口腔肿瘤术后化疗患者人体成分和生化指标的变化

目的探讨口腔肿瘤术后化疗患者人体成分和生化指标的变化。方法选取2018年1月-2019年1月收治的200例口腔肿瘤术后化疗患者,分别于化疗前1周和化疗2周后使用身体成分分析仪检测患者的体重、体脂率、肌肉量和血总蛋白、白蛋白、前白蛋白、肌酐指标。结果①在化疗2周后,患者体重、肌肉量均显著下降,但体脂率上升,P0.05;②在化疗2周后,患者血清白蛋白、前白蛋白、肌酐均显著下降,P0.05。结论口腔肿瘤术后化疗患者在化疗后期存在肌肉量减少等问题,进而引起体重下降,有必要及早进行营养支持。     

肠外营养支持在老年腹部手术病人围手术期的临床应用

目的：研究老年腹部手术病人围手术期肠外营养与普通输液的代谢效应。方法：３２例老年腹部外科病人分成两组，肠外营养组接受肠外营养，非蛋白热量总量１０４．５～１４６．４ｋＪ／（ｋｇ·ｄ），热氮比为４１８～６２７ｋＪ∶１ｑ，糖脂比为４∶６～５∶５。普遍输液组接受葡萄糖供能为主的治疗，术前２天和术后８天观察体重，血浆白蛋白、转铁蛋白、前白蛋白，总淋巴细胞计数，氮平衡等。结果：肠外营养组前白蛋白、氮平衡比术前增加，而普通输液组的体重、前白蛋白下降，治疗后两组比较差异有统计学意义（Ｐ＜０．０５或Ｐ＜０．０１）。结论：适当的肠外营养可使老年病人受益     

甲亢病人围手术期人体组成的动态观察

目的采用人体脂肪分析仪（ＢＦＡ－１００）对甲状腺功能亢进症（以下简称甲亢）病人入院后进行营养评定,并进行人体组成围手术期的动态观察。方法８５例病人入院３天内行体重／身高（ＷＴ／ＨＴ）,三头肌皮皱厚度（ＴＳＦ）,上臂肌围（ＡＭＣ）,握力（ＧＳ）,体脂（ＢＦ）检测,进行营养评定,其中５４例于术前日和术后５天分别行第２次,第３次上述指标测定,结果 甲亢病人入院存在着不同程度的营养不良,发生率为９６％（８     

农村新生儿乙型肝炎疫苗免疫后10年的效果观察

为了解新生儿乙肝疫苗免疫后抗－ＨＢｓ持久性及远期保护效果,从１９８６年开始,结合农村计划免疫给新生儿接种３针１０μｇ／ｍｌ血源乙肝疫苗,对免疫后首次检测ＨＢｓＡｇ阴性的７６２名免疫儿童进行了最长１０年的追踪观察。结果（１）母亲ＨＢｓＡｇ阴性儿和阳性儿的抗－ＨＢｓ阳性率以Ｓ／Ｎ值≥２．１标准计算,分别从免疫后第１年９４．４４％和８４．２１％降至第１０年５０．２４％和３４．７８％,均呈逐年下降趋势;抗－ＨＢｓＳ／Ｎ值的ＧＭＴ由第２年的３１．６２和２３．９９降至第１０年的３．０９和２．５１,下降更为明显,且ＧＭＴ以免疫后３～５年下降最快,而抗－ＨＢｓ阳性率则以９～１０年下降最快。（２）母亲ＨＢｓＡｇ阴性儿６８８名,共观察了３５５９．０人年,出现５例ＨＢｓＡｇ阳转者,ＨＢｓＡｇ年阳转率０．１４％;母亲ＨＢｓＡｇ阳性儿７４名,共观察了４５６．５人年,出现１例ＨＢｓＡｇ阳转者,ＨＢｓＡｇ年阳转率０．２２％,出现的６例ＨＢｓＡｇ阳转者均未形成慢性携带状态。与乙肝疫苗免疫前同龄ＨＢＶ易感儿童ＨＢｓＡｇ年阳转率４．２７％相比,乙肝疫苗对母亲ＨＢｓＡｇ阴性儿和阳性儿的ＨＢｓＡｇ阳转保护率分别为９６．７２％和９４．８５％。     

