維持性血液透析患者維生素D濃度與營(yíng)養(yǎng)狀況的相關(guān)研究
發(fā)布時(shí)間:2018-05-21 01:31
本文選題:血液透析 + 維生素D ; 參考:《承德醫(yī)學(xué)院》2015年碩士論文
【摘要】:目的:了解維持性血液透析(Maintenance Hemodialysis,MHD)患者血清中25-羥維生素D3[25-OH-D3]濃度與營(yíng)養(yǎng)指標(biāo)的相關(guān)性,為提高維持性血液透析患者生活質(zhì)量,降低營(yíng)養(yǎng)不良的發(fā)生率提供研究依據(jù)。方法:選取2014年6月至2014年12月于河北省承德醫(yī)學(xué)院附屬醫(yī)院血液凈化中心行維持性血液透析的120例患者作為研究對(duì)象,其中男性71例,女性49例,年齡22~86歲,平均年齡(57.83±14.76)歲,透析齡為0.25~9.08年,平均透析齡(1.85±1.77)年。收集一般資料:包括性別、年齡、身高、體重、身體質(zhì)量指數(shù)(BMI)、透析時(shí)間、殘余尿量、收縮壓、舒張壓、上臂圍、肱二頭肌皮褶厚度、肱三頭肌皮褶厚度、改良主觀營(yíng)養(yǎng)評(píng)估(MQSGA)、檢查血清25-OH-D3及其它生化指標(biāo)。以25-OH-D3水平大于30ng/ml為正常標(biāo)準(zhǔn),在30~15ng/ml為不足標(biāo)準(zhǔn),小于15ng/ml為缺乏標(biāo)準(zhǔn),其中64例MHD患者25-OH-D3不足、56例MHD患者25-OH-D3缺乏,無(wú)25-OH-D3水平正常者。將25-OH-D3分為不足組與缺乏組,并對(duì)兩組中的各項(xiàng)生化指標(biāo)、一般資料等進(jìn)行統(tǒng)計(jì)學(xué)分析;將MHD合并糖尿病患者58例與MHD非糖尿病患者62例分為糖尿病組與非糖尿病組,并對(duì)兩組中的生化指標(biāo)、一般資料等進(jìn)行統(tǒng)計(jì)學(xué)分析。納入本研究中的MHD患者均知情自愿,并簽署同意書(shū)。透析方法:所有透析患者均采用德國(guó)Fresenius4008S型血液透析機(jī),采用德國(guó)費(fèi)森尤斯聚砜膜透析器,其有效膜面積為1.5~1.7m2,均為碳酸氫鹽透析液,K+2mmol/L、Na+140mmol/L、Cl-109.5mmol/L、Mg2+0.5mmol/L、Ca2+1.5mmol/L、HCO3-32mmol/L,血流的速度為180~250ml/min,透析液的流量為500ml/min,透析溫度為36.5℃,維持性血液透析2~3次/周,透析時(shí)間4h/次,抗凝藥物均采用低分子肝素鈉或普通肝素,血液透析通路為前臂動(dòng)靜脈內(nèi)瘺或右頸內(nèi)靜脈半永久導(dǎo)管。將所有入組MHD患者采取清晨空腹(禁食10~12h)靜脈血2ml,將血標(biāo)本靜置后放入離心機(jī)3000r/min離心10min并收集血清標(biāo)本置于-20℃環(huán)境冷凍保存,用酶聯(lián)免疫法定量測(cè)定人血清或血漿中25-羥基維生素D3[25-OH-D3]的含量,試劑盒購(gòu)自北京博暉創(chuàng)新光電技術(shù)股份有限公司;另外取透析前靜脈血2ml,送入承德醫(yī)學(xué)院附屬醫(yī)院檢驗(yàn)科,采用免疫化學(xué)發(fā)光法檢測(cè)患者透前甲狀旁腺激素(Parathyroid hormone,PTH)、鐵蛋白(Ferritin,FERR),全自動(dòng)生化儀檢測(cè)患者透前血鈣(Calciums--hot Nmmdia,Ca)、磷(Phosphorus,P)、白蛋白(Serumalbumin,ALB)、血紅蛋白(Hemoglobin,HGB)、中性粒細(xì)胞計(jì)數(shù)(Neutrophilicgranulocyte,NEUT#)、血β2微球蛋白(β2-microglobulin,β2-MG)、血尿酸(Uric acid,UA)、血肌酐(Serum Creatinine,Scr),尿素氮(Bloodureanitrogen,BUN)等生化指標(biāo)。統(tǒng)計(jì)學(xué)方法應(yīng)用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。正態(tài)分布的計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差表示。兩組計(jì)量資料的比較采用兩獨(dú)立樣本t檢驗(yàn);率的比較采用卡方檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。探索25-OH-D3的獨(dú)立危險(xiǎn)因素采用Logistics回歸分析。以患者25-OH-D3(不足、缺乏)水平為因變量,以年齡、是否患糖尿病、身體質(zhì)量指數(shù)BMI、上臂圍、白蛋白ALB及血肌酐Scr為自變量。P0.1為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1 MHD患者糖尿病組與非糖尿病組進(jìn)行比較,MHD患者25-OH-D3(15.43±6.11ng/ml vs17.96±5.33ng/ml,p0.01)、ALB(36.68±4.00g/L vs38.90±3.85g/L,p0.01)、β2-MG(18.72±5.45mg/L vs20.67±5.64mg/L,p0.05)、BUN(19.97±6.55mmol/L vs 23.16±8.21mmol/L,p0.05)、Scr(713.70±232.82umol/L vs 909.89±279.57umol/L,p0.01)水平降低,有統(tǒng)計(jì)學(xué)意義;MHD患者的年齡(61.48±12.61歲vs54.42±15.87歲,p0.01)、肱二頭肌皮褶厚度(6.36±3.00cm vs5.14±2.70cm,p0.05)、肱三頭肌皮褶厚度(13.16±5.64cm vs10.95±5.37cm,p0.05)水平升高,有統(tǒng)計(jì)學(xué)意義。(基本情況見(jiàn)表4)2 MHD患者25-OH-D3不足與缺乏組比較,MHD患者的年齡(23.27±4.67歲vs59.68±14.19歲,p0.01)、糖尿病(37.5%vs60.7%,p0.05)比例降低,有統(tǒng)計(jì)學(xué)意義;MHD患者的上臂圍(25.50±2.95cm vs24.65±2.37cm,p0.05)、BMI(23.37±4.58kg/m2 vs21.46±4.23kg/m2,p0.01)、ALB(38.43±4.28g/L vs 37.09±3.68 g/L,p0.05)、Scr(854.78±289.71umol/L vs768.69±252.26umol/L,p0.05)水平升高,有統(tǒng)計(jì)學(xué)意義。(基本情況見(jiàn)表5)3 Logistics回歸分析結(jié)果顯示BMI(p0.05)、ALB(p0.05)、糖尿病(p0.05)為25-OH-D3的獨(dú)立危險(xiǎn)因素。(基本情況見(jiàn)表6、7)結(jié)論:1對(duì)MHD患者25-OH-D3水平檢測(cè)發(fā)現(xiàn),MHD患者中25-OH-D3缺乏普遍存在。2 MHD患者糖尿病組中ALB、25-OH-D3水平明顯低于非糖尿病組,提示糖尿病加重營(yíng)養(yǎng)不良及25-OH-D3缺乏。3 MHD患者的ALB、BMI、糖尿病為25-OH-D3水平的獨(dú)立危險(xiǎn)因素,提示25-OH-D3缺乏與營(yíng)養(yǎng)不良存在相關(guān)性。
