维持性血液透析患者营养状况与死亡风险的相关性探讨

Correlations between nutrition status and mortality in maintenance hemodialysis patients

目的探讨维持性血液透析患者营养状况与死亡风险的相关性。方法选择北京积水潭医院2015-07至2018-12行维持性血液透析的95例患者进行营养评估,包括营养不良-炎症评分(malnutrition inflammation score,MIS)、改良主观综合评估法(modified quantitative subjective global assessment,MQSGA)和全球领导人发起的营养不良评估(global leadership initiative on malnutrition,GLIM)三种评估方法,同时收集患者基本资料及相关检查结果。随访41个月,采用Kappa检验、Kaplan-Meier以及COX回归分析比较不同营养评估方法与患者全因死亡风险的相关性。结果(1)95例中,男50例,女45例,平均(60±13.8)岁,随访中19例死亡,7例失访。(2)MQSGA与MIS两种评分法的一致性较好(Kappa=0.776),GLIM法与MQSGA(Kappa=0.381)及MIS(Kappa=0.311)的一致性不够理想。(3)Kaplan-Meier分析提示,以MIS及MQSGA评分作为分组标准,营养不良组患者的中位生存时间(33个月,37个月)均明显短于营养良好组(41个月,41个月),差异有统计学意义(P<0.001)。(4)多因素COX回归分析提示,在校正透析时间、血红蛋白、瘦组织指数、脂肪组织指数及容量负荷后,MIS评分对血液透析患者死亡的预测效果最佳(HR=3.768,P=0.003)。结论三种营养评估方法均可用于对血液透析患者进行营养评估,其中MIS法有助于预测患者的长期生存情况。

Objective To study the relationship between nutrition status and mortality in maintenance hemodialysis(MHD).Methods A total of 95 MHD patients treated in Beijing Jishuitan Hospital between July 2015 and December 2018 were enrolled in the nutrition assessment,involving the malnutrition inflammation score(MIS),modified quantitative subjective global assessment(MQSGA)and Global Leadership Initiative on Malnutrition(GLIM).Data on disease history and laboratory findings of patients were collected.These patients were followed up for 41 months.The Kaplan-Meier method and COX regression analysis were used to compare the relationship between different nutritional evaluation methods and the risk of all-cause mortality.Results(1)Among the 95 patients,they were 50 males and 45 females,and their age averaged(60±13.8).During follow-up,there were 19 deaths and 7 patients out of touch.(2)There was no difference in the effect of evaluating nutrition status between MQSGA and MIS(Kappa=0.776).But there was difference between GLIM and MQSGA(Kappa=0.381)and between GLIM and MIS(Kappa=0.311).(3)Kaplan-Meier analysis showed that when patients were grouped according to the MQSGA and MIS,the median survival time in the good nutrition group(41 months,41 months)was longer than that in the malnutrition group(33 months,37 months)(P<0.001).(4)COX regression analysis results showed that after adjusting for hemodialysis time,levels of Hb,LTI,FTI and OH,MIS were better predictors of death of patients(HR=3.768,P=0.003).Conclusions Such nutritional assessment methods as MQSGA,MIS and GLIM are all appropriate for nutritional assessment of hemodialysis patients,and the ability of MIS to predict the mortality of hemodialysis patients is better.