维持性血液透析患者营养状况及影响因素分析

Study of nutritional status and influencing factors in maintenance hemodialysis patients

目的调查终末期肾脏病接受维持性血液透析（MHD）患者的营养不良发生率，并探讨其影响因素。方法选择2012年1月—2013年1月间在温州市中心医院血透室行维持性血液透析治疗的86例终末期肾脏病患者，采用改良定量主观整体评估表（MQSGA）评价MHD患者营养状况，根据MQSGA评分（〉10分者判为营养不良）将患者分为营养正常组与营养不良组，并采用t检验或x2检验比较营养正常组与营养不良组患者问临床指标包括年龄、性别、透析龄、体重指数、血红蛋白（Hb）、白蛋白（Alb）、血肌酐（Scr）、血尿素氮（BUN）、胆固醇（Tc）、甘油三酯（TG）、超敏C反应蛋白（hs—CRP）的差异。结果86例MHD患者中，有42例患者MQSGA评分≤10分，纳入营养正常组；11～20分者有42例，21～35者有2例，共44例纳入营养不良组，营养不良发生率为51．16％，重度营养不良发生率为2．33％；营养正常组与营养不良组的年龄、Kt／v、Alb、hs—CRP水平差异有统计学意义（P〈0．05）。2组患者在性别、透析龄、体重指数、血红蛋白、血肌酐、血尿素氮、胆固醇、甘油三酯方面比较，差异无统计学意义（P〉0．05）。结论MHD患者营养不良发生率高，血白蛋白可作为反应机体营养状况的可靠生化指标，而年龄、微炎症状态、透析充分性是影响MHD患者营养状态的重要因素。

Abstract：Objective To investigate the nutritional status and influencing factors in patients with end-stage renal disease treated by maintenance hemodialysis. Methods 86 patients with end-stage renal disease treated by maintenance hemodi- alysis from January 2012 to January 2013 in our hospital hemodialysis room were studied the nutritional status in MHD pa- tients were evaluated by modified quantitative subjective global assessment form（MQSGA） （ 〉 10 were defined as malnu- trition）, patients were divided into normal nutrition group and malnutrition group according to MQSGA score, and the clin- ical parameters were compared between the normal nutrition group and malnourished group, including age, sex, duration of dialysis, body mass index, hemoglobin （ Hb）, albumin （ Alb）, serum creatinine （ Scr）, blood urea nitrogen （ BUN ）, choles- terol（ TC）, triglyceride（ TG）, and high-sensitivity C-reactive protein （hs-CRP）. Results In all of the 86 cases of MHD patients,42 patients MQSGA score ~〈 10 points, incorporating nutrition normal group; 11 - 20 points were of 42 cases, 21 -35 were of two cases,and there were 44 cases were of malnutrition,with the malnutrition rate of 51.16% ,the inci- dence of severe malnutrition was 2.33% ;the age, Kt/v, Alb and hs-CRP in nutrition normal group and malnutrition group were significantly different（ P 〈 0.05 ）. The difference of gender,duration of dialysis ,body mass index, hemoglobin, serum creatinine, blood urea nitrogen, cholesterol and triglycerides aspect in the two groups were not statistically significant （P 〉 0.05）. Conclusion There were high incidence of malnutrition in MHD patients, the albumin can be used as a reliable nutritional status, the indicator of age, micro-inflammation, dialysis adequacy were important factors in affecting nutritional status in MHD patients.