MIS评分在诊断腹膜透析患者PEW中的应用

Application of malnutrition-inflammation score in evaluation of protein energy wasting in patients with peritoneal dialysis

目的分析营养不良炎症评分(malnutrition inflammation score,MIS)系统在腹膜透析患者蛋白质能量消耗(protein-energy wasting,PEW)诊断中的应用效果。方法收集同济大学附属第十人民医院2014至2015年间腹膜透析时间大于3个月的176例腹透患者相关资料。以SGA评分作为诊断腹透患者PEW的标准,制作MIS的受试者工作曲线。结果 MIS诊断腹透患者PEW的受试者工作曲线下面积为0.972,根据曲线截点值评分0~7分患者为营养正常,8~30分患者为蛋白质能量消耗,根据截点值计算MIS诊断PEW的灵敏度为90.90%,特异度为97.00%。对MIS判断为蛋白质能量消耗和非蛋白质能量消耗两组患者进行比较,发现两组患者的体质量、BMI、Hb、hs CRP、Kt/v、FAT MASS及骨骼肌含量差异有统计学意义(P<0.05)。结论 MIS可有效评估腹透患者营养状况,可作为早期筛查腹透患者蛋白质能量消耗的可靠工具,为腹透患者营养干预提供依据。

Objective To evaluate the application of malnutrition inflammation score （MIS） for the nutritional status in patients with peritoneal dialysis （PD）. Methods One hundred and seventy six patients undergoing PD for more than 3 months during 2104 to 2015 were enrolled in this study. The MIS, subject global assessment （ SGA）,serum albumin （ ALB）, transferrin （ TF） , hemoglobin （Hb） , creatinine （Scr）, blood urea nitrogen （BUN）, hsCRP, and body weight （BW） , body mass index （BMI）, fat mass and muscle mass were measured. Results Taking MIS score 〉 7 as cut-off point, the sensitivity and specificity of MIS for diagnosis of protein energy wasting （PEW） were 90. 0% and 97. 0% , respectively. There were significant differences in BW, BMI, Hb, hsCRP, Kt/v and FAT MASS in patients with PEW and those without PEW. Conclusion MIS is an effective tool for evaluation of the nutrition and inflammation status in patients with peritoneal dialysis, and it would be used for screening of early PEW.