[Abstract]:Objective: to understand the correlation between the serum concentration of 25- hydroxyvitamin D3[25-OH-D3] and the nutritional indexes in the serum of Maintenance Hemodialysis (MHD) patients, so as to provide the basis for improving the quality of life of maintenance hemodialysis patients and reducing the incidence of malnutrition. Method: from June 2014 to December 2014 in Hebei Province, Chengde medicine was selected. 120 cases of maintenance hemodialysis were performed in the blood purification center of the Affiliated Hospital of the college. There were 71 males and 49 females, age 22~86 years, the average age (57.83 + 14.76) years, 0.25~9.08 years of dialysis age and average age of dialysis (1.85 + 1.77) years. The data included sex, age, height, weight, body mass index (BM). I), dialytic time, residual urine volume, systolic pressure, diastolic pressure, upper arm circumference, skin fold thickness of biceps brachii, skin fold thickness of triceps brachii, modified subjective nutrition assessment (MQSGA), serum 25-OH-D3 and other biochemical indexes. 25-OH-D3 level was higher than 30ng/ml as normal standard, 30~15ng/ml was less than 15ng/ml as a lack standard, 64 cases M HD patients were deficient in 25-OH-D3, 56 cases of MHD patients with 25-OH-D3 deficiency and no 25-OH-D3 level. The 25-OH-D3 was divided into insufficient group and lack group, and the biochemical indexes in the two groups were statistically analyzed. 58 cases of diabetic patients and 62 non diabetic patients with MHD were divided into diabetes group and non diabetic group, and two of non diabetic patients were divided into two. The biochemical indexes and general data in the group were statistically analyzed. The MHD patients in this study were informed voluntarily and signed the agreement. All dialysis patients were treated with German Fresenius polysulfone membrane dialyzer with a German Fresenius polysulfone membrane dialyzer with an effective membrane area of 1.5~1.7m2, which were both bicarbonate. Analysis of fluid, K+2mmol/L, Na+140mmol/L, Cl-109.5mmol/L, Mg2+0.5mmol/L, Ca2+1.5mmol/L, HCO3-32mmol/L, the velocity of blood flow was 180~250ml/min, the flow rate of dialysate was 500ml/min, the dialysis temperature was 36.5 C, the maintenance hemodialysis was 2~3 / week, the dialysis time was 4h/ times, and the anticoagulant used low molecular weight heparin sodium or ordinary heparin, hemodialysis pathway. For the forearm arteriovenous fistula or the right internal jugular vein of the internal jugular vein, all the MHD patients were treated with the early morning fasting (fasting 10~12h) venous blood 2ml. The blood specimens were placed in the centrifuge 3000r/min centrifuge 10min and the serum samples were collected at -20 centigrade for cryopreservation, and the quantitative determination of 25- hydroxyvitamins in human serum or plasma by enzyme immunoassay was used to determine the 25- hydroxyl dimension in human serum and plasma. The content of D3[25-OH-D3] was purchased