目的 探讨不同营养评估工具对老年维持性血液透析(maintenance hemodialysis，MHD)患者营养状况的评估效果，并分析其与衰弱及不良结局的相关性。 方法 纳入146例老年(年龄≥65岁)MHD患者，分别采用营养风险筛查2002(nutritional risk screening 2002，NRS2002)、微型营养评估简表(mini-nutritional assessment-short form，MNA-SF)及营养不良炎症评分(malnutrition inflammation score，MIS)评估营养状况并进行一致性检验。根据疲劳、耐力、行走、疾病、体质量减轻(fatigue resistance，ambulation, illness，loss of weight，FRAIL)量表及不良结局将患者分为衰弱组和非衰弱组及存活组和死亡组，比较不同分组间临床资料及营养状况差异。采用多因素Logistic回归分析NRS2002、MNA-SF和MIS与衰弱的关系，采用Kaplan-Meier生存分析和多因素COX回归分析NRS2002、MNA-SF和MIS与预后的关系。 结果 NRS2002、MNA-SF、MIS评估营养不良的发生率分别为41.78%、43.84%、52.74%；MIS与NRS2002和MNA-SF(Kappa=0.701,0.714)一致性较好，NR2002与MNA-SF一致性较低(Kappa=0.427)。衰弱组中NRS2002(χ2=5.385，P=0.020)、MNA-SF(χ2=5.023，P=0.025)、MIS(χ2=8.119，P=0.004)评估的营养不良比例高于非衰弱组；多因素Logistic回归显示：NRS2002(OR=3.903， 95%CI：1.393～10.937，P=0.010)和MIS(OR=4.574，95% CI：1.435～14.585，P=0.010)是衰弱的独立危险因素。死亡组中NRS2002(χ2=10.905，P＜0.001)、MNA-SF(χ2=6.837，P=0.009)、MIS(χ2=12.296，P＜0.001)评估的营养不良比例高于生存组；Kaplan-Meier分析显示营养不良者(NRS2002、MNA-SF、MIS)的累计生存率均低于营养正常者(χ2=7.375、9.681、12.252，P值分别为0.007、0.002、＜0.001)。多因素COX回归显示NRS2002(HR=2.587，95%CI：1.210～5.533，P=0.014)、MNA-SF(HR=2.663，95%CI：1.218～5.821， P=0.014)和MIS(HR=3.697，95%CI：1.494～9.147，P=0.005)均是不良结局的独立危险因素。 结论 MIS与NRS2002和MNA-SF在评估老年MHD患者营养状况时一致性较好，且MIS与NRS2002均是衰弱及不良结局的危险因素，可能更适合临床预后评估。
Abstract
Objective To investigate the efficacy of different nutritional assessment tools in evaluating the nutritional status of elderly patients undergoing maintenance hemodialysis (MHD) and analyze their correlation with frailty and adverse outcomes. Methods A total of 146 elderly patients (aged ≥65 years) undergoing MHD were enrolled. Nutritional status was assessed using the Nutritional Risk Screening 2002 (NRS2002), Mini-Nutritional Assessment-Short Form (MNA-SF), and Malnutrition Inflammation Score (MIS), followed by consistency analysis. Patients were divided into frailty and non-frailty groups, as well as survival and death groups, based on the FRAIL scale (Fatigue, Resistance, Ambulation, Illness, Loss of Weight) and adverse outcomes. Differences in clinical data and nutritional status between groups were compared. Multivariate logistic regression was used to analyze the relationship between NRS2002, MNA-SF, MIS, and frailty. Kaplan-Meier survival analysis and multivariate Cox regression were employed to evaluate the relationship between NRS2002, MNA-SF, MIS, and prognosis. Results The incidence of malnutrition assessed by NRS2002, MNA-SF, and MIS was 41.78%, 43.84%, and 52.74%, respectively. MIS showed good consistency with NRS2002 and MNA-SF (Kappa=0.701, 0.714), while NRS2002 and MNA-SF had low consistency (Kappa=0.427). The proportion of malnutrition assessed by NRS2002 (χ²=5.385, P=0.020), MNA-SF (χ²=5.023, P=0.025), and MIS (χ²=8.119, P=0.004) was significantly higher in the frailty group than in the non-frailty group. Multivariate logistic regression revealed that NRS2002 (OR=3.903, 95%CI: 1.393～10.937, P=0.010) and MIS (OR=4.574, 95%CI: 1.435～14.585, P=0.010) were independent risk factors for frailty. The proportion of malnutrition assessed by NRS2002 (χ²=10.905, P＜0.001), MNA-SF (χ²=6.837, P=0.009), and MIS (χ²=12.296, P＜0.001) was significantly higher in the death group than in the survival group. Kaplan-Meier analysis showed that the cumulative survival rate of malnourished patients (assessed by NRS2002, MNA-SF, MIS) was significantly lower than that of patients with normal nutrition (χ²=7.375, 9.681, 12.252, P=0.007, 0.002, <0.001, respectively). Multivariate Cox regression indicated that NRS2002 (HR=2.587, 95%CI: 1.210～5.533, P=0.014), MNA-SF (HR=2.663, 95%CI: 1.218～5.821, P=0.014), and MIS (HR=3.697, 95%CI: 1.494～9.147, P=0.005) were independent risk factors for adverse outcomes. Conclusion MIS shows good consistency with NRS2002 and MNA-SF in assessing nutritional status in elderly MHD patients. Both MIS and NRS2002 are risk factors for frailty and adverse outcomes and may be more suitable for clinical prognosis evaluation..
关键词
营养风险筛查2002 /
微型营养评估简表 /
营养不良炎症评分 /
维持性血液透析 /
衰弱 /
死亡
Key words
Nutritional risk screening 2002 /
Mini-nutritional assessment-short form /
Malnutrition inflammation score /
Maintenance hemodialysis /
Frailty /
Death
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