透析营养客观评分法评估血液透析患者的营养状况：75例观察  

Application of objective score of nutrition on dialysis for evaluating nutritional status in maintenance hemo- dialysis patients for 75 cases

作　　者：杜邱娜[1] 严玉澄[1] 朱铭力[1] 陆任华[1] 张伟明[1] 蒋蓉[1] 王咏梅[1] 钱家麒[1] 倪兆慧[1] 庞慧华[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,200127

出　　处：《中华临床营养杂志》2012年第4期222-228,共7页Chinese Journal of Clinical Nutrition

基　　金：上海市科委重大项目（08DZ1900500）

摘　　要：目的应用透析营养客观评分法对维持性血液透析患者进行营养评估，了解营养不良的发生情况及严重程度，探讨引起患者营养不良的影响因素。方法选择维持性血液透析患者75例，以透析营养客观评分作为营养不良的判断标准对患者进行营养评估，将患者分为营养正常、轻中度营养不良和重度营养不良3组。采用Logistic回归法分析引起患者营养不良的相关因素，和传统的主观综合营养评估进行比较，观察其对血液透析患者营养不良评估的价值。结果75例患者中男女比例1.13∶1，平均年龄（54.90±12.10）岁，透析龄（85.37±54.17）个月。根据透析营养客观评分营养正常患者15例（20%）、轻中度营养不良者42例（56%）、重度营养不良者18例（24%）。重度营养不良组与营养正常组相比，患者的体重指数［（19.81±2.22）比 （23.90±2.44 ）kg/m2，P=0.030］、干体重［（50.85±7.60）比 （59.94±10.89） kg, P=0.020］差异具有统计学意义，并且轻中度营养不良、重度营养不良组与营养正常组相比，患者的胆固醇［（4.60±0.84）、（3.73±0.68）mmol/L 比 （5.71±1.64）mmol/L，P=0.011，P=0.000］、标准蛋白质分解率［1.17 、1.15 g/（kg·d）比1.45 g/（kg·d），P=0.030，P=0.010］、肱三头肌皮下脂肪厚度［（1.44±0.77）、（1.00±0.41）cm比（1.80±0.63）cm，P=0.032，P=0.020］、上肢中臂周径［（24.85±1.48）、（21.66±1.48）cm比（24.99±2.30）cm，P=0.046，P=0.037］差异具有统计学意义。多因素Logistic回归显示C反应蛋白 ［OR=12.482，95%CI=0.190-130.928，P=0.035］和标准蛋白质分解率 ［OR=0.128，95% CI=0.022-0.736，P=0.021］与营养不良存在相关性。结论营养不良在维持性血液透析患者中的发生率较高，炎症和蛋白质摄入不足是引起血液透析患者营养不良的独立影响因素。ObjectiveTo evaluate the nutritional status in maintenance hemodialysis patients using objective score of nutrition on dialysis. MethodsPatients on maintenance hemodialysis were randomly selected and divided into three groups based on objective score of nutrition on dialysis： normal nutritional status group, moderate nutritional status group, and low nutritional status group. Logistic regression analysis was performed to identify factors of malnutrition. Furthermore, the results were compared with those of subjective global assessment. ResultsTotally 75 patients （male： female=1.13∶1） with a mean age of （54.90±12.10） years and a mean vintage of （85.37±54.17） months were enrolled. As determined by objective score of nutrition on dialysis, 15 patients （20%） were divided into normal nutritional status group, 42（56%）into moderate nutritional status group, and 18（24%） into low nutritional status group. Compared with the normal nutritional status group, the low nutritional status group had significantly different body mass index [（19.81±2.22） vs （23.90±2.44）kg/m2, P=0.030] and dry weight [（50.85±7.60） vs （59.94±10.89） kg, P=0.020]. In addition, compared with normal nutritional status group, the moderate nutritional status group and low nutritional status group had significantly different total cholesterol [（4.60±0.84） and （3.73±0.68）mmol/L vs （5.71±1.64）mmol/L, P=0.011, P=0.000], normalized protein catabolic rate [1.17 and 1.15 g/（kg·d）vs 1.45 g/（kg·d）, P=0.030, P=0.010], triceps skinfold thickness [（1.44±0.77） and （1.00±0.41）cm vs （1.80±0.63）cm, P=0.032, P=0.020], mid-arm circumference [（24.85±1.48） and （21.66±1.48）cm vs （24.99±2.30）cm, P=0.046, P=0.037]. Logistic regression analysis indicated C-reactive protein （OR=12.482, 95%CI=0.190-130.928, P=0.035） and normalized protein catabolic rate （OR=0.128,95% CI=0.022-0.736, P=0.021） were significantly correlated with malnutrition. ConclusionMalnutrition is com

关 键 词：血液透析 营养不良 透析营养客观评分 炎症 蛋白质饮食 

分 类 号：R459.5[医药卫生—治疗学]