老年肿瘤病人术后的营养评价

病人术后尤其是肿瘤病人术后营养不良或严重营养不良是外科临床常见的问题。为了解老年肿瘤病人术后的营养状况,我们于１９９７年４～５月对医大一院所有住院的老年肿瘤术后病人进行了一次营养状况评价。现报告如下。对象和方法　（１）对象：选择５０岁以上的所有肿瘤病人,术后３～１０天,均经病理检查确诊。年龄５１～７８岁,共７０例,其中男３４例,女３６例。（２）方法：身高为入院时实测身高（ｃｍ）;体重为测量时的实际体重（ｋｇ）;标准体重为身高－１０５。评价标准：实测体重占标准体重的百分比,在±１０％范围内为营养正…     

术后短期全肠外营养临床疗效对比研究

探讨营养状况尚可、接受中等手术病人术后短期 TPN的实际临床价值。采用前瞻性对比研究的方法 ,将 6 0例术前无营养不良、接受中等腹部手术、术后 10天内可开始进食的病人分为营养组和对照组 ,营养组术后予 TPN治疗 ,对照组术后常规治疗 ,观察两组病人手术前后体重、血浆白蛋白、外周血淋巴细胞总数、术后胃肠功能恢复时间和并发症发生率。结果两组病人手术前后的体重、血浆白蛋白、外周血淋巴细胞总数均无差异 (P>0 .0 5 ) ;而营养组和对照组肛门排气时间分别是 (5 6 .5± 9.6 )和 (45 .5± 7.5 ) h,两组比较差异显著 (t=5 ,P<0 .0 1) …     

围手术期谷氨酰胺强化的TPN对大肠肿瘤患者的影响

目的研究围手术期谷氨酰胺强化的TPN对大肠肿瘤患者营养状况,免疫功能的影响。方法将30例大肠肿瘤病人随机分为常规TPN组和谷氨酰胺强化TPN(Gln-TPN)组。每组15例病人。检测术前、术后病人的体重、血浆白蛋白、前白蛋白、转铁蛋白、氮平衡等营养指标及外周血总淋巴细胞数、T淋巴细胞亚群CD3+,CD4+,CD8+等免疫指标。结果两组病人术后体重、血浆前白蛋白、转铁蛋白浓度,氮平衡,CD3+细胞、CD8+细胞百分比均较术前明显下降,术后水平两组间比较差异无统计学意义。Gln-TPN组CD4+细胞数量,CD4+/CD8+,白蛋白浓度,总淋巴细胞数方面高于常规TPN组(P<0.05)。结论谷氨酰胺强化的TPN可减少肌肉分解,脂肪消耗,促进机体蛋白质的合成,促进淋巴细胞增殖,提高总淋巴细胞数,CD4+细胞及CD4+/CD8+,增强机体的细胞免疫功能。     

胃肠道肿瘤术后的肠外营养支持

２９例胃肠道恶性肿瘤病人，均作肿瘤切除术。根据术后不同的ＰＮ支持方法分为三组。Ａ组（９例）术后给予常规静脉补液（葡萄糖热能４１．８ｋＪ／ｋｇ·ｄ－１）；Ｂ组（１０例）连续５ｄ给予葡萄糖热能１２５．５ｋＪ／（ｋｇ·ｄ）和１４－氨基酸－８０００．１７ｇ氮...     

