中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (05): 281-285.doi: 10.3969/j.issn.1671-4091.2015.05.006

• 临床研究 • 上一篇    下一篇

不同营养评估方法对腹膜透析患者营养状态的评估及住院风险的预测价值

毛永辉,赵班,李天慧,贾莺梅,汪明芳   

  1. 卫生部北京医院肾脏内科
  • 收稿日期:2014-08-06 修回日期:2015-03-11 出版日期:2015-05-12 发布日期:2015-05-29
  • 通讯作者: 毛永辉 Mmdn2009@163.com E-mail:mmdn2009@163.com

Comparison of different methods for the assessment of nutritional status and the prediction of risks during hospitalization in peritoneal dialysis patients

  • Received:2014-08-06 Revised:2015-03-11 Online:2015-05-12 Published:2015-05-29

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摘要： 目的比较应用血清白蛋白、改良SGA 法(MQSGA)和MIS 评分预测腹膜透析(PD)患者住院风险的差异。方法横断面及回顾性研究。选择符合纳入标准的57 例病情稳定的腹膜透析患者，对其进行改良SGA 和MIS 评分，以及血清白蛋白等各项临床指标检测，记录患者1 年内住院情况，分析不同评估方法对患者营养状态的判定及其与住院风险相关性的差异。结果①3 种营养评估方法对腹膜透析患者诊断营养不良的发生率由低到高分别为：血清白蛋白(57.9% )；MQSGA 评分(70.2% )；MIS 评分(100%)。②3 种营养评估方法之间的相关性显著(P＜0.01)；MQSGA 和MIS 评分与住院频次和各项临床营养指标的相关性显著(P＜0.01)。③以PEW 为标准，血清ALB、MQSGA 和MIS 评分对营养不良诊断的ROC 曲线下面积分别为0.028、0.966、0.961。④住院组患者的血清白蛋白、前白蛋白水平低于非住院组(P＜0.05)，住院组患者的Hs-CRP 水平以及MQSGA 和MIS 评分均显著高于非住院组(P=0.000)。⑤非条件Logistic多元回归分析显示MQSGA 与腹膜透析患者住院的相对危险度最高[RR=2.559，95% CI(1.498～4.372)，P=0.001]。结论MIS 评分诊断腹膜透析患者营养不良的发生率最高，MQSGA 与MIS 评分具有相似的营养评估效果，MQSGA 与MIS 评分都具有预测腹膜透析患者住院风险的价值，MQSGA 对住院风险的预测价值相对更高。

关键词: 腹膜透析, 营养不良, 改良定量主观整体营养评价法, 营养不良-炎症评分

Abstract: 【Abstract】Objective Nutritional status can be evaluated by serum albumin, modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS). This study sought to determine the value of these methods for malnutrition assessment in peritoneal dialysis (PD) patients. Methods
Fifty-seven clinically stable patients undergoing PD were recruited for the evaluation of nutritional status by serum albumin, MQSGA and MIS. Their anthropometry and biochemical assays were evaluated. Correlation among the results from the 3 methods was conducted. Receiver operating characteristic (ROC) curve was applied to study the sensitivity and specificity of the 3 methods for the evaluation of malnutrition status. Logistic proportional hazard regression model was used to assess the risks during hospitalization. Results ①Malnutrition status was found in all PD patients by MIS, in 70.2% patients by MQSGA, and 57.9% patients by serum albumin. ②MQSGA and MIS correlated to anthropometry, biochemical assays and hospitalization frequency. Nutritional assessments by MQSGA, MIS and serum albumin were significantly correlated (P＜0.01). ③Area under the curve of MQSGA, MIS and serum albumin was 0.966, 0.961 and 0.028, respectively, for malnutrition diagnosed by PEW. ④Logistic proportional hazard regression demonstrated that MQSGA score had the highest correlation with the risks during hospitalization (RR 2.559, CI 1.498～4.372, P=0.001). Conclusions MIS is a sensitive method for the evaluation of malnutrition in PD patients. MQSGA is similar to MIS for malnutritional assessment in PD patients. MQSGA may be a better predictor for risks during hospitalization in PD patients.

Key words: peritoneal dialysis, malnutrition, modified quantitative subjective global assessment（MQSGA）, malnutrition-inflammation score（MIS）