13年开同PEW- 1.29.ppt

辅助检查发现患者血肌酐、尿素氮、甲状旁腺激素（PTH）显著高于正常值，而白蛋白低于正常值 经诊断，该患者患有慢性肾脏病3期、肾性贫血、高血压营养不良 针对所含疾病，采取了降压、纠正贫血和营养不良。然而在补充了足够的能量及蛋白后，患者的营养不良状况却没有改善。那么CKD患者的营养不良与一般意义的营养不良有何不同呢？ 一般所说的营养不良是指饮食能量及营养过多或过少引发的健康状况紊乱，包括营养不足和营养过剩。营养不足是指饮食能量及营养缺乏，包括蛋白能量营养不良（PEM）和微量营养素缺乏；营养过剩则是指肥胖。 一般所说的营养不良包括蛋白能量营养不良即PEM。PEM是指蛋白质和（或）热量的供给不能满足机体维持正常生理功能的需要时发生的疾病。PEM的原因包括摄入减少、需求增加或丢失所致。如蛋白摄入减少、饮食蛋白质量低下、疾病状态下营养需求增加，营养丢失导致体内蛋白和能量不足。总之，PEM是由于供需失去平衡而导致蛋白和能量不能满足机体正常代谢需要。 PEW与PEM不同。PEW是蛋白能量消耗，目前国际肾脏营养和代谢协会已将肾性营养不良命名为PEW（蛋白-能量消耗），而进行性骨骼肌萎缩是PEW的主要临床表现形式，且单纯补充营养素无效。PEW普遍存在于CKD患者中，并且是CKD预后不良显著相关，同时PEW也是肾病消耗的“罪魁祸首”。 我们使用PEW而不用PEM，是因为PEW的某些原因与营养摄入不足或过量营养丢失无关，并且PEM是PEW促发因素之一。 我们通过一张表来看一下PEW与PEM的区别。二者相同的一点是能量平衡被打破。而在其它方面则有显著不同。PEM时食欲增加，PEW时食欲降低；PEM代谢率降低，PEW代谢率增加；PEM肌肉量基本不变，而PEW则降低；PEM时脂肪量降低，而PEW则基本不变；PEM对补充能量治疗有效；而PEW无效。 Cachexia and protein-energy wasting in children with chronic kidney disease Pediatr Nephrol (2012) 27:173–181 * So, what is kidney failure? Kidney failure is a progressive decline of kidney’s ability to clean excess waste and fluid from the blood. For example, CKD patients may found urine protein or frequent urination in earlier stage, but they become less urine in the late stage because the kidney is not able to clean the fluid from the blood. A most important indicator is “GFR”. The numbers of GFR showing the remaining percentage of patient’s kidney function. The progression of CKD is divided into five stages. Take ESRD (end stage renal disease, stage 5) as example, the kidney function only left 15%. In the latest 2009 USRDS report, we can see the prevalence of each stage. The diagram above displays the five stages of CKD according to the NKF K/DOQI guidelines. As you can see, as GFR decreased, the stage of CKD increases in severity, with stage 5 CKD or end-stage renal disease (ESRD) at a GFRof 15 or less. The NKF has placed a focus on public education and identification of at risk individuals with stage 1 and 2 CKD to help stop the progression of CKD to ESRD. The rate has a huge drop from 7.6% at sta