比较MQSGA及MIS对老年维持性血液透析患者营养状况的评估研究

Comparison of the modified quantitative subjective global assessment (MQSGA) and the malnutrition-inflammation score(MIS) for the evaluation of nutritional status in elderly maintenance hemodialysis patients

目的比较行改良定量整体主观评估(modified quantitative subjective global assessment,MQSGA)及营养不良炎症评分(malnutrition-inflammation score,MIS)对老年维持性血液透析患者营养状况评估的准确性以及其对心脑血管事件预测价值。方法纳入2014年1月到2016年12月的236例维持性血液透析患者,纳入维持性血液透析大于3个月,年龄大于60岁的老年患者。行MQSGA和MIS,收集患者基本临床资料和实验室检测数据。利用人体测量检测患者身体质量指数、上臂皮褶厚度、三头肌皮褶厚度、上臂围、上臂肌围分析MQSGA和MIS与各项指标的相关性,并比较两种方法对营养不良-炎症状态的评价效能。比较心脑血管事件组与无心脑血管事件两组患者的临床指标,并将不同营养评估方法评分与心脑血管事件发生采用logistic多元回归分析。结果本研究纳入236例维持性血液透析患者,其中男性138例,女性108例,平均年龄为(73.4±7.6)岁,维持性血液透析时间为(35.1±14.2)月。MQSGA营养分级中营养不良患者比例总共达到64.4%,同时MIS营养分级中营养不良患者比例达到65.8%,两者并无明显差异(χ2=0.150,P=0.699)。除三头肌皮褶厚度外,MIS与各营养指标及炎症指标的相关系数绝对值均高于MQSGA。提示MIS较MQSGA评分能够更好的反映老年维持性血液透析患者的营养状态。心脑血管事件组患者MIS[9.2(4.1~26.6)分比5.2(1.2~12.8)分,Z=2.641,P<0.001]、MQSGA[12.3(7.3~32.4)分比7.5(7.2~12.6)分,Z=2.012,P<0.001]、前白蛋白(38.2±11.5)mg/dl比(29.8±8.0)mg/dl,t=2.951,P=0.002)、C反应蛋白[11.1(0.1~16.9)mg/L比2.6(0.2~17.4)mg/L,Z=2.715,P<0.001]均明显高于无心脑血管事件组。logistic多元回归分析发现MQSGA与血液透析患者心脑血管事件风险相对危险度[RR=1.516,95%CI(1.109~2.001),P=0.005]明显低于MIS与心脑血管事件风险的相对危险度[RR=2.563,95%CI(1.561~5.211),P=0.003],提示MIS对血液透析患者心脑血管事件风险的预测价值更大。结论 MIS较MQSGA评分能够较好的反映老年维持性血液透析患者的营养状态。MIS可能对预测老年透析患者心血管事件风险更有临床价值。

Objective To compare the accuracy of modified quantitative subjective global assessment（MQSGA） and malnutrition-inflammation score（MIS） for the evaluation of nutritional status and the prediction of cardio-and cerebro-vascular events in elderly maintenance hemodialysis（MHD） patients. Methods A total of 236 MHD patients treated in the period from January 2014 to December 2016 were enrolled in this study. Patients were on MHD for more than 3 months and over 60 years old. MQSGA and MIS were performed for these patients. Clinical data and laboratory test results were collected. Body mass index（BMI）,skin fold thickness of upper arm, skin fold thickness of triceps muscle, upper arm circumference and upper arm muscle circumference were measured. The correlation of these parameters with MQSGA and MS was analyzed. The effectiveness of MQSGA and MS for the evaluation of malnutrition-inflammation status was compared. Clinical data were compared between patients with cardio-and cerebro-vascular events and those without cardio-and cerebro-vascular events. Multivariate logistic regression was used to analyze the relationship between the scores from different nutrition evaluation method and cardio-and cerebro-vascular events. Results This study enrolled 236 MHD patients（138 males and 108 females, average age 73.4 ± 7.6 years, and MHD duration 35.1±14.2 months）. The proportion of malnutrition in this cohort was 64.4% by MQSGA and was 65.8% by MIS（χ2=0.150, P=0.699）. Except for the skin fold thickness of triceps muscle, the absolute values of correlation coefficient for nutrition and inflammatory indexes were higher from MIS than from MQSGA, suggesting that MIS is better than MQSGA for the evaluation of nutritional status in elderly MHD patients. The levels of MIS score（Z=2.641, P〈0.001）, MQSGA（Z=2.012, P〈0.001）, pre-albumin（t=2.951, P=0.002）, and C reactive protein（Z=2.715, P〈0.001） were significantly higher in patients with cardio-and cerebro-vascular events than in those without cardio-and cerebro-vascular events. Multivariate logistic regression showed that the relative risk（RR） of cardio-and cerebro-vascular events from MQSGA（RR=1.516, 95% CI1.109-2.001, P=0.005） was significantly lower than that from MIS（RR=2.563, 95% CI 1.561-5.211, P=0.003）, suggesting that MIS is more valuable than MQSGA in predicting the risk of cardio-and cerebro-vascular events in elderly MHD patients. Conclusion MIS was better than MQSGA for the evaluation of nutritional status and the prediction of cardiovascular events in elderly MHD patients.