Bossola Maurizio, La Torre Giuseppe, Giungi Stefania, Tazza Luigi, Vulpio Carlo, Luciani Giovanna
Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy.
Am J Nephrol. 2008;28(3):405-12. doi: 10.1159/000112597. Epub 2007 Dec 14.
The present study aimed at making prospective longitudinal measurements of nutritional and inflammatory parameters to determine whether nutritional and inflammatory status decline or increase over time in a cohort of prevalent hemodialysis patients, and to evaluate which factors influence eventual changes.
64 hemodialysis patients were followed at 0, 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, and 36 months. At each follow-up visit, dry body weight, serum albumin, serum total cholesterol, total white blood cells, total lymphocyte count, serum glucose, C-reactive protein, ferritin, fibrinogen, hemoglobin, and weekly erythropoietin dose were assessed.
Changes in nutritional and inflammatory parameters over time.
43 patients completed the study at 36 months. Mean serum albumin levels (g/dl) improved significantly between baseline (3.76 +/- 0.24) and 36 months (3.93 +/- 0.27) (F = 4.005; p = 0.0009). Dialytic age was significantly associated with changes of serum albumin (F = 2.797; p = 0.028). The mean dry weight slightly remained stable over time (F = 1.473; p = 1.0) as well as the level of total cholesterol (p = 0.77) and lymphocyte count (F = 1.539; p = 0.186). Over time, the levels of C-reactive protein tended to decrease, although the differences were not statistically significant (F = 1.332; p = 0.19). Over time, the serum level of fibrinogen (F = 0.422; p = 0.17) and ferritin (F = 0.314; p = 0.52) remained stable. The number of white blood cells significantly decreased over time (F = 4.691; p = 0.0079) and dialytic age (F = 3.214; p = 0.015) was the variable significantly associated with such decline. The hemoglobin levels (F = 1.423; p = 0.14) and the weekly erythropoietin dose did not change significantly during the study (F = 1.019; p = 0.61), nor did the serum glucose levels (F = 1.231; p = 0.10).
These results support the hypothesis that end-stage renal disease and HD are not necessarily associated with deterioration of the nutritional status over time.
本研究旨在对营养和炎症参数进行前瞻性纵向测量，以确定一组维持性血液透析患者的营养和炎症状态随时间推移是下降还是上升，并评估哪些因素会影响最终的变化。
64例血液透析患者在0、3、6、9、12、15、18、21、24、27、30、33和36个月时接受随访。在每次随访时，评估干体重、血清白蛋白、血清总胆固醇、白细胞总数、淋巴细胞总数、血清葡萄糖、C反应蛋白、铁蛋白、纤维蛋白原、血红蛋白以及每周促红细胞生成素剂量。
营养和炎症参数随时间的变化。
43例患者在36个月时完成研究。基线时平均血清白蛋白水平（g/dl）为3.76±0.24，36个月时为3.93±0.27，显著改善（F = 4.005；p = 0.0009）。透析龄与血清白蛋白变化显著相关（F = 2.797；p = 0.028）。平均干体重随时间略有稳定（F = 1.473；p = 1.0），总胆固醇水平（p = 0.77）和淋巴细胞计数（F = 1.539；p = 0.186）也是如此。随着时间推移，C反应蛋白水平有下降趋势，尽管差异无统计学意义（F = 1.332；p = 0.19）。随着时间推移，纤维蛋白原（F = 0.422；p = 0.17）和铁蛋白（F = 0.314；p = 0.52）的血清水平保持稳定。白细胞数量随时间显著减少（F = 4.691；p = 0.0079），透析龄（F = 3.214；p = 0.015）是与这种下降显著相关的变量。在研究期间，血红蛋白水平（F = 1.423；p = 0.14）和每周促红细胞生成素剂量没有显著变化（F = 1.019；p = 0.61），血清葡萄糖水平也没有变化（F = 1.231；p = 0.10）。
这些结果支持以下假设，即终末期肾病和血液透析不一定会随着时间的推移导致营养状况恶化。
