维持性血液透析患者三种营养状况评估方法的比较研究  

Comparing Outcome Predictability of Markers of Malnutrition in Maintenance Hemodialysis

作　　者：王文龙 李云生 程勇军 柯颖杰 郝世军 戴再友 严海红 王莹 郑丹 吴光华 

机构地区：[1]浙江省温岭市第一人民医院肾内科

出　　处：《中国中西医结合肾病杂志》2012年第11期976-980,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：温岭市科技计划项目(No.2009WLCB0085)

摘　　要：目的:比较营养不良-炎症评分(MIS)、改良SGA(MQSGA)和血清白蛋白三种维持性血液透析(MHD)患者营养评估方法,为选择MHD患者营养评估方法提供依据。方法:选取我院血透中心行MHD3个月以上患者为研究对象,观察指标:(1)营养不良指标:MIS、MQSGA和血清白蛋白。(2)人体测量学指标:体重指数(BMI)、肱三头肌皮褶厚度(TSF)、上臂围(MAC)、上臂肌围(MAMC)等。(3)生化指标:血清白蛋白、转铁蛋白、总胆固醇、肌酐、铁蛋白。统计分析MIS、MQSGA和白蛋白与其他营养指标的相关性,并对所有患者追踪1年,分为住院组和未住院组,比较两组中MIS、MQSGA和白蛋白的差异,然后建立COX比例风险模型,分析这3个指标与MHD患者住院风险有无关系。结果:(1)MIS标准:118例MHD患者全部为营养不良占100%;MQSGA标准:营养不良占74.57%;白蛋白标准:营养不良占16.95%。(2)白蛋白、MQSGA和MIS与血液生化和人体测量指标呈现相关性(P<0.05),但是以MIS与其他营养指标的相关系数最大。(3)118例MHD患者中,住院组MIS和MQSGA均显著高于未住院组(P<0.05)。(4)Cox风险比例模型显示MIS与患者住院风险有关。结论:MIS对营养不良的检出率最高,与其他营养评价指标的相关性更好,可以预测MHD患者的住院风险。Objective：To compare the action of malnutrition - inflammation score （MIS）, subjective global assessment of nutrition （MQSGA） and serum albumin in evaluatting malnutrition in maintenance hemodialysis （MHD） patients. Methods：All the patients came from Hemo - purified Center of The 1 th People Hospital of Wenling. We detected the following parameters ： （ 1 ） nutri- tional parameters ： including MIS, MQSGA, and serum albumin. （2） Anthropometry： including body mass index （ BMI）, triceps skinfold （TSF）, mid - arm circumference （MAC） and mid - arm muscle circumference （ MAMC ）. （ 3 ） Biochemical assays： inclu- ding serum total protein, albumin, transferrin, ferritin, total iron binding capacity, serum creatinine, uric acid, urea nitrogen and haemoglobin. We conducted correlation analysis of MIS, MQSGA, serum albumin and anthropometry, biochemical assays respectly. Followed all the patients for 12 months, the MHD patients who have ever hospitalized within the follow-up piriod were divided into the Observed group, and who have not ever hospitalized were divided into the Compared group. Compared of parameters in the two groups. And Cox＇ s proportional hazard regression model was used to assess the risk of the first hospitalization. Results： （ 1 ） All the MHD patients were in malnutrition status acceding to MIS, and 74.57% of them acceding to MQAGA, and 16.95% of them acceding to serum albumin. （2） MIS, MQSGA and serum albumin correlate with anthropemetry and biochemical assays, but the correlation co- efficients were larger between MIS and anthropemetry and biochemical assays; （3）The MIS and MQSGA were significantly higher in Observed group than that of Compared group（P 〈0.05） ; （4）The Cox＇ s proportional hazard regression model relative risk （RR） for first hospitalization in MIS were 1. 101. Conclusion：MIS appear to be a better method of evaluating malnutrition in MHD patients.

关 键 词：血液透析 营养不良 炎症 营养不良-炎症评分 

分 类 号：R692.5[医药卫生—泌尿科学]