MNA和NRS2002对老年住院患者营养评估的比较

Comparison of malnutrition risk screening methods MNA and NRS 2002 in geriatric inpatients

目的简易营养评价法（MNA）是专为老年人设计的营养评估方法，而营养风险筛查2002（NRS2002）常用于住院患者，本研究探讨哪一种营养评估方法更适用于老年住院患者。方法本研究纳入了179名在内科老年病房住院的≥65岁的老年患者，分别应用MNA简表（MNA-SF）和NRS2002进行营养风险评估，比较两种筛查方法的评估结果以及对临床营养治疗的指导作用，并分析与传统的临床营养指标相关性。结果MNA-SF评估，营养不良危险者55例，营养不良者42例，总的营养风险异常率54．2％，较NRS2002筛查（有营养风险69例，38．5％）差异有统计学意义。MNA-SF筛查的营养不良危险组和营养不良组的营养治疗率分别为29．1％和50．0％，而NRS2002的营养风险组的营养治疗率为49．3％。常用的营养指标体质量指数（BMI）、体质量变化、血清白蛋白和前白蛋白与两种营养评估结果的相关性低（γ=0．09～0．48），上述指标的异常对营养风险筛查结果无可靠的提示作用。结论内科住院老年患者的营养风险筛查，同一个患者群体MNA-SF可发现较多具有营养风险的患者，而NRS2002筛查结果异常对营养治疗的指导意义更大。常用的营养指标如BMI、血清蛋白不是可靠的营养风险筛查指标。

Objective To investigate which one out of the 2 most commonly used tools for screening malnutrition, Mini Nutritional Assessment （MNA, specially designed for the elderly） and nutritional risk screening 2002 （NRS 2002, usually for inpatients） is more suitable for the geriatric inpatients. Methods A total of 179 inpatients over 65 years old from geriatric ward in our hospital from July 2010 to January 2012 were enrolled in this study. All the patients were assessed with MNA-short form （SF） and NRS2002 within 48h after admission. The coincidence of the 2 tools was studied, and their efficiency of guiding the patients for nutritional support was compared. Meanwhile, the relationship of the nutritional status screened by the 2 methods with traditionally used nutritional indicators, i.e. body mass index （BMI）, serum albumin and pre-albumin was analyzed. Results By MNA-SF, 55 cases （30.7%） were rated as at risk of malnutrition, and 42 cases （23.5%） were as malnutrition, which were significantly different from the results by NRS2002 （69 cases as at risk of nutrition, 38.5%）. MNA-SF had an efficiency of 29.1% for the patients at risk of malnutrition, and of 50% for those of malnutrition, and NRS 2002 had an efficiency of 49.3%. Besides, the commonly used nutritional indicators BMI, serum albumin and pre-albumin showed little correlation with the results rated by MNA-SF and NRS2002 （γ = 0.09 to 0.48）, indicating that these indicators had no reference value for nutritional risks screening. Conclusion In the nutritional risks screening for geriatric inpatients in department of internal medicine, MNA-SF is a relatively sensitive tool for screening nutritional risks, while, NRS2002 has a better value in the guidance for the patients needing for nutritional therapy. The conventionally used nutritional indicators such as BMI, serum albumin and pre-albumin are not reliable or effective factors for screening nutritional risks in the elderly.