目的 探讨血液透析患者在补充口服营养补充剂后蛋白质-能量消耗(protein-energy wasting,PEW)的改善效果。 方法 收集江西省6所医院中进行维持性血液透析3个月以上且符合PEW诊断的患者共90例，按1:1的比例随机分为对照组及试验组各45人，对2组患者个体按标准体质量计算各营养素需要量后，进行膳食指导，试验组以口服营养补充剂[乐析能补充剂1罐/日(含热量450kcal，20.3g蛋白质)]代替，连续治疗3个月。观察补充乐析能前和试验3个月后2组的体质量指数、血红蛋白、白蛋白等实验室指标以及安全性效果评估等相关参数的变化。 结果 共纳入90例患者，最终有84例患者(对照组41例，试验组43例)按要求完成了全部试验，其中入组患者的平均年龄为(61.6±11.39)岁，男性47例(55.95%)。干预前对照组能量及蛋白质摄入分别为(1461.69±379.95)kcal,(53.81±21.87)g；试验组为(1522.14±402.27)kcal,(54.92±16.61)g，2组的能量及蛋白质平均摄入无统计学差异 (t=0.269，P=0.650；t=0.122，P=0.422)，2组间钾、钙、铁、磷等矿物质摄入平均水平无统计学差异 (t=0.777，1.485，-0.853，-0.012，P=0.497，0.332，0.065，0.352)。干预3个月后,对照组体质量、体质量指数等体格测量相关数据的变化较试验前变化不明显(t=0.977、1.038，P=0.343，0.315)，试验组干预前后体质量、体质量指数升高，主观综合性营养评分(subjective global assessment,SGA)下降(t =-2.325、
-2.257、3.598，P=0.027，0.032，0.001)；2组血清白蛋白、血红蛋白均较干预前上升，其中试验组血清白蛋白上升更明显[试验组前后差值=(3.40±3.78)g/L，对照组干预前后差值=(1.48±3.5)g/L，t=2.415，P=0.018]；试验组血钙升高幅度高于对照组(t=3.126,P=0.002)，试验组血糖变化幅度小于对照组(t=2.083,P=0.045)。 结论 维持性血液透析患者持续给予营养补充剂乐析能可从多方面有效改善血液透析患者PEW症状及其它并发症。
Objectives: To investigate the improvement of protein-energy wasting (PEW) in hemodialysis patients after supplementation with Lexineng nutritional supplements. Methods: A total of 90 patients who had been on maintenance haemodialysis for more than 3 months and met the diagnosis of PEW in the hemodialysis units of 6 hospitals in Jiangxi Province were collected and randomly divided into a control group and a test group of 45 patients each. After the patients were given dietary instructions, the corresponding number of calories in the test group was replaced by one can of Lexineng supplement daily for 3 months. Changes in body mass index, laboratory parameters such as haemoglobin and albumin and assessment of safety effects were observed in both groups before and after 3 months of treatment with Lexineng supplementation.Results:A total of 90 patients were included in the study and 84 patients (41 in the control group and 43 in the trial group) eventually completed the trial as required, of whom 47 (55.95%) were male and the mean age was (61.6±11.39) years. The mean mineral intake levels were similar and the differences in the indicators between the two groups were not significant (p>0.05). After 3 months of the trial, the results showed that the changes in body measurements such as weight (Wt) and BMI in the control group were not significant compared to those before the trial (p>0.05), while the Wt、BMI increased significantly and the subjective global assessment (SGA) decreased significantly in the trial group (p<0.05). Serum albumin (Alb) and haemoglobin increased in both groups compared to the pre-test, with Alb and haemoglobin increasing more significantly in the test group (p<0.001), and albumin and haemoglobin were significantly higher compared to the control group (p<0.05); Leukodystrophy was also significant in reducing serum creatinine levels and increasing serum calcium concentrations (p<0.05), and was able to reduce blood glucose levels without increasing the fat burden.Conclusion: Sustained supplementation with Lexineng on maintenance hemodialysis is effective in improving PEW symptoms and other complications in haemodialysis patients in many ways.
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