Abstract: Background　Heart failure is an unavoidable syndrome in the end stage of heart disease.It has a high mortality and disability rate. Water and sodium retention is the main manifestation of heart failure. Human component analyzer can accurately evaluate the intracellular and extracellular water content of human body. At present, there are few reports about the application of human component analysis in guiding clinical medication in the treatment of heart failure at home and abroad. Objective　To analyze the body fluid distribution and nutritional status of patients with heart failure before and after diuretic treatment. Methods　A total of 33 patients with heart failure（heart failure group） admitted to the Department 4 of Cardiology, Hebei General Hospital and 33 patients without heart failure（non-heart failure group） admitted in the same hospital from January 2017 to January 2018 were selected as the study subjects. White blood cell count（WBC）, hemoglobin（Hb） , albumin（ALB） , aspartate aminotransferase（AST） , alanine aminotransferase（ALT） , creatinine（Cr） , blood potassium, blood sodium, total cholesterol（TC） , total triglyceride（TG） , high density lipoprotein（HDL）, low density lipoprotein（LDL） were measured. Nutrition physicians in our hospital measured extracellular water（ECW） , intracellular water（ICW） , total body water（TBW） , intracellular water/total body water（ICW%） , total body water/body mass （TBW%） , protein content, skeletal muscle content, body fat rate, extracellular water/total body water（ECW%） before and after diuretic treatment in heart failure group and non-heart failure group．The differences between the above indexes before and after diuretic treatment in heart failure group and non-heart failure group were compared. Results　There were no significant differences in sex and age between the two groups（χ2=0.243, P=0.622; t=1.405, P=0.165）．There were significant differences in Hb, ALB and Cr between the two groups（P<0.05） ．ICW% before diuretic treatment in heart failure group was lower than that in non-heart failure group, and ECW%（whole body, right upper extremity, left upper extremity, right lower extremity, left lower extremity） was higher than that in non-heart failure group（P<0.05）．After diuretic treatment, ECW%（whole body, right upper extremity, left upper extremity, trunk, right lower extremity, left lower extremity） in heart failure group was higher than that in non-heart failure group（P<0.05） ．ICW% increased and ECW%（whole body） decreased after diuretic treatment in heart failure group（P<0.05）．Conclusion　The abnormal water distribution and fluid retention in extracellular fluid in patients with heart failure showed that ECW（whole body, right upper extremity, left upper extremity, right lower extremity, left lower extremity） increased, while ICW% decreased, especially in lower extremity edema.Diuretic treatment could correct the above abnormalities to a certain extent. ECW%（whole body） decreased and ICW%（whole body） increased in patients with heart failure after diuretic treatment, but ECW%（right upper extremity, left upper extremity, trunk, right lower extremity, left lower extremity） had no difference before and after the treatment in heart failure group.

Key words: Heart failure, Human body composition analysis, Diuresis, Water

摘要： 背景　心力衰竭是心脏疾病发展到终末阶段几乎不可避免的综合征，具有较高的病死率和致残率，水钠潴留是心力衰竭的主要表现，人体成分分析仪可精准评价人体的细胞内外水分，而目前国内外关于心力衰竭患者治疗中应用人体成分分析来指导临床用药的报道较少。目的　分析心力衰竭患者利尿治疗前后体液分布及营养状况。方法　选取2017年1月—2018年1月河北省人民医院心内四科病房住院治疗的33例心力衰竭患者（心力衰竭组）及33例无心力衰竭的住院患者（非心力衰竭组）作为研究对象。检测患者的白细胞计数（WBC）、血红蛋白（Hb）、清蛋白（ALB）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、肌酐（Cr）、血钾、血钠、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）。本院营养科医师对非心力衰竭组、心力衰竭组利尿治疗前和利尿治疗后测定其细胞外水分（ECW）、细胞内水分（ICW）、机体总水分（TBW）、细胞内水分占机体总水分的比例（ICW%）、机体总水分/体质量（TBW%）、蛋白质含量、骨骼肌含量、体脂率、全身及机体各节段的细胞外水分占机体总水分的比例（ECW%）。比较心力衰竭患者利尿治疗前后上述指标之间以及与非心力衰竭组的差异。结果　两组间性别、年龄比较，差异无统计学意义（χ2=0.243，P=0.622；t=1.405，P=0.165）。两组间Hb、ALB、Cr比较，差异有统计学意义（P<0.05）。心力衰竭组患者利尿治疗前ICW%低于非心力衰竭组，ECW%（全身、右上肢、左上肢、右下肢、左下肢）高于非心力衰竭组（P<0.05）。心力衰竭组患者利尿治疗后ECW%（全身、右上肢、左上肢、躯干、右下肢、左下肢）高于非心力衰竭组（P<0.05）。心力衰竭组患者利尿治疗后ICW%较利尿治疗前上升，而ECW%（全身）较利尿治疗前下降（P<0.05）。结论　心力衰竭患者水分分布异常，体液潴留于细胞外液，表现为ECW%（全身、右上肢、左上肢、右下肢、左下肢）升高，而ICW%降低，尤以双下肢水肿为主，应用利尿剂治疗后可在一定程度上纠正上述异常。与利尿治疗前相比，心力衰竭患者利尿治疗后，ECW%（全身）降低，ICW%升高，ECW%（右上肢、左上肢、躯干、右下肢、左下肢）无差异。

关键词: 心力衰竭, 人体成分分析, 利尿, 水分