维持性血液透析患者营养不良-炎性反应状态与其住院及死亡风险的临床研究  

Impact of malnutrition and inflammation status on hospitalization and mortality in maintenance hemodiaiysis patients

作　　者：王文龙[1] 柳茂森[2] 王会玲[3] 李云生[1] 程勇军[1] 柯颖杰[1] 林华志[1] 吴光华[1] 

机构地区：[1]浙江温岭市第一人民医院温州医学院附属温岭医院肾内科,317500 [2]台州市中心医院消化科 [3]解放军第四五五医院南京军区肾脏病中心肾脏科

出　　处：《中华肾脏病杂志》2012年第5期383-387,共5页Chinese Journal of Nephrology

基　　金：温岭市科技计划项目基金（2009WLCB0085）

摘　　要：目的探讨维持性血液透析（MHD）患者营养和炎性反应状态与其住院和死亡情况的关系，并寻找能够反映MHD患者住院和死亡风险的营养及炎性反应指标。方法随访观察1年我院血透中心MHD患者的营养和炎性反应状况，比较住院和非住院患者的营养及炎性反应状态的差别；并通过Cox比例风险模型寻找能够反映患者1年内首次住院及死亡风险的营养及炎性反应指标。结果人组患者118例，轻、中、重度营养不良的住院率分别为32．93％、56．67％和83．33％；病死率分别为3．66％、6．67％和80．00％；存在微炎性反应状态和不存在微炎性反应状态患者的住院率分别为56．45％和46．43％，病死率分别为14．29％和1．61％。住院患者营养不良．炎性反应评分（8．36比5．86，P〈0．05）和改良主观营养评价得分（14．49比12．88，P〈0．05）均高于未住院患者，差异有统计学意义。与非住院患者比较，住院患者Scr（886．83μmol／L比991．76μmol／L，P〈0．05）、白蛋白（38．57g／L比40．27g／L，P〈0．05）较低，差异有统计学意义。住院患者TNF．仪高于非住院患者（65．41μg／L比59．76μg／L，P〈0．05），差异有统计学意义。Cox比例风险模型显示营养不良炎性反应评分（MIS）和TNF—α与患者首次住院的危险性有关，其值越大，1年内首次住院的危险性越大。结论MHD患者营养不良与炎性反应状态的程度越重，其住院和死亡的风险越大。营养不良．炎性反应评分和TNF-α水平越高，1年内首次住院的危险性越大。Objective To investigate the impact and the associated parameters of malnutrition and inflammation status on hospitalization and mortality of maintenance hemodialysis （MHD） patients. Method A total of 118 MHD patients were included in the study with 1 year＇s follow-up. The malnutrition and inflammation parameters were compared between the hospitalized patients and out-patients. Cox＇s proportional hazard regression model was used to explore the malnutrition and inflammation parameters which could forecast the risk of hospitalization and mortality. Result The hospitalization rate of MIlD patients with mild, moderate and severe malnutrition was 32.93%, 56.67% and 83.33% respectively, and the mortality was 3.66%, 6.67% and 80.00% respectively. The hospitalization rate of MHD patients with or without micro- inflammation status was 56.45% and 46.43%, and the mortality was 14.29% and 1.61%. Inpatients had a higher malnutrition-inflammation score（MIS, 8.36 vs 5.86, P〈0.05） and subjective global assessment of nutrition （MQSGA,14.49 vs 12.88, P〈0.05）, a lower creatinine level （886.83μmol/L vs 991.76 μmol/L, P〈0.05） and a lower albumin level （38.57 g/L vs 40.27 g/L, P〈 0.05） than out-patients. Inpatients also had a higher level of TNF-α （65,41μg/L vs 59.76 μg/L, P〈0.05） than out-patients. Cox proportional hazard model analysis showed that MIS and TNF-α were associated with patient＇s first hospitalization risk. Conclusions For the MHD patients, the more severe the malnutrition and micro-inflammation status is, the worse the clinical outcome is. The higher levels of MIS and TNF-α result in greater risk of hospitalization.

关 键 词：肾透析 营养不良 炎症 营养不良-炎性反应评分 

分 类 号：R459.5[医药卫生—治疗学]