from Beijing Bo Hui innovation Optoelectronic Technology (Limited by Share Ltd), and the pre dialysis venous blood 2ml was taken into the Affiliated Hospital of Chengde Medical College laboratory department, and the immunochemiluminescence method was used to detect Parathyroid hormone (PTH), Ferritin, FERR, and automatic biochemical analyzer. Calciums--hot Nmmdia (Ca), phosphorus (Phosphorus, P), albumin (Serumalbumin, ALB), hemoglobin (Hemoglobin, HGB), neutrophilic granulocyte count (Neutrophilicgranulocyte, NEUT#), beta 2 microglobulin (beta 2-microglobulin, beta), blood uric acid, urea nitrogen, urea nitrogen, were detected. Itrogen, BUN) and other biochemical indexes. Statistical method was used to make statistical analysis with SPSS17.0 software. The measurement data of normal distribution were expressed with mean standard deviation. Two independent sample t tests were used for the comparison of the two groups of measurement data; the comparison of the rate adopted the chi square test, and P0.05 was the difference of the overall planning significance. To explore the independent risk factors for 25-OH-D3. Logistics regression analysis. With the patient's 25-OH-D3 (deficiency, lack) level as the dependent variable, age, diabetes, body mass index BMI, upper arm circumference, albumin ALB and serum creatinine Scr as independent variables,.P0.1 were statistically significant. Results: 1 MHD patients were compared with non diabetic group, MHD patients 25-OH-D3 (15.43 + 6.11). Ng/ml vs17.96 + 5.33ng/ml, P0.01), ALB (36.68 + 4.00g/L vs38.90 + 3.85g/L, P0.01), and beta 2-MG (18.72 + 5.45mg/L vs20.67 23.16). 42 + 15.87 years old, P0.01), the thickness of the biceps brachii skin fold (6.36 + 3.00cm vs5.14 + 2.70cm, P0.05), the thickness of the triceps brachii (13.16 + 5.64cm vs10.95 + 5.37cm, P0.05), was statistically significant. (the basic situation is table 4) 2 MHD patients were compared with the deficiency group, the age of the MHD patients (23.27 + 4.67 years old, 14.19 years old, sugar), sugar The ratio of 37.5%vs60.7% (P0.05) was reduced, and there was statistical significance. The upper arm circumference of MHD patients (25.50 + 2.95cm vs24.65 + 2.37cm, P0.05), BMI (23.37 + 4.58kg/m2 vs21.46 + 4.23kg/m2, P0.01), (38.43 + 37.09 + 3.68), had statistical significance. In this case, table 5) 3 Logistics regression analysis results show that BMI (P0.05), ALB (P0.05), and diabetes (P0.05) are independent risk factors for 25-OH-D3. (basically, table 6,7) conclusion: 1 for MHD patients 25-OH-D3 level detection, 25-OH-D3 deficiency generally exists in the diabetic group in MHD patients, significantly lower than non diabetes. The disease group suggests that diabetes aggravated dystrophy and 25-OH-D3 deficiency of.3 MHD patients with ALB, BMI, and diabetes are independent risk factors for 25-OH-D3 levels, suggesting a correlation between the lack of 25-OH-D3 and malnutrition.
【學(xué)位授予單位】:承德醫(yī)學(xué)院
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2015
【分類(lèi)號(hào)】:R459.5
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 劉玉清;;血液透析患者營(yíng)養(yǎng)及其影響因素調(diào)查[J];河北醫(yī)藥;2006年04期
,本文編號(hào):1917151
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