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中华肾病研究电子杂志 ›› 2013, Vol. 02 ›› Issue (05) : 260 -264. doi: 10.3877/cma.j.issn.2095-3216.2013.05.010

综述

慢性肾脏病的蛋白质能量消耗及干预策略
王会玲1,(), 张金元1   
  1. 1.200052 上海,中国人民解放军第四五五医院肾脏科,南京军区肾脏病研究所
  • 出版日期:2013-10-15
  • 通信作者: 王会玲

Protein-energy wasting and intervention strategies in chronic kidney disease

Hui-ling WANG1,(), Jin-yuan ZHANG1   

  1. 1.Department of Nephrology, 455th Hospital of People's Liberation Army, Institute of Nephrology of Nanjing Military Area Command, Shanghai 200052, China
  • Published:2013-10-15
  • Corresponding author: Hui-ling WANG
引用本文:

王会玲, 张金元. 慢性肾脏病的蛋白质能量消耗及干预策略[J/OL]. 中华肾病研究电子杂志, 2013, 02(05): 260-264.

Hui-ling WANG, Jin-yuan ZHANG. Protein-energy wasting and intervention strategies in chronic kidney disease[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2013, 02(05): 260-264.

蛋白质-能量消耗(PEW)在进展期慢性肾脏病(CKD)普遍存在,且与患者不良预后密切相关。 笔者将对PEW 诊断标准、发生机制和临床干预治疗的最新进展进行了系统回顾和分析。PEW 诊断依据国际肾脏营养与代谢学会(ISRNM)提出的标准,从生化指标、非预期的身体质量降低、肌肉量丢失、饮食蛋白质和/或热量摄入不足4 个方面综合判断。 PEW 发病机制复杂,涉及多种因素引起蛋白质分解代谢增加,其中骨骼肌消耗是其最主要特征和核心环节。 胰岛素抵抗和炎症状态可以激活泛素-蛋白酶体系统,导致CKD 患者肌肉蛋白降解增加。 对患者筛查和PEW 严重程度的评估,需要结合病史及辅助检查的各项指标进行综合分析,营养不良-炎症评分是较好的综合评价系统。选择合理的营养治疗方案是PEW 的首选干预策略,其他药物干预的效果尚待证实。

Protein energy wasting (PEW) is common in patients with advanced chronic kidney disease (CKD) and is associated with adverse clinical outcomes. In this paper, we have made a systematic review and analysis of recent progress in the diagnostic criteria, pathogenetic mechanisms, and therapeutic strategies of PEW. According to the criteria established by International Society of Renal Nutrition and Metabolism (ISRNM), four main established categories are to be recognized for diagnosing PEW, including biochemical indices, unexpected lower body mass, muscle mass loss, lack of dietary protein and/or calorie intake. The pathogenetic mechanism of PEW is complex, involving various factors that lead to increased protein catabolism among which muscle wasting is the major characteristic and core link. Muscle wasting in CKD patients are increased mainly through the ubiquitin-proteasome system activation by insulin resistance and inflammation, etc. Patients screening and assessment of PEW severity should be made through a comprehensive analysis combining medical history and laboratory examinations. Malnutrition-inflammation scoring is a useful evaluation system. Selection of proper nutrition treatment is the preferred intervention strategy for PEW. The efficacy of other intervention with drugs still remains to be confirmed.

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