家庭血液透析与常规血液透析患者的人体成分：一项横断面、匹配、对照研究。
Body composition in home haemodialysis versus conventional haemodialysis: a cross-sectional, matched, comparative study.
机构信息
Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia.
出版信息
Nephrol Dial Transplant. 2010 Feb;25(2):568-73. doi: 10.1093/ndt/gfp490. Epub 2009 Sep 17.
BACKGROUND
Nutritional status predicts outcome in dialysis populations. Increased dialysis time and/or frequency reportedly improves nutritional status. We examined the impact of more intensive dialysis on body composition.
METHODS
A cross-sectional, matched study comparing home haemodialysis (HHD) patients (>15 h/week, n = 28) and conventional haemodialysis (CHD) patients (<15 h/ week, n = 28), matched for age, sex, length of time on dialysis and diabetes, was performed. We measured total body protein (TBP) by in vivo neutron activation, total body fat (TBF) and skeletal muscle mass (SKMM) by dual-energy x-ray absorptiometry (DEXA) and biochemical and inflammatory parameters. Visceral (VFA) and subcutaneous fat areas (SFA) were determined from computed tomography.
RESULTS
There was no significant difference in TBP (10.2 +/- 1.9 kg CHD versus 10.8 +/- 1.8 kg HHD, P = 0.18) or SKMM (25.6 +/- 5.6 kg CHD versus 26.2 +/- 4.2 kg HHD). TBF was not different (27.7 +/- 10.7 kg CHD versus 27.8 +/- 16.0 kg HHD), although the HHD group had greater VFA (182.0 +/- 105.6 cm(2) versus 173.8 +/- 90.1 cm(2)) and lower SFA (306.7 +/- 176.4 cm(2) versus 309.7 +/- 138.1 cm(2)), the difference was not statistically significant. Albumin concentrations were significantly increased in the HHD group (37.5 +/- 3.56 g/L versus 35.18 +/- 4.11 g/L, P = 0.03), whilst phosphate concentrations (1.57 +/- 0.41 mmol/LHHD versus 1.92 +/- 0.62 mmol/ LCHD, P = 0.02) and inflammatory parameters were lower. There was a positive relationship between hours of dialysis and TBP (beta = 0.08; P = 0.03).
CONCLUSION
Surrogate nutritional markers and inflammatory parameters improved with more intensive dialysis, but this was not reflected by improved body composition. Further prospective studies are required to confirm whether more intensive dialysis affects body composition, and whether this impacts on metabolic risk and clinical outcome.
背景
营养状况可预测透析人群的预后。据报道，增加透析时间和/或频率可改善营养状况。我们研究了更强化透析对身体成分的影响。
方法
进行了一项横断面、匹配研究，比较了家庭血液透析（HHD）患者（>15 小时/周，n=28）和常规血液透析（CHD）患者（<15 小时/周，n=28），两组在年龄、性别、透析时间和糖尿病方面相匹配。我们通过体内中子激活法测量总体蛋白（TBP），通过双能 X 射线吸收法（DEXA）测量总体脂肪（TBF）和骨骼肌质量（SKMM），并测量生化和炎症参数。通过计算机断层扫描确定内脏（VFA）和皮下脂肪面积（SFA）。
结果
CHD 组的 TBP（10.2±1.9kg 与 HHD 组的 10.8±1.8kg，P=0.18）或 SKMM（25.6±5.6kg 与 HHD 组的 26.2±4.2kg）无显著差异。TBF 也没有差异（CHD 组为 27.7±10.7kg 与 HHD 组为 27.8±16.0kg），尽管 HHD 组的 VFA 更大（182.0±105.6cm²与 173.8±90.1cm²），SFA 更小（306.7±176.4cm²与 309.7±138.1cm²），但差异无统计学意义。HHD 组的白蛋白浓度显著升高（37.5±3.56g/L 与 35.18±4.11g/L，P=0.03），而磷酸盐浓度（1.57±0.41mmol/L 与 1.92±0.62mmol/L，P=0.02）和炎症参数较低。透析时间与 TBP 呈正相关（β=0.08；P=0.03）。
结论
替代营养标志物和炎症参数随着透析的强化而改善，但身体成分并未改善。需要进一步的前瞻性研究来证实更强化的透析是否会影响身体成分，以及这是否会影响代谢风险和临床结果。
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