炎症及营养不良评分法在人工肾透析患者营养评估中的作用

摘要

背景:人工肾透析患者普遍存在营养不良,哪种整体营养评估方法更能准确反映患者的营养状况尚无定论.目的:比较3种营养评估方法在人工肾透析患者营养不良评估中的地位.方法:选择人工肾透析患者62例,分别应用主观整体营养评估SGA、改良定量主观营养评估MQSGA和营养不良炎症评分MIS进行营养评估,同时测定人体测量学指标及各种生化指标作为客观营养指标;按测定超敏C-反应蛋白水平分为升高组和正常组,比较两组各营养指标及营养评分有无差异,并进行Pearson相关分析与偏相关分析.结果与结论:升高组患者营养不良的程度较正常组严重,无论哪种评分法均值均表明两组患者存在不同程度的营养不良,但两组MIS评分值差异明显,说明MIS评分更能反应Ⅱ型营养不良患者的营养状态.无论采用Pearson相关分析,还是控制年龄、身高、体质量后的偏相关分析,MIS评分法与传统SGA和MQSGA法比较,均与更多主观、客观营养指标相关,提示MIS法在透析患者营养状态评估中更具优势,更能准确地评估其营养状态.%BACKGROUND: Malnutrition is commonly found in artificial kidney hemodialysis patients, but which is the best method for assessing nutritional status remains unclear.OBJECTIVE: To compare the three methods including subjective global assessment (SGA), modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS) used for the evaluation of nutritional status in artificial kidney hemodialysis patients.METHODS: The nutritional status of 62 artificial kidney hemodialysis patients was evaluated by SGA, MQSGA and MIS separately. The anthropometric indices and serum biochemical parameters were measured. According to the levels of high sensitivity C-reactive protein (hs-CRP), all patients were divided into elevated CRP group and normal CRP group.The objective nutritional parameters and the malnutrition scores were compared between these two groups. Pearson's correlation analysis was utilized to assess the relationship of hs-CRP and SGA, MQSGA, MIS and some other objective nutritional parameters. At the same time, the partial correlation analysis was utilized to assess the relationship of SGA, MQSGA and MIS and some other objective nutritional parameters.RESULTS AND CONCLUSION: The degree of nutritional status in the elevated CRP group was much worse than that in the normal CRP group, but the mean values in the two methods show that all patients had different degrees of nutritional status. But the difference of MIS in the two groups was magnificent, indicati ng that MIS is better in evaluating the nutritional status of type Ⅱ malnutrition. MIS is more relative to the objective or subjective nutritional indices than SGA and MQSGA by Pearson correlation analysis or partial correlation analysis in terms of excepting age, body height and weight. As a quantitative evaluation method of malnutrition , MIS is more accurate in evaluating the inflammatory level and nutritional status in artificial kidney hemodialysis patients compared with SGA and MQSGA.