握力对腹膜透析病人营养状况的预测价值  

Predictive value of grip strength for nutritional status in peritoneal dialysis patients

作　　者：吕桂兰 周婷婷 席海玲 孙慧敏 陈赟敏 张稳 LV Gui-lan;ZHOU Ting-ting;XI Hai-ling;SUN Hui-min;CHEN Yun-min;ZHANG Wen(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing 210000,Jiangsu,China;Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,Jiangsu,China;Department of Information,General Hospital of Eastern Theater Command,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院国家肾脏疾病临床医学研究中心,江苏南京210002 [2]南京大学医学院附属金陵医院,江苏南京210093 [3]东部战区总医院保障中心信息科,江苏南京210002

出　　处：《肠外与肠内营养》2020年第6期358-362,共5页Parenteral & Enteral Nutrition

基　　金：院管课题(2017085)。

摘　　要：目的:评价握力对腹膜透析病人营养状况的预测价值。方法:研究对象为终末期肾病行腹膜透析且规律透析3个月以上的病人110例,收集病人的一般资料、握力水平、人体测量学指标、主观营养评价、实验室指标、透析相关指标,并对相关指标进行分析。通过营养不良-炎症评分系统(MIS)评估病人营养风险,并根据MIS得分进行分组,MIS≥7.5分的病人为营养风险组,MIS<7.5分的病人为无营养风险组。结果:营养风险组病人握力、残余肾功能水平低于无营养风险组,超敏C反应蛋白高于无营养风险组,且差异均有统计学意义。两组病人在营养不良的传统风险因素如透析充分性、血红蛋白、血脂、前白蛋白等无统计学差异,两组资料具备可比性。单因素分析结果显示BMI、透析龄、GS、eGFR、LDL和超敏C反应蛋白共6个因素有统计学意义,多因素Logistic回归分析筛选出握力、透析龄、BMI是腹膜透析病人营养不良发生的独立危险因素。握力预测腹膜透析病人营养状况的曲线下面积(AUC)为0.720(95%CI:0.616~0.823,P=0.001),最佳截值为28.5 kg。结论:握力是腹膜透析病人发生营养不良的良好预测指标。Objective:To evaluate the predictive value of grip strength for the nutritional status in peritoneal dialysis patients.Methods:The subjects of the study were 110 patients with end-stage renal disease who underwent peritoneal dialysis and regular dialysis for more than 3 months.The patients’general information,grip strength,anthropometric indicators,subjective nutritional evaluation,laboratory indicators,and dialysis-related indicators were collected and analyzed.The nutritional risk of the patients was assessed by the malnutrition-inflammation score system(MIS)and grouped according to the MIS score.Patients with MIS≥7.5 as no nutritional risk group,Patients with MIS<7.5 as no nutritional risk group Results:The levels of grip strength and residual renal function in the nutritional risk group were lower than those in the no nutritional risk group,and the high-sensitivity C-reactive protein was higher than those in the no nutritional risk group,and the differences were statistically significant.There was no statistically significant difference between the two groups of patients in the traditional risk factors of malnutrition,such as dialysis adequacy,hemoglobin,blood lipids,prealbumin,etc.The data of the two groups were comparable.Univariate analysis,the results showed that 6 factors including BMI,dialysis age,GS,eGFR,LDL and high-sensitivity C-reactive protein were statistically significant.Multivariate Logistic regression analysis indicated grip strength,Dialysis age and BMI were independent risk factors for malnutrition in peritoneal dialysis patients.The AUC for predicting the nutritional status of PD patients was 0.720(95%CI:0.616~0.823,P=0.001),and the optimal cut-off value was 28.5 kg.Conclusion:Grip strength is a good predictor of malnutrition in peritoneal dialysis patients.

关 键 词：握力 腹膜透析病人 营养状况 预测价值 

分 类 号：R459.3[医药卫生—治疗学] R692.5[医药卫生—临床医学]