两种营养评价方法在老年糖尿病肾病患者中的应用及比较

摘要

目的 应用营养风险筛查2002(Nutritional Risk Screening 2002,NRS2002)及微型营养评价法(Mini Nutritional Assessment,MNA)对老年糖尿病肾病(diabetic nephropathy,DN)住院患者进行营养评价,寻找适合该人群的营养筛查方法,早期发现存在营养风险的患者、及时给予指导及干预.方法 对210例老年DN住院患者采用NRS2002及MNA进行营养筛查,同时测定体质量指数(body mass index,BMI),上臂肌围(arm muscle circumference,AMC)、小腿围(calf circumference,CC)等人体测量学指标和总蛋白(total protein,TP)、白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)等实验室指标,评估营养不良发生率,用Kappa值比较NRS2002、MNA两种营养评价方法的评定效果,同时与传统指标进行相关性分析.结果 210例老年DN患者中,不同营养评价方法得出营养不良的发生率结果不同(17.1%~40.5%),NRS2002为37.1%,MNA为40.5%,人体测量指标评价法17.1%,实验室检查指标评价方法20.5%,MNA、NRS2002评分与TP、ALB、PA、BMI、AMC、CC具有相关性.NRS2002营养风险筛查与MNA一致性检验差异有统计学意义(Kappa=0.612,P<0.01).结论 相比传统的营养评价指标,综合性营养评价方法NRS2002和MNA的结果更为全面、准确.%Objective Nutrition Risk Screening 2002 (NRS2002 )and Mini-Nutritional Assessment (MNA) were applied in nutritional assessment for elderly diabetic nephropathy(DN)of hospitalized patients,and appropriate nutritional assessment methods,as well as the implementation of nutrition interventions for the population were explored.Methods A total of 210 elderly hospitalized DN patients were evaluated with NRS2002 and MNA for nutritional screening.Simultaneously assessment was made in the prevalence of malnutrition by measuring body mass index (BMI),arm muscle circumference (AMC),calf circumference (CC)and total protein (TP),albumin (ALB), prealbumin (PA).Kappa value of the two nutritional measurements,i.e.NRS2002 and MNA were compared to analyze the accuracy of the two methods,and correlation analysis was conducted for the two methods and traditional indicators.Results For 210 cases of elderly patients with DN,two evaluation methods gave different nutrient malnutrition incidence results (17.1%-40.5% ), NRS2002 was 37.1%, MNA 40.5%, anthropometric indexes evaluation was 17.1%,laboratory parameters evaluated method was 20.5%.MNA and NRS2002 scores were TP, ALB,PA,BMI,AMC and CC relevant.NRS2002 nutrition risk screening and MNA consistency test showed significant difference(Kappa=0.612,P <0.01).Conclusion Compared with the traditional nutritional evaluations, MNA and NRS2002 as comprehensive nutritional assessment methods,are more comprehensive and accurate.