三种营养筛查工具对维持性血液透析患者透析相关性蛋白质能量消耗的评价比较

Comparison of evaluation of dialysis-related protein-energy wasting evaluated by three nutritional screening tools in patients with maintenance hemodialysis

目的比较微型营养评价精法(MNA-SF)、营养不良炎症评分(MIS)、营养风险筛查2002(NRS 2002)三种营养筛查工具用于维持性血液透析患者透析相关性蛋白质-能量消耗(PEW)的评价差异。方法选取2016年6月至2019年7月就诊本院的维持性血液透析患者212例,分别采用MNA-SF、MIS、NRS 2002进行营养筛查,采集同期患者清蛋白、前清蛋白、胆固醇、体质量指数(BMI)、上臂围减少量、肌酐值、摄入量等指标,依据国际肾脏营养与代谢学会(ISRNM)的PEW的诊断标准,判定患者PEW情况,比较三种营养筛查工具用于PEW的诊断效能差异。结果以常规界值诊断,MNA-SF量表共准确筛查出PEW患者106例,存在误诊21例,漏诊9例;MIS量表共准确筛查出103例PEW患者,产生误诊14例、漏诊12例;NRS 2002共准确筛查PEW患者100例,产生误诊12例,漏诊15例;以分值数据测算,从曲线下面积来判断,三种筛查工具的诊断效能均处于良好水平,但MNA-SF的最佳截断点是≤11分,与常规诊断截点<11分略有不同。结论维持性血液透析患者发生透析相关性蛋白质-能量消耗可采用MNA-SF、MIS、NRS2002三种营养筛查工具,但需将MNA-SF法的诊断截点设为≤11分,达到提高诊断效能的目的。在临床护理过程中,可以依据患者临床需求,选择筛查方式。

Objective To compare the evaluation differences of dialysis-related protein-energy wasting(PEW)evaluated by short-form mini-nutritional assessment(MNA-SF),malnutrition inflammation score(MIS),nutrition risk screening 2002(NRS 2002)three nutritional screening tools in patients with maintenance hemodialysis.Methods We selected 212 cases of patients with maintenance hemodialysis who were treated in our hospital from June 2016 to July 2019,used MNA-SF,MIS,and NRS 2002 for nutrition screening,and gathered the albumin,prealbumin,cholesterol,body mass index(BMI),the reduction of upper arm circumference,creatinine value,intake and other indicators of patients in the same period,determined the patient's PEW situation according to International Society of Renal Nutrition and Metabolism(ISRNM)'s PEW diagnostic criteria,and compared the differences in the diagnostic efficacy of three nutritional screening tools for PEW.Results With the routine cut-off diagnosis,we accurately screened 106 cases of PEW patients by using the MNA-SF scale,of which 21 cases were misdiagnosed,and 9 cases were missed diagnoses.In additon,we accurately screened 103 cases of PEW patients by using the MIS scale,resulting in 14 cases of misdiagnosis.12 cases of missed diagnosis,and accurately screened 100 cases of PEW patients by NRS 2002,resulting in 12 cases of misdiagnosis,and 15 cases of missed diagnosis.Based on the score data and judged from the area under the curve,the diagnostic performance of the three screening tools was at a good level.But the best cut-off point of MNA-SF was≤11 points,which was slightly different from the routine diagnostic cut-off point<11 points.Conclusion In patients with maintenance hemodialysis undergoing dialysis-related PEW,three nutritional screening tools,MNA-SF,MIS,and NRS2002,can be used,but the diagnostic cut-off point of the MNA-SF method should be set to≤11 points to improve the diagnostic efficiency purpose.In the clinical nursing process,the screening method can be selected according to the clinical needs of patients.