中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (01): 14-17.doi: 10.3969/j.issn.1671-4091.2016.01.004

• 临床研究 • 上一篇    下一篇

主观综合评分联合生物电阻抗法评估血液透析患者的营养状况

王国勤1,徐彩棉2,李狄1,卞维静1,程虹1   

  1. 1. 首都医科大学附属北京安贞医院
    2. 北京和平里医院肾内科
  • 收稿日期:2015-07-14 修回日期:2015-10-31 出版日期:2016-01-12 发布日期:2016-05-19
  • 通讯作者: 卞维静 13911530708@163.com E-mail:bianweijing65@163.com

Assessment of nutritional status using body composition monitor and modified quantitative subjective global assessment in hemodialysis patients

  • Received:2015-07-14 Revised:2015-10-31 Online:2016-01-12 Published:2016-05-19

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摘要： 目的 调查分析维持性血液透析(maintenance hemodialysis patients, MHD)患者的营养状况及其相关因素。方法分别采用改良主观综合评估法(modified quantitative subjective global assessment, MQSGA)和人体成分检测仪(body composition monitor，BCM)对我院MHD1 年以上的患者进行营养状况评估，采集近6 个月的实验室数据，调查3 天饮食情况及统计平均每日蛋白质摄入量(dietary protein intake，DPI)。结果87 例患者纳入分析，男性49 例。以MQSGA 进行评估，87 例患者中营养良好占66.67%、营养不良占32.18%；以BCM 进行评估，营养良好占60.92% (53/87)、营养不良占39.08%(34/87)。两种方法对营养状况的评估结果是高度一致的(kappa=0.768)。87 例患者中49 例完成饮食调查，DPI 为(1.05±0.30)g/(kg·d)。以MQSGA 评分进行分组，营养良好组(58 例)与营养不良组(29例)患者的白蛋白(albumin,Alb)、尿酸(Uric acid,UA)、血肌酐(serum creatine，SCr)、尿素清除指数(Kt/V)、肌肉组织指数(lean tissue index,LTI)、体质量指数(body mass index, BMI)及DPI 有显著性差异(P＜0.05)。多元回归分析提示，MQSGA 评分与年龄(P=0.000)、白蛋白(P=0.018), BMI(P=0.001)独立相关。结论MQSGA 和BCM 对营养状态的评估具有高度的一致性；年龄、血清白蛋白(Alb)水平及BMI是影响MHD患者营养状态的独立影响因素。

关键词: 营养评估, 营养不良, 血液透析

Abstract: Objective To evaluate nutrition status and its related factors in maintenance hemodialysis (MHD) patients. Method We respectively used modified quantitative subjective global assessment (MQSGA) and body composition monitor (BCM) to evaluate the nutritional status in MHD patients for more than one year. Biochemical markers were collected, and food intake in a period of 3 days was measured by food records. Results We performed an observational study on 87 MHD patients (49 males and 38 females). The prevalence of malnutrition was 32.18% by using MQSGA. The prevalence of malnutrition was 39.08% by using
BCM (lean tissue index <10% of the normal value). There was no difference in evaluating nutrition status between MQSGA and BCM (kappa=0.768). Forty-nine patients had the food intake records, and the average daily protein intake (DPI) was 1.05±0.30 g/(kg· d). According to MQSGA scores, patients were classified into well-nourished group and mal-nourished group. Age, DPI, serum albumin (Alb), serum creatinine (SCr), uricacid (UA), body mass index (BMI), lean tissue index (LTI), and overhydration were significantly different between the two groups (P＜0.05). Logistic analysis revealed that MQSGA score was negatively correlated with Alb(r=-0.38, P=0.001), SCr(r=-0.33, P=0.00), UA(r=-0.32, P=0.01), Kt/V(r=-0.243, P=0.02), BMI (r=-0.338, P=0.001), and LTI (r=-0.471, P= 0.000), and positively correlated with age (r=0.37, P=0.00). In addition, overhydration was independently correlated with age, ALB and BMI (r=0.33, P=0.00) in MHD patients. Conclusions Our data indicate that the assessment of nutritional status by BCM is highly consistent with that by MQSGA. Age, Alb and BMI are the independent factors for malnutrition in MHD patients.

Key words: Nutritional Status, dietary protein intake, hemodialysis