摘要
目的评估血液透析患者营养状况,分析营养不良的相关因素。方法选取同济大学附属杨浦医院透析中心维持性血液透析患者98例,分别采用营养不良-炎症评分法（malnutrition inflammation score,M IS）和透析客观营养评价法（Objective Score of Nutrition on Dialysis,OSND）进行营养状态评估,同时测量人体指标、血生化指标作为客观营养指标进行相关性分析。以血清白蛋白〈35 g/L为营养不良标准,对M IS、OSND行ROC曲线分析;采用logistic回归法分析营养不良发生的相关因素。结果根据OSND评价标准,98例血透患者中营养状态正常44例（44.9%）,营养不良54例（55.1%）;根据M IS评价标准,营养状态正常56例（57.1%）,营养不良42例（42.9%）。相关性分析显示M IS与三头肌皮褶厚度（triceps skin fold thickness,T S F）、体质量指数（body m ass index,B M I）存在负相关,与C-反应蛋白（C reactive protein,C RP）存在正相关;OSND与上臂围（upper arm circumference,M AC）、血清白蛋白（serum albumin,ALB）、胆固醇（cholesterol,TC）存在正相关,与CRP存在负相关。M IS的ROC曲线下面积为0.732（95%CI 0.625～0.838）;O S N D的RO C曲线下面积为0.844（95%C I 0.762～0.926）。L ogistic回归结果显示A L B（O R=3.700,95%C I=1.258～10.886,P=0.017）、HB（O R=6.346,95%C I=2.192～18.373,P=0.001）、C RP（OR=4.693,95%CI=1.603～13.743,P=0.005）是M IS筛查营养不良发生的独立预测因素。ALB（OR=24.781,95%C I=6.970～88.110,P=0.000）、B M I（O R=5.345,95%C I=1.462～19.543,P=0.011）是O S N D筛查营养不良发生的独立预测因素。结论 M IS、O S N D都适用于维持性血液透析患者的营养评价,比较而言,OSND更适合。血透患者营养不良发生率较高,影响因素多,需要综合干预。
Objective To evaluate the nutritional status of patients with maintenance hemodialysis and to analyze the related factors of malnutrition. Methods Ninety eight patients receiving maintenance hemodialysis in Yangpu District Hospital were enrolled in the study. The nutritional status of patients was evaluated with Objective Score of Nutrition on Dialysis （OSND） and malnutrition inflammation score（ MIS）, respectively; the blood biochemical indexes and body measurement index were determined. Serum albumin 〈 30 g/L was regarded as malnutrition criteria, and the receiver operating characteristic curve （ROC） of MIS or OSND for malnutrition was analyzed. The related factors of malnutrition were analyzed with logistic regression. Results According to OSND of 98 patients were classified as normal in nutritional status （44. 8% ）, 54 cases were as malnutrition （55.1% ） ; while according to MIS, 56 cases （ 57. 1% ） as normal nutritional status, and 42 cases （42. 9% ） as malnutrition. Correlation analysis revealed that MIS had negative correlation with triceps skin fold thickness（TSF） and body mass index（ BMI）, and had a positive correlation with C reactive protein （CRP）. OSND had a positive correlation with upper arm circumference （MAC）, serum albumin（ ALB ）, and cholesterol（ TC）, but had a negative correlation with C reactive protein（CRP）. Area of ROC curve of M1S was 0. 732（95% CI 0. 625 -0. 838）, and that of OSND was 0. 844（95% CI 0. 762 - 0. 926 ）. Logistic regression analysis showed that ALB （ OR = 3.700,95% CI = 1. 258 - 10. 886, P = 0. 017 ）, HB （ OR = 6. 346,95 % CI = 2. 192 - 18. 373, P = 0. 001 ）, CRP （ OR = 4. 693, 95% CI = 1. 603 - 13.743 ,P -- 0. 005 ） were independent predictors in MIS assessment of malnutrition. ALB（ OR = 24. 781,95% CI = 6. 970 - 88. 110, P = 0. 000）, BMI （ OR = 5. 345,95% CI = 1. 462 - 19. 543 ,P-0. 011 ） were independent predictors in OSND assessment of malnutrition. Conclusion MIS and OSND are both applica
出处
《同济大学学报（医学版）》
CAS
2015年第4期68-74,共7页
Journal of Tongji University(Medical Science)
关键词
血液透析
营养不良
透析客观营养评价法
营养不良-炎症状态评价法
maintenance hemodialysis
malnutrition
objective score of nutrition on dialysis
malnutrition-inflammation score