外科营养对消化道肿瘤病人术后营养状况的影响

目的比较肠内营养与肠外营养对消化道肿瘤病人术后营养状况的影响。方法将40例消化道肿瘤病人随机分为肠内营养(EN)组和肠外营养(PN)组,每组20例,试验周期为7天。术后第1天开始给予等热量、等氮量的营养支持一周(术后第1天和第2天分别提供热卡19.33～19.97Kcal/kg,氮量0.14～0.15g/kg;术后第3天至第7天每日提供热卡26.9～28.55kcal/kg,氮量0.2～0.21g/kg)。检测术前和术后第8天病人的体重、肱三头肌皮褶厚度、上臂肌围、血浆白蛋白、转铁蛋白、血清氨基酸谱和累计氮平衡等营养指标。结果两组病人均无严重并发症发生。两组病人术后第8天的体重均明显下降(P<0.001),组间无差异。两组病人术后第8天的肱三头肌皮褶厚度和上臂肌围较术前明显减小(P<0.05),而两组间无显著性差异。两组病人血浆白蛋白水平在术后第8天明显下降,而EN组较PN组下降幅度小(P<0.05)。两组病人的血浆转铁蛋白水平在术后与术前相比无明显变化。累计7天氮平衡EN组为(-26.1±15.3)g,而PN组为(-23.4±10.3)g,两组间无明显差异。EN组能明显升高血清天门冬氨酸(ASP)、丝氨酸(SER)、谷氨酸(GLU)、半胱氨酸(CYS)、异亮氨酸(ILE)及苯丙氨酸(PHE)的水平,对于其它氨基酸无明显影响。而PN组经过营养支持后,血清蛋氨酸(MET)浓度升高,组氨酸(HIS)浓度下降,其它氨基酸变化不明显。结论消化道肿瘤病人术后可出现明显的负氮平衡和低蛋白血症。术后早期应激状态下,肠内营养或肠外营养均不能避免机体分解代谢状态。术后早期进行肠内营养是安全、可行、有效的。肠内营养可以达到与肠外营养一样的维持体重和氮平衡的临床疗效。肠内营养较肠外营养能更好地维持血浆白蛋白水平和血清氨基酸水平。     

腹部手术病人应用肠外营养支持的临床观察

目的：评价腹部外科围手术期病人胃肠外营养与普通输液的代谢效应。 方法：３７例腹部外科病人分成两组，胃肠外营养组接受肠外营养，普通输液组接受以葡萄糖供能为主的治疗。术前和术后１周观察血红蛋白、总淋巴细胞计数、血生化、血浆蛋白、氮平衡和体重等的变化。 结果：胃肠外营养组血浆白蛋白、氮平衡比术前增加而普通输液组的体重、血浆白蛋白水平下降，治疗后两组比较差异有统计学意义（Ｐ〈０．０５）。 结论：适当的肠外     

Improvement of nutritional status as assessed by multifrequency BIA during 15 weeks of refeeding in adolescent girls with anorexia nervosa

In patients with anorexia nervosa (AN), an assessment of changes in body composition and nutritional status is crucial for adequate nutritional management during refeeding therapies. Phase-sensitive multifrequency bioelectrical impedance analysis (BIA) is an inexpensive and noninvasive technique with which to determine nutritional status and body composition. We investigated 21 female adolescents with AN (initial BMI 15.5 +/- 1.1 kg/m(2)) 4 times between wk 3 and 15 of inpatient refeeding and 19 normal-weight, age-matched female controls. From wk 3 to 15, BMI, fat mass, body cell mass (BCM), total body water (TBW), intracellular water (ICW) but not extracellular mass (ECM), and extracellular water (ECW) increased significantly. Reactance (Xc), phase angle (PhA), and the ECM/BCM index as parameters of nutritional status improved significantly in patients and no longer differed from controls in wk 15, although the BMI of patients was significantly lower than those of controls. Changes in the ECM/BCM index were due to accretion of BCM, which was associated with an increase of ICW. Multifrequency phase-sensitive BIA seems to be a promising tool for the assessment of changes in nutritional status and body composition in patients with AN. An individually determined and controlled hyperenergetic diet as part of a multidimensional, interdisciplinary treatment program for eating disorders seems to quickly improve the nutritional status of AN patients.     

