Evaluation of Ideal Body Weight in Dialysis Patients through Bioelectrical Impedance Analysis

使用生物電阻分析評估透析病患之乾體重

蔡文生(Weng-Sheng Tsai) ； 吳家兆(Chia-Chao Wu) ； 林石化(Shih-Hua Lin) ； 朱柏齡(Pauling Chu) ； 吳三江(San-Chiang Wu) ； 許育瑞(Yu-Juei Hsu) ； 林裕峰(Yuh-Feng Lin)

《Acta Nephrologica》 16卷3期 (2002/07) Pp. 119-124

摘要

背景：對每位透析病患乾體重的調整是必要的，但許多病患在臨床已達乾體重時仍有過多的體液堆責。因為生物電阻分析法可以準確的測量身體體液分部的比例，因此本實驗針對臨床乾體重的透析病患及正常對照組，用生物電阻分析法來研究其體液分佈的差異。
材料及方法：93位透析病患，包括56位血液透析及37位連續腹膜透析的病患，以及36位性別及年齡相整的對照組進行生物電阻分析。透析病患由臨床及理學方法評估乾體重並由腎臟科醫師鬟週調整乾體重。生物電姐分析使用多頻生物電阻分析儀（InBody 3.0(上標 TM)，Biospace Co. Ltd, USA）。在血液透析病患對血液透椷治療前後都測量一次。測量項目包括體重（BW），身體總水量（TBW），細胞外液水量（ECF）及細胞內液水量（ICF），為了做進一步分析，這些透析病患根據ECF/TBW比值大或小於0.35分對達腫組及非水腫組。
結果：在透析病患及對照組內，TBW/BW比值並無差異。在血液透析及連續腹膜透析之間亦無任何差異存在，然而血液透析病患及對照組之間存在有意義的差別（血液透析0.342±0.0054 vs對照組0.328±0.002，p＜0.05）。在水腫組的血液及腹膜透析病患比非水腫病患及正敘對照組有較高的ECF/TBW及較低的ICF/ECF值，但在非水腫組的透析病患及正敘對照組之間，此二項比例則無差異存在。有趣的是在TBW/BW及ECW/TBW之間並無明顯關連。
結論：生物電阻分析法對乾體重的判斷是一個適當而且非侵襲性的方法，在透析病患以ECW/TBW及ICF/ECF的比值比TBW/BW比值更能準確地評估乾體重。

關鍵字

生物電阻分析法 ； 乾體重 ； 透析 ； 身體總水量 ； 細胞外液水量

並列摘要

Background: It is essential to define dry weight (DW) for each patient in clinical dialysis, but many patient remain with fluid overload even in clinical DW. Currently, bioelectrical impedance analysis (BIA) can accurately measure the compostition of different body fluid compartments. The present study was conducted to investigate the body fluid compartment by BIA in dialysis patients.
Materials and Methods: Ninety three dialysis patients including 56 hemodialysis (HD) patients and 37 continuous ambulatory peritoneal dialysis (CAPD) patients and thirty six sex and age matched controls have underwent BIA measurement. The dry weight of dialysis patients was adjusted DW by nephrologists weekly. BIA was performed with a multifrequency bioimpedance analyzer (InBody 3.0(subscript TM), Biospace Co. Ltd. U.S.A). Both pre- and post-hemodialysis measurement were performed in hemodialysis patients. Body weight (BW), total body water (TBW), extracellular fluid (ECF) and intracellular fluid (ICF) were measured. For furthere evaluation, the dialysis patients were divided into edematous and nonedemaous group based on ECF/TBW ratio greater or less than 0.35.
Results: There was no significant difference of TBW/BW ratio between dialysis groups or between dialysis groups and control group. Eventhough there was no difference of ECF/TBW between HD group and CAPD group, there was significant difference between HD groups and control group (HD 0.342±0.004 vs control 0.328±0.002, p＜0.05). There were significant difference of ECF/TBW and ICF/ECF ratio either between edematous group and nonedematous group (p＜0.05) or between edematous group and normal controls (p＜0.05), but no difference between non-edematous group and normal control or between edematous group and normal controls (p＜0.05). Interestingly, there were no significant relationships between TBW/BW and ECF/TBW.
Conclusions: BIA is an appropriate noninvasive method for DW determination and the ECF/TBW and ICF/ECF ratio was more accurate than TBW/BW ratio to evaluate the optimal DW in dialysis patient.

並列關鍵字

Bioelectrical impedance analysis ； dry weight ； dialysis ； extracellular fluid ； total body water