不同营养评估方法与维持性血液透析患者死亡关系的比较

Comparison of the relationship between different nutrition assessment methods and mortality in maintenance hemodialysis patients

目的本研究的目的是研究不同的营养评估方法与维持性血液透析患者的预后的关系。方法对我院血液透析中心的83名患者进行营养评估,包括主观综合性营养评估(subjective global assessment,SGA)、营养不良-炎症评分(malnutrition inflammation score,MIS)和微型营养评定简表(mini nutrition assessment short form,MNA-SF)。同时收集基本资料、辅助检查结果。随访48月(40±13月),采用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差别。结果 Kaplan-Meier分析提示:SGA<25分患者的死亡风险较SGA≥25分患者高(P<0.05),MIS>10分组比MIS≤10分死亡风险高(P>0.05)。以MNA-SF分组,MNA-SF≥11分死亡风险低于NA-SF<11分(P>0.05)。多因素Cox回归分析提示,SGA及MIS不同分组仍然与维持性血液透析患者不同的全因死亡风险有关(P<0.05)。结论不同营养评估方法对于维持性血液透析患者长期生存的预测能力不同,SGA法以及MIS法所评价的营养状况与维持性血液透析患者长期的全因死亡风险有较好相关性。

Objective To study the relationship between different nutrition assessment methods and mortality in maintenance hemodialysis （MHD） patients.Methods A total of 83 MHD patients were enrolled in the nutrition assessment including subjective global assessment （SGA）,malnutrition-inflammation score （MIS）,and short form mini nutritional assessment （MNA-SF） methods.General disease history and laboratory findings were collected.Patients were followed up for 48 months （40± 13 months）.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 Kaplan-Meier method showed that the risk of death was higher in patients with SGA ＜25 than in those with SGA ≥25 （P＜0.05）,was higher in patients with MIS ＞ 10 than those with MIS ＜10 （P＞0.05）,and was lower in patients with MNA-SF ≥11 than those with NASF ＜11 （P＞0.05）.Multivariate Cox regression analysis showed that SGA and MIS scores correlated to the risk of all-cause mortality in MHD patients （P＜0.05）.Conclusions Different nutritional assessment methods have different ability for predicting long-term prognosis in MHD patients.Nutritional status assessed by SGA method or MIS method correlates better with the long-term risk of all-cause mortality in MHD patients.