BIA法评估44例CKD患者的营养状况及分析

摘要:目的　运用生物电阻抗分析（Bioelectric Impedance Analysis,BIA）评价慢性肾脏病（Chronic Kidney Disease,CKD）患者的营养状况,并将其和生化指标评估结果对比,为早期发现CKD患者营养不良状态、及时给予营养干预提供有效参考。方法　随机选择2014年11月-12月期间在某三甲医院CKD管理中心注册的CKD患者57例,根据其浮肿指数、依从性等共纳入研究对象44例,应用BIA法评估研究对象的营养状况并与生化指标评价结果比较。结果　BIA和生化检查营养不良率（含营养不良风险）分别为45.4%和25%,且差异有统计学意义（χ2＝4.034,P＜0.05）。女性身体细胞量、细胞内水分和蛋白质的质量均显著高于男性（P＜0.05）,而男、女性ALB水平差异无统计学意义。在ALB水平正常的CKD患者中,其体细胞量、细胞内水分、蛋白质、骨骼肌、体脂肪均低于正常范围。BIA营养不良的研究对象的骨骼肌量和血清白蛋白（serum Albumin,ALB）水平显著相关（r＝0.58,P＜0.05）。结论　CKD患者营养不良率较高;与生化检查相比,BIA可早期发现CKD患者的营养不良状态和营养不良风险,有利于医生对营养不良患者及时采取有效的营养干预。     

Validation of bioimpedance analysis as a measure of change in body cell mass as estimated by whole-body counting of potassium in adults

BACKGROUND: The body cell mass (BCM) is an important measure of macronutrient status, but measurements are difficult to obtain outside of sophisticated research laboratories. Bioimpedance analysis (BIA) is a simple technique that holds promise as a means of estimating body composition. The purpose of this study was to evaluate the ability of BIA to estimate changes in BCM as measured by whole body counting of 40K (TBK). METHODS: Paired studies of BCM, including both TBK and BIA, were compared in 87 human immunodeficiency virus-positive subjects and in 62 healthy, weight-stable control adults. Potential errors in the predictions were examined. RESULTS: BCM change by TBK and BIA correlated closely (r = .755). After accounting for errors related to repeat measures of TBK, the correlation coefficient was .784, with a standard error of the estimate of 1.24 kg. The differences between predicted and measured BCM change were consistent with a normal distribution. However, there was a systematic error in prediction, with BIA underpredicting the magnitudes of both gains and losses in BCM by TBK. CONCLUSIONS: BIA is a useful surrogate for measuring changes in BCM in clinical circumstances. Because TBK assesses only intracellular potassium, whereas BIA reflects all intracellular cations, the underprediction of BCM change by BIA compared with TBK could be related to changes in intracellular potassium concentration as a result of malnutrition or its treatment.     

Errors in estimating peritoneal fluid by bioelectrical impedance analysis and total body electrical conductivity.

Whole-body bioelectrical impedance analysis (BIA) and total body electrical conductivity (TOBEC) have been used to estimate body composition and generalized changes in total body water (TBW). The sensitivity of these methods to measure small, rapid, localized changes in body water has not been fully evaluated. We compared the prediction of TBW by whole-body and segmental BIA and TOBEC with deuterium oxide dilution (D2O) in 10 control subjects and 7 renal failure patients receiving continuous ambulatory peritoneal dialysis (CAPD) prior to and after dialysate infusion. Using D2O as the reference method, there was no significant mean residual error between TBW predicted by BIA and TOBEC in controls (?1.2 +/? 1.5 and ?0.9 +/? 1.0 kg) and CAPD patients pre-infusion (?1.0 +/? 2.0 and 0.29 +/? 2.01 kg). After infusing 1.9 +/? 0.18 kg dialysate, the mean residual error between change in body weight and the three methods was ?0.44 +/? 0.53 kg for D2O (p < 0.1), ?1.7 +/? 0.25 kg for BIA (p < 0.0001), and 1.2 +/? 0.4 kg for TOBEC (p < 0.001). Segmental BIA detected a 7.6% reduction in trunkal resistance with no significant change across the limbs, consistent with abdominal fluid accumulation. It is concluded that whole-body BIA underpredicts and TOBEC overpredicts small changes in peritoneal fluids.     

