的  探讨长期营养监测对维持性血液透析(maintenance hemodialysis，MHD)患者预后的预测价值。 方法  采用单中心回顾性队列研究，纳入2015年6月在北京大学人民医院接受MHD治疗且规律营养监测的MHD患者113例，随访至2022年7月。收集患者的基线人口统计学特征、实验室检查结果及死亡原因等指标。营养监测包括血清白蛋白、主观综合营养评估(subjective global assessment，SGA)、身体测量(上臂围、肱三头肌皮褶厚度、上臂肌围)及握力测定。研究终点为全因死亡。采用Logistic回归分析营养指标与预后的关系。 结果  随访期间共48例患者死亡，主要死亡原因为心血管事件(60.4%)、脑血管意外(16.7%)和感染(8.3%)。存活组患者末次SGA评分为A级的患者占比高于死亡组(χ2=15.890，P＜0.001)。多因素Logistic回归分析显示：年龄(OR=1.044，95% CI：1.007～1.082，P=0.018)、基线血肌酐(OR=0.998，95% CI：0.996～1.000，P=0.042)和基线的血镁水平(OR=0.035，95% CI：0.001～0.968，P=0.048)是MHD患者全因死亡的独立预测因素。患者随访5年内发生死亡的独立危险因素为血肌酐(OR=0.997，95% CI：0.995～0.999，P=0.003)和上臂肌围(OR=0.792，95% CI：0.574～0.977，P=0.023)。 结论  长期、规律的综合营养监测对MHD患者预后具有重要预测价值。SGA评分有助于识别近期死亡高危患者，而上臂肌围可作为预测长期预后的关键指标。

Objective To investigate the value of long-term nutritional monitoring for prognosis of maintenance hemodialysis (MHD) patients.  Methods A single-center, retrospective and cohort study was conducted, enrolling 113 MHD patients who received regular nutritional monitoring at our center in June 2015 and were followed up until July 2022. Baseline demographic characteristics, laboratory results, and cause of death were collected. Nutritional monitoring included serum albumin measurement, subjective global assessment (SGA), anthropometric measurements (mid-upper arm circumference, triceps skinfold thickness, mid-upper arm muscle circumference), and handgrip strength assessment. The endpoint was all-cause mortality. Logistic regression analysis was used to examine the relationship between nutritional indicators and prognosis.  Results During follow-up, 48 patients died primarily due to cardiovascular events (60.4%), cerebrovascular accidents (16.7%), and infections (8.3%). The proportion of patients with a final SGA score of grade A in the survival group was significantly higher than that in the death group, and the difference between the two groups was statistically significant (χ²=15.89, P<0.001). Multivariate logistic regression analysis showed that age (OR=1.044, 95% CI: 1.007～1.082, P=0.018), baseline serum creatinine (OR=0.998, 95% CI: 0.996～1.000, P=0.042), and baseline serum magnesium (OR=0.035, 95% CI: 0.001～0.968, P=0.048) were the independent predictors of all-cause mortality in MHD patients. The independent risk factors for death within 5 years in follow-up period were serum creatinine (OR=0.997, 95% CI: 0.995～0.999, P=0.003) and arm muscle circumference (OR=0.792, 95% CI: 0.574～0.977, P=0.023).  Conclusion  Long-term and regular comprehensive nutritional monitoring contributes to a predictive value for prognosis in MHD patients. SGA score id helpful to identify the patients with high risk of recent mortality, while upper arm circumference serves as a key indicator for predicting long-term prognosis.