| Objective To evaluate the nutritional status of the patients with diabetic nephropathy during maintenance hemodialysis,to observe arteriosclerosis in lower extremities,and to explore the influence of malnutrition to arteriosclerosis in lower extremities.Methods 67 patients with diabetic nephropathy requiring maintenance hemodialysis were selected.(1)To investigate the change of dry weight,dietary intake, gastrointestinal symptoms,function capacity,co-morbidity including number of years on dialysis,measure and calculate triceps skinfold(TSF),mid-arm circumference(MAC),mid-arm muscle circumference(MAMC)and body mass index(BMI),to detect serum Total protein(TP),albumen(ALB),globulin(GLO), pre-albumen(PA),urea nitrogen(BUN),creatinia(CR),insulin-like growth-1(IGF-1), total cholesterol(TC),triglycerides(TG),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),apolipoprotein-A1(APO-A1),apolipoprotein-B(APO-B), lipoprotein a(Lpa),kalium(K),sodium(Na),calcium(Ca),phosphorus(P-),carbonic acid(HCO3),alkaline phosphatase(ALP),blood sugar(BS),insulin(IRI),C-peptide, saccharify haemoglobin(GHB),C-reaction protein(CRP),transferritin(TF), parathyroid thormone(iPTH),red blood cell count(RBC),hemoglobin(HGB),white blood cell count(WBC),lymphatic cell count(TLC),blood platelet(PLT),urine urea nitrogen during 6 months.Malnutrition inflammation score(M IS)proposed by American Kalantar were applied to evaluate nutritional status of 67 selected patients, divided group A(1-10grade),group B(11-20grade),group C(21-30grade).age, sex,smoking,blood pressure,blood sugar et al were compared in three group patients, many markers reflecting protein,fat and mineral level and metabolism in three group patients were compared,CRP level of the three nutritional status were also compared.(2)Hereinafter markers were monitored at the beginning and six months later:arterial endarterium lubricity extent and scleroses speckles in lower extremities were observed by two dimension ultrasound,blood vessel inner diameter and inner-middle membrane thick were measured,artery narrow degree were calculated, artery blood flow,imperfect and narrow degree were observed by color doppler ultrasound,blood stream velocity flow curve,velocity flow and reverse blood stream were observed by pulse Doppler,peak value blood stream velocity,pulsate index and resistance index were obtained.Results Selected 67 patients were divided three groups by M IS results,29 patients in group A,24 patients in group B,14 patients in group C.1.(1)There were no obvious statistics difference in sex,smoking,blood pressure, blood sugar(BS),insulin and C-peptide,age and saccharify haemoglobin(GHB) increased in group C compared with group A.(2)HB,TP,PA,ALB,IGF-1,BUN, Cr,nPCR,TLC decreased,CRP increased in group C compared with group A,TP, PA,ALB,IGF-1,nPCR decreased in group B compared with group A,HB,PA, ALB,IGF-1,BUN,Cr,nPCR,TLC decreased,CRP increased in group C compared with group B.(3)TC,HDL,APOA1 decreased.APOB,LPαincreased in group C compared with group A;APOA1 decreased,APOB,LPαincreased in group B compared with group A,the difference have statistics significance,TC,HDL have no obvious statistics difference;TC,HDL,APOA1 decreased,APOB,LPαincreased in group C compared with group B,the difference have statistics significance;TG, LDL-C increased in every three group compared with control group,but there were no obvious statistics difference between three group.(4)There were no obvious statistics difference between three group for K,Na,Ca,P-,P- leveL were higher than normal;HCO3 decreased in group C compared with group A and B,AKP,iPTH increased in group C compared with group A and B.the difference have statistics significance. 2.(1)Artery scleroses speckles rate in anterior tibial artery,posterior tibial artery and dorsal artery of toot were higher in group C compared with group A and B at the beginning,others have no obvious statistics difference;Ⅱgrade of artery narrow rate were higher in group C compared with group A and B,Ⅲgrade of artery narrow rate were higher in group C compared with group B,O grade of artery narrow rate were lower group A compared with group C,others have no obvious statistics difference; Blood vessel inner diameter were lower in group C compared with group A and B,B with A,IMT lever were higher in group C compared with group A and B,B with A, Vmax of interior tibial artery and posterior tibial artery were lower in group C compared with group A and B,dorsal artery of toot Vmax were lower in group B and C compared with group A,PI and RI were higher in group C compared with group A and B,all above have statistics difference.(2)Six months later,artery scleroses speckles rate,artery narrow rate,blood vessel inner diameter,IMT level and blood stream dynamics parameter have statistics difference in group C compared with group B,there were no obvious difference in group A.3.Relativity analysis:TSF,MAMC,BMI,TP,ALB,PA,IGF-1,nPCR, HDL-C and APO-A1 have negative correlation with the development of arteriosclerosis in lower extremities,TG,TC,LDL-C,APO-B,LPα,Ca,P-,CRP and iTPH have positive correlation with the development of arteriosclerosis in lower extremities,BUN,SCr,K,Na,HCO3,AKP,TF,HB and TLC have no evident correlation with the occur and development of arteriosclerosis in lower extremities.Conclusion 1.Malnutrition and arteriosclerosis in lower extremities are common complications in patients with diabetic nephropathy during maintenance hemodialysis, arteriosclerosis rate and development speed in lower extremities were higher when malnutrition situation became bad,there are evident correlation between malnutrition and arteriosclerosis in lower extremities.2.Protein,fat,calcium,phosphonium metabolism disorder and inflammational condition are important factor in the occur and development of arteriosclerosis in lower extremities.
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