【摘要】目的探讨口服营养补充对维持性血液透析蛋白质能量消耗(PEW)患者的营养状况影响。方法采取7 分主观整体评估(SGA)方法对2013 年1 月～2014 年12 月在广州市红十字会医院血液净化中心进行维持性血液透析的患者192 人进行PEW 患病率调查，并对符合纳入标准的PEW 患者62 人随机分为对照组和口服营养补充组(ONS)，每组各31 人，观察其干预前后SGA 评分及营养状况指标的变化。结果本中心维持性血液透析患者PEW 的患病率为39.1%(75/192)。与对照组比较，ONS 干预后可明显改善血清白蛋白(37.19±1.54 比35.18±5.11)g/L、前白蛋白(305.74±43.20 比275.68±65.23)mg/L、转铁蛋白(1.43±0.25 比1.28±0.25)g/L 水平，差异有统计学意义(P＜0.05)；ONS 可增加SGA 评分、体质量、体质量指数、上臂围、上臂肌围，并降低血清C 反应蛋白水平，但差异无统计学意义(P＞0.05)。两组间肱三头肌皮褶厚度、血清总三酰甘油、总胆固醇水平无明显差异(P＞0.05)。结论维持性血液透析患者患者蛋白质能量消耗患病率高，口服营养补充可改善血液透析PEW 患者的营养状况指标，有可能可改善血液透析患者的PEW状况。

【Abstract】Objective To study the effect of oral nutrition supplement on nutritional status in maintenance hemodialysis (MHD) patients with protein-energy wasting (PEW). Method We investigated the prevalence of PEW by the 7-point subjective global assessment (SGA) in 192 MHD patients treated in the Blood
Purification Center of Guangzhou Red Cross Hospital in the duration from Jan. 2013 to Dec. 2014. Sixty-two MHD patients with PEW were randomly divided into control group (n=31) or oral nutrition supplement group (ONS, n=31). Changes of SGA score and nutritional status markers after intervention were compared between the two groups. Result The prevalence of PEW was 39.1% (75/192) in our center. After intervention in ONS group, serum albumin (37.19±1.54 vs. 35.18±5.11 g/L), prealbumin (305.74±43.20 vs. 275.68±65.23 mg/ L), and transferrin (1.43±0.25 vs. 1.28±0.25 g/L) increased significantly (P＜0.05) as compared with those in control group. SGA score, body weight, body mass index, upper arm circumference, and arm muscle circumference increased and C reactive protein level decreased in ONS group but without statistical significance (P＞ 0.05). Triceps skinfold thickness, total serum triglyceride and cholesterol levels were indifferent between the two groups (P＞0.05). Conclusion The prevalence of PEW was higher in MHD patients. Oral nutrition supplement can improve the nutritional status in MHD patients with PEW.