主观综合评分联合生物电阻抗法评估血液透析患者的营养状况
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摘要
目的调查分析维持性血液透析(maintenance hemodialysis patients,MHD)患者的营养状况及其相关因素。方法分别采用改良主观综合评估法(modified quantitative subjective global assessment,MQSGA)和人体成分检测仪(body composition monitor,BCM)对我院MHD1年以上的患者进行营养状况评估,采集近6个月的实验室数据,调查3天饮食情况及统计平均每日蛋白质摄入量(dietary protein intake,DPI)。结果 87例患者纳入分析,男性49例。以MQSGA进行评估,87例患者中营养良好占66.67%、营养不良占32.18%;以BCM进行评估,营养良好占60.92%(53/87)、营养不良占39.08%(34/87)。两种方法对营养状况的评估结果是高度一致的(kappa=0.768)。87例患者中49例完成饮食调查,DPI为(1.05±0.30)g/(kg·d)。以MQSGA评分进行分组,营养良好组(58例)与营养不良组(29例)患者的白蛋白(albumin,Alb)、尿酸(Uric acid,UA)、血肌酐(serum creatine,SCr)、尿素清除指数(Kt/V)、肌肉组织指数(lean tissue index,LTI)、体质量指数(body mass index,BMI)及DPI有显著性差异(P<0.05)。多元回归分析提示,MQSGA评分与年龄(P=0.000)、白蛋白(P=0.018),BMI(P=0.001)独立相关。结论 MQSGA和BCM对营养状态的评估具有高度的一致性;年龄、血清白蛋白(Alb)水平及BMI是影响MHD患者营养状态的独立影响因素。
Objective To evaluate nutrition status and its related factors in maintenance hemodialysis(MHD) patients. Method We respectively used modified quantitative subjective global assessment(MQSGA) and body composition monitor(BCM) to evaluate the nutritional status in MHD patients for more than one year. Biochemical markers were collected, and food intake in a period of 3 days was measured by food records. Results We performed an observational study on 87 MHD patients(49 males and 38 females). The prevalence of malnutrition was 32.18% by using MQSGA. The prevalence of malnutrition was 39.08% by using BCM(lean tissue index <10% of the normal value). There was no difference in evaluating nutrition status between MQSGA and BCM(kappa=0.768). Forty-nine patients had the food intake records, and the average daily protein intake(DPI) was 1.05±0.30 g/(kg· d). According to MQSGA scores, patients were classified into well-nourished group and mal-nourished group. Age, DPI, serum albumin(Alb), serum creatinine(SCr), uric acid(UA), body mass index(BMI), lean tissue index(LTI), and overhydration were significantly different between the two groups(P<0.05). Logistic analysis revealed that MQSGA score was negatively correlated with Alb(r=-0.38, P=0.001), SCr(r=-0.33, P=0.00), UA(r=-0.32, P=0.01), Kt/V(r=-0.243, P=0.02), BMI(r=-0.338,P=0.001), and LTI(r=-0.471, P=0.000), and positively correlated with age(r=0.37, P=0.00). In addition, overhydration was independently correlated with age, ALB and BMI(r=0.33, P=0.00) in MHD patients. Conclusions Our data indicate that the assessment of nutritional status by BCM is highly consistent with that by MQSGA. Age, Alb and BMI are the independent factors for malnutrition in MHD patients.
Objective To evaluate nutrition status and its related factors in maintenance hemodialysis(MHD) patients. Method We respectively used modified quantitative subjective global assessment(MQSGA) and body composition monitor(BCM) to evaluate the nutritional status in MHD patients for more than one year. Biochemical markers were collected, and food intake in a period of 3 days was measured by food records. Results We performed an observational study on 87 MHD patients(49 males and 38 females). The prevalence of malnutrition was 32.18% by using MQSGA. The prevalence of malnutrition was 39.08% by using BCM(lean tissue index <10% of the normal value). There was no difference in evaluating nutrition status between MQSGA and BCM(kappa=0.768). Forty-nine patients had the food intake records, and the average daily protein intake(DPI) was 1.05±0.30 g/(kg· d). According to MQSGA scores, patients were classified into well-nourished group and mal-nourished group. Age, DPI, serum albumin(Alb), serum creatinine(SCr), uric acid(UA), body mass index(BMI), lean tissue index(LTI), and overhydration were significantly different between the two groups(P<0.05). Logistic analysis revealed that MQSGA score was negatively correlated with Alb(r=-0.38, P=0.001), SCr(r=-0.33, P=0.00), UA(r=-0.32, P=0.01), Kt/V(r=-0.243, P=0.02), BMI(r=-0.338,P=0.001), and LTI(r=-0.471, P=0.000), and positively correlated with age(r=0.37, P=0.00). In addition, overhydration was independently correlated with age, ALB and BMI(r=0.33, P=0.00) in MHD patients. Conclusions Our data indicate that the assessment of nutritional status by BCM is highly consistent with that by MQSGA. Age, Alb and BMI are the independent factors for malnutrition in MHD patients.