Whole-body and segmental bioelectrical-impedance analysis in patients with cirrhosis of the liver: changes after treatment of ascites.

Bioelectrical impedance analysis (BIA) is a simple technique for determining body water and calculating body composition. It has been validated in healthy control subjects but not in patients with liver disease. We examined the ability of BIA to detect changes in total body water (TBW) due to removal of ascites. In 12 cirrhotic patients, BIA of the whole body and of body segments was performed before and after treatment of ascites with paracentesis (n = 12) and diuretics (n = 2). TBW changes predicted by BIA, by using two prediction equations, were significantly less than body weight changes (51% and 45% of the weight loss). BIA of body segments showed highly significant changes in both the trunk and the leg and small changes in the arm. These data indicate that BIA of the whole body is not a suitable technique for monitoring fluid changes in cirrhotic patients with ascites. Changes in BIA of body segments may be due to mobilization of edema after the removal of ascites.     

Estimation of total body water from foot-to-foot bioelectrical impedance analysis in patients with cancer cachexia – agreement between three prediction methods and deuterium oxide dilution

INTRODUCTION: Bioelectrical impedance analysis (BIA) is a useful bedside measure to estimate total body water (TBW). The aim of this study was to determine the agreement between three equations for the prediction of TBW using BIA against the criterion method, deuterium oxide dilution, in patients with cancer cachexia. METHODS: Eighteen measurements of TBW using foot-to-foot BIA in seven outpatients with cancer cachexia (five male and two female, age 56.4 +/- 6.7 years) at an Australian hospital. Three prediction formulae were used to estimate TBW - TBW(ca-radiotherapy) developed in patients with cancer undergoing radiotherapy, TBW(ca-underweight) and TBW(ca-normal weight) developed in underweight and normal weight patients with cachexia. TBW was measured using the deuterium oxide dilution technique as the gold standard. RESULTS: Mean measured TBW was 39.5 +/- 6.0 L. There was no significant difference in measured TBW and estimates from prediction equations TBW(ca-underweight) and TBW(ca-radiotherapy). There was a significant difference in measured TBW and TBW(ca-normal weight). All prediction equations overestimated TBW in comparison with measured TBW. The smallest bias was observed with TBW(ca-underweight) (0.38 L). The limits of agreement are wide (>7.4 L) for each of the prediction equations compared with measured TBW. CONCLUSIONS: At a group level, TBW(ca-underweight) is the best predictor of measured TBW in patients with cancer cachexia. For an individual however, the limits of agreement are wide for all prediction equations and are unsuitable for use. Practitioners need to be aware of the limitations of using TBW prediction equations for individuals.     

Improved assessment of body cell mass by segmental bioimpedance analysis in malnourished subjects and acromegaly

BACKGROUND: Estimation of body cell mass (BCM) has been regarded valuable for the assessment of malnutrition. AIM: To investigate the value of segmental bioelectrical impedance analysis (BIA) for BCM estimation in malnourished subjects and acromegaly. METHODS: Nineteen controls and 63 patients with either reduced (liver cirrhosis without and with ascites, Cushing's disease) or increased BCM (acromegaly) were included. Whole-body and segmental BIA (separately measuring arm, trunk, leg) at 50 kHz was compared with BCM measured by total-body potassium. Multiple regression analysis was used to develop specific equations for BCM in each subgroup. RESULTS: Compared to whole-body BIA equations, the inclusion of arm resistance improved the specific equation in cirrhotic patients without ascites and in Cushing's disease resulting in excellent prediction of BCM (R(2) = 0.93 and 0.92, respectively; both P<0.001). In acromegaly, inclusion of resistance and reactance of the trunk best described BCM (R(2) = 0.94, P<0.001). In controls and in cirrhotic patients with ascites, segmental impedance parameters did not improve BCM prediction (best values obtained by whole-body measurements: R(2)=0.88 and 0.60; P<0.001 and <0.003, respectively). CONCLUSION: Segmental BIA improves the assessment of BCM in malnourished patients and acromegaly, but not in patients with severe fluid overload.     

