Yadav Sanjay, Ali Uma S, Deshmukh Manoj
Department of Pediatrics, Lilavati Hospital and Research Centre, A 791, Bandra Reclamation, Gen Arun Kumar Vaidya Nagar, Bandra West, Mumbai, 400050, India.
Department of Radiology, Lilavati Hospital and Research Centre, A 791, Bandra Reclamation, Gen Arun Kumar Vaidya Nagar, Bandra West, Mumbai, 400050, India.
Pediatr Nephrol. 2024 May;39(5):1491-1497. doi: 10.1007/s00467-023-06060-3. Epub 2023 Jul 29.
The current diagnosis of protein energy wasting (PEW) is based on scoring systems that lack precision in measuring muscle deficits. We undertook this cross-sectional study to determine the prevalence of PEW in children with chronic kidney disease (CKD) using a scoring system that included dual energy x-ray absorptiometry (DEXA) for measuring lean body mass (LBM) and to determine the prevalence of selected markers in PEW.
Thirty CKD and 20 healthy children (1-18 years) were evaluated for (1) reduced dietary protein intake (DPI); (2) BMI < fifth centile for height age (BMI/HA); (3) serum albumin < 3.8 g/dl, cholesterol < 100 mg/dl, or CRP > 3 mg/L; (4) LBM < fifth centile for height age [LBMr] on DEXA. PEW was scored as minimal-one parameter positive in 2/4 categories; standard-one parameter positive in 3/4 categories; or modified-standard plus height < 2 SD.
Twenty children with CKD (66.7%) had PEW, (5/9) 55% in CKD 3, and (15/21) 71% in advanced CKD; minimal 12, standard 1, and modified 7. LBMr was seen in 20 (100%), reduced DPI in 16 (80%), and BMI/HA in 6 (30%) children with PEW. LBMr had 100% sensitivity and BMI/HA 100% specificity. LBMr was seen in 8 who had no other criteria for PEW. None of the parameters were positive in controls (p < 0.01).
PEW prevalence in CKD was high. Both prevalence and severity were higher in advanced CKD. LBMr was a highly sensitive marker to detect PEW. LBMr seen in some children with CKD who were negative for other markers could represent subclinical PEW.
目前蛋白质能量消耗（PEW）的诊断基于评分系统，而这些系统在测量肌肉缺陷方面缺乏精确性。我们开展了这项横断面研究，以使用包含双能X线吸收法（DEXA）测量瘦体重（LBM）的评分系统来确定慢性肾脏病（CKD）患儿中PEW的患病率，并确定PEW中选定标志物的患病率。
对30名CKD患儿和20名健康儿童（1至18岁）进行评估，评估内容包括：（1）膳食蛋白质摄入量（DPI）减少；（2）BMI低于身高年龄的第五百分位数（BMI/HA）；（3）血清白蛋白<3.8 g/dl、胆固醇<100 mg/dl或CRP>3 mg/L；（4）DEXA测量的LBM低于身高年龄的第五百分位数[LBMr]。PEW的评分标准为：轻度——2/4项指标阳性；标准型——3/4项指标阳性；或改良型——标准型加身高<2个标准差。
20名CKD患儿（66.7%）患有PEW，CKD 3期患儿中（5/9）55%患病，晚期CKD患儿中（15/21）71%患病；轻度12例，标准型1例，改良型7例。20例（100%）PEW患儿存在LBMr降低，16例（80%）存在DPI减少，6例（30%）存在BMI/HA降低。LBMr的敏感性为100%，BMI/HA的特异性为100%。8名无其他PEW标准的患儿存在LBMr降低。对照组中无任何参数为阳性（p<0.01）。
CKD患儿中PEW的患病率较高。晚期CKD的患病率和严重程度更高。LBMr是检测PEW的高度敏感标志物。一些其他标志物为阴性的CKD患儿中出现的LBMr降低可能代表亚临床PEW。
