【摘要】目的生物电阻抗分析法(bioelectrical impedance analysis，BIA)可用来评估营养状况[相位角(phase angle，PA)]及容量状态[人体多余水分(over-hydration，OH)]，本研究通过BIA 评估持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)患者的营养状况与容量状态，探讨CAPD 患者PA 的影响因素及预估营养不良。方法纳入2017 年10 月～2020 年10 月于吉林大学第二医院腹膜透析中心行CAPD 的门诊患者200 例，入选患者开始腹膜透析(peritoneal dialysis，PD)3 个月后行BIA 检测，根据PA 的参考值，分为营养不良组(PA＜4.5°)和营养正常组(PA≥4.5°),回顾性分析患者的临床和实验室资料，探讨影响CAPD 患者PA 的相关因素，并预测营养不良的最佳临界值。结果200 例患者中营养不良的患病率为55.50%，营养不良组的患者较营养正常组OH 升高(Z= -5.984，P＜0.001)，而白蛋白、肌肉组织指数(lean tissue index，LTI)均下降(t 为3.823 和6.719, P 均＜0.001)，相关分析结果显示PA 与白蛋白(r=0.232,P=0.003)和LTI(r=0.556,P＜0.001)呈正相关,与OH 呈负相关(r=- 0.583,P＜0.001)。根据ROC 曲线结果，当OH 大于2.85L 或LTI 小于12.85kg/m2 或白蛋白低于35.05g/L 时，CAPD 患者出现营养不良的可能性大，此时的特异性(分别为67.50%、74.70%、40.30%)及敏感性(分别为71.40%、67.10%、86.30%)都相对较高。结论在CAPD 患者中营养不良的现象普遍存在，可结
合OH、LTI 及白蛋白水平预估患者的营养状况。纠正CAPD 患者的营养不良，不仅要对患者予以营养支持，同时要积极纠正患者的容量超负荷状态。
【Abstract】Objective Bioelectrical impedance analysis (BIA) can be used to evaluate the nutrition status by phase angle (PA) and the volume status of overhydration (OH). This study investigated the nutrition status and the volume status by BIA in patients with continuous ambulatory peritoneal dialysis (CAPD), to explore the influencing factors of PA and the prediction of malnutrition by PA. Methods 200 CAPD patients in the Peritoneal Dialysis Center of the Second Hospital, Jilin University during October 2017 to October 2020 were enrolled. Patients subjected to BIA 3 months after peritoneal dialysis. Patients were then divided into
malnutrition group (PA＜4.5° ) and normal nutrition group (PA≥4.5° ) based on the reference PA value. Their clinical and laboratory data were collected and compared. The factors affecting PA in CAPD patients and the optimal value for the prediction of malnutrition were explored. Results The prevalence of malnutrition was 55.50% in the 200 CAPD patients. Compared with normal nutrition group, the prevalence of OH was higher (Z=-5.984, P<0.001), while the levels of albumin and lean tissue index (LTI) were lower (t=3.823 and 6.719, P<0.001) in malnutrition group. Univariate correlation analyses showed that PA was positively correlated with albumin (r=0.232, P=0.003) and LTI (r=0.556, P <0.001), and was negatively correlated with OH (r=- 0.583, P<0.001). ROC curve shows that when the values are set at >2.85L for OH, <12.85kg/m2 for LTI and <35.05g/L for albumin for the prediction of malnutrition in CAPD patients, the specificities are 67.50%, 74.70% and 40.30% respectively, and the sensitivities are 71.40%, 67.10% and 86.30% respectively. Conclusion Malnutrition is relatively prevalent in CAPD patients. Clinically, the values of OH, LTI and albumin are useful to estimate nutrition status in CAPD patients. In addition to nutritional support, correction of OH is also important to treat malnutrition in CAPD patients.
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