the patient.

METHODS

In 40 PD patients, dual-energy x-ray absorptiometry (DEXA), multifrequency bioimpedance analysis (MF-BIA), and anthropometry were compared with respect to the evaluation of body composition [fat mass and lean body mass (LBM; by DEXA), and fat-free mass (FFM; by MF-BIA, anthropometry]. The influence of fluid status on the measurement of LBM/FFM by the various techniques was assessed by their relation to left ventricular end-diastolic diameter (LVEDD), assessed by echocardiography, and by estimating the ratio between extracellular water (ECW) and total body water (TBW), assessed by bromide and deuterium dilution, with LBM (DEXA). The relevance of handgrip muscle strength as a nutritional parameter was assessed by its relation to LBM and other nutritional parameters.

RESULTS

Despite highly significant correlations, wide limits of agreement between the various techniques were present with respect to assessment of body composition (expressed as % body weight) and were most pronounced for anthropometry: LBM (DEXA) - FFM (MF-BIA) = 3.4% +/- 12.2%; LBM (DEXA) - FFM (anthropometry) = -5.7% +/- 7.8%; fat mass (DEXA - MF-BIA) = -4.2% +/- 7.9%; fat mass (DEXA - anthropometry) = 2.9% +/- 7.2%. The ratio between ECW and LBM (DEXA) was 0.36 +/- 0.08 L/kg (range 0.25 - 0.67 L/kg), and the ratio between TBW and LBM was 0.75 +/- 0.06 L/kg (range 0.63 - 0.86 L/kg), which shows the variability in hydration state of LBM/FFM between individual patients. LBM/FFM measured by all three techniques was significantly related to LVEDD, suggesting an important influence of hydration state on this parameter. Handgrip muscle strength was significantly related to LBM/FFM, as measured by all three techniques, but not to other nutritional parameters.

CONCLUSION

Wide limits of agreement were found between various techniques used to assess body composition in PD patients. The assessment of body composition was strongly influenced by hydration state. The handgrip test is related to body composition, but not to other nutritional parameters.

摘要

目的

可靠评估腹膜透析（PD）患者的营养状况至关重要。然而，用于评估PD患者身体成分的技术可能会受到液体状态异常的影响。本研究的主要目的是比较用于评估身体成分的不同技术，并评估液体状态对身体成分评估的影响。次要目的是评估握力肌肉力量在患者营养评估中的相关性。

方法

在40例PD患者中，比较了双能X线吸收法（DEXA）、多频生物电阻抗分析（MF-BIA）和人体测量法在身体成分评估方面的差异[脂肪量和瘦体重（LBM；通过DEXA），以及去脂体重（FFM；通过MF-BIA、人体测量法）]。通过各种技术测量的LBM/FFM与左心室舒张末期内径（LVEDD）的关系评估液体状态对其测量的影响，LVEDD通过超声心动图评估，通过溴化物和氘稀释法评估细胞外液（ECW）与总体水（TBW）的比例，并与LBM（DEXA）进行比较。通过握力肌肉力量与LBM和其他营养参数的关系评估其作为营养参数的相关性。

结果

尽管各种技术之间存在高度显著的相关性，但在身体成分评估（以体重百分比表示）方面，各种技术之间存在广泛的一致性界限，人体测量法最为明显：LBM（DEXA）-FFM（MF-BIA）=3.4%±12.2%；LBM（DEXA）-FFM（人体测量法）=-5.7%±7.8%；脂肪量（DEXA-MF-BIA）=-4.2%±7.9%；脂肪量（DEXA-人体测量法）=2.9%±7.2%。ECW与LBM（DEXA）的比例为0.36±0.08 L/kg（范围0.25-0.67 L/kg），TBW与LBM的比例为0.75±0.06 L/kg（范围0.63-0.86 L/kg），这表明个体患者之间LBM/FFM水合状态的变异性。通过所有三种技术测量的LBM/FFM与LVEDD显著相关，表明水合状态对该参数有重要影响。握力肌肉力量与通过所有三种技术测量的LBM/FFM显著相关，但与其他营养参数无关。