综合营养风险因素对腹膜透析患者营养不良及预后的预测价值  

Predictive value of comprehensive nutritional risk factors for malnutrition and prognosis in peritoneal dialysis patients

作　　者：梁嫦娜 吕晶 马莹 顾问 路万虹[1] Liang Changna;Lv Jing;Ma Ying;Gu Wen;Lu Wanhong(Department of Nephrology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;不详)

机构地区：[1]西安交通大学第一附属医院肾内科,西安710061 [2]西安交通大学第一附属医院影像科,西安710061

出　　处：《临床内科杂志》2023年第10期672-676,共5页Journal of Clinical Internal Medicine

基　　金：陕西省重点研发计划(2019KW-040);陕西省自然科学基础研究计划项目(2022JM-598)。

摘　　要：目的研究不同营养状况腹膜透析(PD)患者握力、karnofsky活动指数(KPS)评分、饮食摄入和生化及营养指标与其营养不良的关系,探寻预测PD患者营养不良及预后的最佳指标。方法根据改良主观定量整体性营养评估法(MQ-SGA)评分将130例PD患者分为营养良好组(<10分,110例)和营养不良组(≥10分,20例),收集所有患者的一般资料、实验室检查结果、握力、KPS评分、饮食摄入指标及综合营养风险因素数量并进行组间比较。危险因素采用单因素及多因素logistic回归分析评估。采用受试者工作特征(ROC)曲线筛选PD患者营养不良的预测因素。影响因素采用Cox比例风险回归分析评估。采用Kaplan-Meier曲线比较累积生存率。结果营养良好组年龄、空腹血糖、超敏C反应蛋白(hsCRP)水平及糖尿病病史患者比例均低于营养不良组,血肌酐、血白蛋白、血镁、前白蛋白水平及握力、KPS评分、每日能量摄入(DEI)均高于营养不良组(P<0.05)。营养不良组男性患者握力明显低于营养良好组男性,营养良好组男性患者握力明显高于同组女性,营养良好组男性和女性的KPS评分均明显高于营养不良组同性别患者(P<0.05)。多因素logistic回归分析结果显示,高综合营养风险因素及低KPS评分均是PD患者营养不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,男性握力、KPS评分、年龄、血白蛋白、血肌酐、hsCRP、血镁、DEI、前白蛋白、空腹血糖及综合营养风险因素对PD患者营养不良均有较好的预测价值(P<0.05)。Cox比例风险回归分析结果显示,综合营养风险因素≥3个是全因死亡和心血管事件死亡(CVD)的独立危险因素,KPS评分是全因死亡的独立保护因素;糖尿病病史是CVD的独立危险因素,24 h尿量是CVD的独立保护因素(P<0.05)。Kaplan-Meier曲线分析结果显示,综合营养风险因素≥3个的PD患者累积生存率低于综合营养风险因素<3个Objective To investigate the relationship between grip strength,karnofsky performance status(KPS)score,dietary intake,biochemical and nutritional indicators with malnutrition in peritoneal dialysis(PD)patients of different nutritional status,and explore the best indicators for predicting malnutrition and prognosis in PD patients.Methods According to the modified subjective comprehensive nutrition assessment(MQ-SGA)score,130 PD patients were divided into well-nourished group(<10 point,110 cases)and malnourished group(≥10 point,20 cases).General data,laboratory results,grip strength,KPS score,dietary intake index and number of combined nutritional risk factors were collected and compared between groups.Risk factors were assessed by univariate and multivariate logistic regression analysis.Predictive factors of malnutrition in PD patients were screened by using receiver operating characteristics(ROC)curves.The influencing factors were evaluated by Cox proportional risk regression analysis.Kaplan-Meier curve was used to compare the cumulative survival rate.Results Age,fasting blood glucose,hypersensitive C-reactive protein(hsCRP)levels and the proportion of diabetic patients in well-nourished group were lower than those in malnourished group,while serum creatinine,serum albumin,serum magnesium,prealbumin levels,grip strength,KPS score and daily energy intake(DEI)were higher than those in malnutrition group(P<0.05).Grip strength in male patients with malnourished group was significantly lower than that in male patients with well-nourished group,grip strength of male patients with well-nourished group was significantly higher than that in female patients in the same group,and the KPS score of male and female patients with well-nourished group was significantly higher than that in patients with the same sex in malnourished group(P<0.05).Multi factor logistic regression analysis showed that high comprehensive nutritional risk factors and low KPS score were independent risk factors for malnutrition in PD patients(P<0.05)

关 键 词：腹膜透析 营养不良 综合营养风险因素 

分 类 号：R692.5[医药卫生—泌尿科学]