中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 519-522.doi: 10.3969/j.issn.1671-4091.2018.08.004

• 临床研究 • 上一篇    下一篇

比较MQSGA 及MIS 对老年维持性血液透析患者营养状况的评估研究

封蕾1,李云姝1,李萍1,陈客宏1   

  1. 1.陆军军医大学附属大坪医院肾内科血液净化中心
  • 收稿日期:2018-03-01 修回日期:2018-05-15 出版日期:2018-08-12 发布日期:2018-08-12
  • 通讯作者: 陈客宏 415651555@qq.com E-mail:chenkehong@foxmail.com
  • 基金资助:

    国家自然科学基金项目81770731

Comparison of the modified quantitative subjective global assessment (MQSGA) and the malnutritioninflammation score (MIS) for the evaluation of nutritional status in elderly maintenance hemodialysis patients

  • Received:2018-03-01 Revised:2018-05-15 Online:2018-08-12 Published:2018-08-12

PDF

562

摘要： 【摘要】目的比较行改良定量整体主观评估(modified quantitative subjective global assessment，MQSGA)及营养不良炎症评分(malnutrition-inflammation score，MIS)对老年维持性血液透析患者营养状况评估的准确性以及其对心脑血管事件预测价值。方法纳入2014 年1 月到2016 年12月的236 例维持性血液透析患者，纳入维持性血液透析大于3 个月，年龄大于60 岁的老年患者。行MQSGA和MIS，收集患者基本临床资料和实验室检测数据。利用人体测量检测患者身体质量指数、上臂皮褶厚度、三头肌皮褶厚度、上臂围、上臂肌围分析MQSGA 和MIS 与各项指标的相关性，并比较两种方法对营养不良－炎症状态的评价效能。比较心脑血管事件组与无心脑血管事件两组患者的临床指标，并将不同营养评估方法评分与心脑血管事件发生采用logistic 多元回归分析。结果本研究纳入236 例维持性血液透析患者，其中男性138 例，女性108 例，平均年龄为(73.4±7.6)岁，维持性血液透析时间为(35.1±14.2)月。MQSGA 营养分级中营养不良患者比例总共达到64.4%，同时MIS 营养分级中营养不良患者比例达到65.8%，两者并无明显差异(χ2=0.150，P=0.699)。除三头肌皮褶厚度外，MIS 与各营养指标及炎症指标的相关系数绝对值均高于MQSGA。提示MIS 较MQSGA 评分能够更好的反映老年维持性血液透析患者的营养状态。心脑血管事件组患者MIS[9.2(4.1～26.6)分比5.2(1.2～12.8)分, Z=2.641, P＜0.001]、MQSGA[12.3(7.3～32.4)分比7.5(7.2～12.6)分，Z=2.012，P＜0.001]、前白蛋白(38.2±11.5)mg/dl 比(29.8±8.0)mg/dl，t=2.951, P=0.002)、C 反应蛋白[11.1(0.1～16.9) mg/L 比2.6(0.2～17.4)mg/L，Z=2.715，P＜0.001]均明显高于无心脑血管事件组。logistic 多元回归分析发现MQSGA 与血液透析患者心脑血管事件风险相对危险度[RR=1.516，95% CI(1.109～2.001)，P=0.005]明显低于MIS 与心脑血管事件风险的相对危险度[RR=2.563, 95% CI(1.561～5.211)，P=0.003] ，提示MIS 对血液透析患者心脑血管事件风险的预测价值更大。结论MIS 较MQSGA 评分能够较好的反映老年维持性血液透析患者的营养状态。MIS 可能对预测老年透析患者心血管事件风险更有临床价值。

关键词: 血液透析, 老年, 营养不良, MIS评分, 心血管事件

Abstract: 【Abstract】Objective To compare the accuracy of modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS) for the evaluation of nutritional status and the prediction of cardio- and cerebro-vascular events in elderly maintenance hemodialysis (MHD) patients. Methods A total of 236 MHD patients treated in the period from January 2014 to December 2016 were enrolled in this study. Patients were on MHD for more than 3 months and over 60 years old. MQSGA and MIS were performed for these patients. Clinical data and laboratory test results were collected. Body mass index (BMI), skin fold thickness of upper arm, skin fold thickness of triceps muscle, upper arm circumference and upper arm muscle circumference were measured. The correlation of these parameters with MQSGA and MS was analyzed. The effectiveness of MQSGA and MS for the evaluation of malnutrition-inflammation status was compared. Clinical data were compared between patients with cardio- and cerebro-vascular events and those without cardio- and cerebro-vascular events. Multivariate logistic regression was used to analyze the relationshipbetween the scores from different nutrition evaluation method and cardio- and cerebro-vascular events. Results This study enrolled 236 MHD patients (138 males and 108 females, average age 73.4±7.6 years, and MHD duration 35.1±14.2 months). The proportion of malnutrition in this cohort was 64.4% by MQSGA and was 65.8% by MIS (χ2=0.150, P=0.699). Except for the skin fold thickness of triceps muscle, the absolute values of correlation coefficient for nutrition and inflammatory indexes were higher from MIS than from MQSGA, suggesting that MIS is better than MQSGA for the evaluation of nutritional status in elderly MHD patients. The levels of MIS score (Z=2.641, P＜0.001), MQSGA (Z=2.012, P＜0.001), pre-albumin (t=2.951, P= 0.002), and C reactive protein (Z=2.715, P＜0.001) were significantly higher in patients with cardio- and cerebro-vascular events than in those without cardio- and cerebro-vascular events. Multivariate logistic regression showed that the relative risk (RR) of cardio- and cerebro-vascular events from MQSGA (RR=1.516, 95% CI 1.109-2.001, P=0.005) was significantly lower than that from MIS (RR=2.563, 95% CI 1.561～5.211, P=0.003), suggesting that MIS is more valuable than MQSGA in predicting the risk of cardio- and cerebro-vascular events in elderly MHD patients. Conclusion MIS was better than MQSGA for the evaluation of nutritional status and the prediction of cardiovascular events in elderly MHD patients.

Key words: Hemodialysis, elderly, malnutrition, MIS score, cardiovascular events