引文
[1]Stojanovic M,Stojanovic D,Stefanovic V,et al.The impact of malnutrition on mortality in patients on maintenance hemodialysis in Serbia[J].Artif Organs,2008,32(5):398-405.
[2]Janardhan V,Soundararajan P,Rani NV,et al.Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis[J].Indian J Pharm Sci,2011,73(1):38-45.
[3]张渊,张亚玲,洪大情,等.不同评估方法对维持性血液透析患者营养评估的比较[J].中国血液净化,2011,10(8):437-439.
[4]National Kidney Foundation:K/DOQI.Clinical Practice Guidelines for Nutrition in Chronic Renal Failure[J].Am J Kidney Dis,2000,35(suppl2):S1-S140.
[5]Erdo?an E,Tutal E,Uyar ME,et al.Reliability of bioelectrical impedance analysis in the evaluation of the nutritional status of hemodialysispatients-a comparison with Mini Nutritional Assessment[J].Transplant Proc,2013,45(10):3485-3488.
[6]Antje F,Andrew D.Assessment of Body Composition in Peritoneal Dialysis Patients Using Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry[J].Am J Nephrol,2011,33(2):150-156.
[7]Rosenberger J,Kissova V,Majernikova M,et al.Body composition monitor assessing malnutrition in the hemodialysis population independently predicts mortality[J].J Ren Nutr,2014,24(3):172-176.
[8]Beberashvili I,Sinuani I,Azar A,et al.Serum uric acid as a clinically useful nutritional marker and predictor of outcome in maintenancehemodialysis patients[J].Nutrition,2015,31(1):138-147.
[9]Stolic R,Trajkovic G,Stolic D.Nutrition parameters as hemodialysis adequacy markers[J].Hippokratia,2010,14(3):193-197.
[10]Marlies A,Manfred H,Michael H.Fluid overload in hemodialysis patients:across-sectional study to determine its association with cardiac biomarkers and nutritional status[J].BMC Nephrology,2013,14:266.
[11]Lowrie EC,Lew NL.Death risk in hemodialysis patients:the predictive value of commonly measured variables and an evalueation of death rate difference between facilities[J].Am J Kidney Dis,1990,15(5):458-482.
[12]Kalantar-Zadeh K,Kopple JD,Block G,et al.A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients[J].Am J Kidney Dis,2001,38(6):1251-1263.
[2]Janardhan V,Soundararajan P,Rani NV,et al.Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis[J].Indian J Pharm Sci,2011,73(1):38-45.
[3]张渊,张亚玲,洪大情,等.不同评估方法对维持性血液透析患者营养评估的比较[J].中国血液净化,2011,10(8):437-439.
[4]National Kidney Foundation:K/DOQI.Clinical Practice Guidelines for Nutrition in Chronic Renal Failure[J].Am J Kidney Dis,2000,35(suppl2):S1-S140.
[5]Erdo?an E,Tutal E,Uyar ME,et al.Reliability of bioelectrical impedance analysis in the evaluation of the nutritional status of hemodialysispatients-a comparison with Mini Nutritional Assessment[J].Transplant Proc,2013,45(10):3485-3488.
[6]Antje F,Andrew D.Assessment of Body Composition in Peritoneal Dialysis Patients Using Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry[J].Am J Nephrol,2011,33(2):150-156.
[7]Rosenberger J,Kissova V,Majernikova M,et al.Body composition monitor assessing malnutrition in the hemodialysis population independently predicts mortality[J].J Ren Nutr,2014,24(3):172-176.
[8]Beberashvili I,Sinuani I,Azar A,et al.Serum uric acid as a clinically useful nutritional marker and predictor of outcome in maintenancehemodialysis patients[J].Nutrition,2015,31(1):138-147.
[9]Stolic R,Trajkovic G,Stolic D.Nutrition parameters as hemodialysis adequacy markers[J].Hippokratia,2010,14(3):193-197.
[10]Marlies A,Manfred H,Michael H.Fluid overload in hemodialysis patients:across-sectional study to determine its association with cardiac biomarkers and nutritional status[J].BMC Nephrology,2013,14:266.
[11]Lowrie EC,Lew NL.Death risk in hemodialysis patients:the predictive value of commonly measured variables and an evalueation of death rate difference between facilities[J].Am J Kidney Dis,1990,15(5):458-482.
[12]Kalantar-Zadeh K,Kopple JD,Block G,et al.A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients[J].Am J Kidney Dis,2001,38(6):1251-1263.