Validation of body composition determination by bioelectrical impedance analysis in acromegaly.

Body composition determination by bioelectrical impedance analysis (BIA) has been compared with measurement of total body water (TBW) by tritiated water dilution and estimation of body fat (BF) by measurement of TBW and total body potassium (TBK) in a four-compartment model, in patients with acromegaly. This disorder is accompanied by a profound aberration in body composition. Furthermore TBW and BF were predicted on the basis of anthropometric variables alone. Paired comparisons of TBW estimations by isotope dilution and BIA showed good correlation (Spearman's rank correlation 0.95, P less than 0.01). Isotope dilution resulted in a mean of 1.7 liter (standard deviation 1.87) higher values. Comparison of BF estimations showed also a significant correlation (Spearman's rank correlation 0.75, P less than 0.01), with slightly higher values for BIA (mean 1.4 kg; standard deviation 2.99). BIA improved the prediction of TBW and BF compared with predictions based on anthropometric variables. In a population of acromegalic patients, BIA seemed to be a useful method to estimate TBW and BF.     

Bioelectrical impedance analysis--part I: review of principles and methods

The use of bioelectrical impedance analysis (BIA) is widespread both in healthy subjects and patients, but suffers from a lack of standardized method and quality control procedures. BIA allows the determination of the fat-free mass (FFM) and total body water (TBW) in subjects without significant fluid and electrolyte abnormalities, when using appropriate population, age or pathology-specific BIA equations and established procedures. Published BIA equations validated against a reference method in a sufficiently large number of subjects are presented and ranked according to the standard error of the estimate. The determination of changes in body cell mass (BCM), extra cellular (ECW) and intra cellular water (ICW) requires further research using a valid model that guarantees that ECW changes do not corrupt the ICW. The use of segmental-BIA, multifrequency BIA, or bioelectrical spectroscopy in altered hydration states also requires further research. ESPEN guidelines for the clinical use of BIA measurements are described in a paper to appear soon in Clinical Nutrition.     

Assessment of bioelectrical impedance analysis for the prediction of total body water in cystic fibrosis

The aim of this study was to compare the measurement of total body water (TBW) by deuterium (2H2O) dilution and bioelectrical impedance analysis (BIA) in patients with cystic fibrosis (CF) and healthy controls. Thirty-six clinically stable patients with CF (age 25.4+/-5.6 yrs) and 42 healthy controls (age 25.4+/-4.8) were recruited into this study. TBW was measured by 2H2O dilution and predicted by BIA in patients and controls. The TBW predicted from BIA was significantly different from TBW as measured using 2H2O in patients (P<0.05) but not in controls. Mean (+/-SD) values for predicted and measured TBW differed by 5.6 (+/-9.1) L in patients and 0.4 (+/-3.6)L in controls. This bias was consistent for all controls but not for patients. In CF, BIA over predicted TBW determined by 2H2O dilution to an increasing extent at larger TBW volumes. There was a strong correlation between height2/impedance and TBW in patients with CF (r=0.90; y=0.67x+2.50) and in controls (r=0.81; y=0.57x+9.60). The slope of the regression lines was similar for both groups, however the y intercepts were significantly different (P<0.05). BIA overestimates TBW in patients with CF, possibly due to invalid factory installed regression equations within BIA instrumentation. Future studies employing BIA as a measure of TBW or FFM in CF should use alternative predictive equations to those that have been developed for healthy individuals. A large scale study to develop specific regression equations for use in CF is warranted.