三种营养状况评估工具在慢性肾病非透析住院患者中的应用

Application of Three Nutritional Assessment Tools in Evaluating Nutritional Status of Non-Dialytic Chronic Kidney Disease Patients

目的:探讨几种常用营养评估方法在慢性肾病(chronic kidney disease, CKD)非透析患者营养状况评价中的临床应用,以寻找更适合CKD营养不良的评估方法。方法:本研究选取2017年2月—2017年7月在上海交通大学医学院附属新华医院肾内科住院的83名CKD非透析患者为研究对象,根据CKD定义及分期标准将其分为A组(CKD 1~3期)和B组(CKD 4~5期)。采用主观综合营养评分(subjective global-nutritional assessment, SGA)工具、体格测量和生物电阻抗分析(bioelectrical impedance analysis, BIA)、血生化检测等方法评估患者营养状况。结果:经SGA评估的营养不良发生率为9.6%;体格测量评估的消瘦、超重和肥胖分别为6.02%、34.94%、12.05%。血红蛋白、前白蛋白和白蛋白水平低下的检出率分别为81.93%、3.17%、79.52%。肱三头肌皮褶厚度、上臂围、上臂肌围值B组低于A组,组间差异均有统计学意义(P<0.05),握力低于正常值在52%以上,腰臀比大于正常值在84%以上。BIA检测提示,全身、躯干和双下肢水分比率及体脂百分比均高于正常值(P<0.05),且均随着肾小球滤过率(glomerular filtration rate, GFR)降低呈上升趋势(P<0.05)。结论:CKD非透析患者贫血和低蛋白血症的发生率较高;消瘦与肌少性中心肥胖并存。传统方法在评估营养不良的发生率时可能存在低估现象,而BIA在评估CKD非透析患者水潴留情况、体脂方面有一定的应用价值。

【Objective】 To assess the nutritional status of non-dialytic CKD patients using three nutritional assessment tools in order to find a suitable method to diagnose malnutrition early in CKD patients. 【Method】 A total of 83 CKD non-dialysis patients who were hospitalized in the Department of Nephrology, Xinhua Hospital from February 2017 to July 2017 were rolled in our study. According to the definition and staging criteria of CKD, all objectives were divided into group A(CKD stage 1-3) and group B(CKD stage 4-5). Sbjective global nutritional assessment(SGA),physical measurement and bioelectrical impedance analysis(BIA) were used to evaluate the nutritional status of patients. 【Result】 The incidence of malnutrition assessed by SGA was 9. 6%, and the rates of emaciation, overweight and obesity assessed by physical measurement were6. 02%, 34. 94%and 12. 05%, respectively. Deficiency states of Hemoglobin, prealbumin and albumin biochemistry were 81. 93%,3. 17%and 79. 52%, respectively. The rate of grip strength lower than normal value was more than 52%, and the ratio of waist to hip greater than normal value was more than 84%. The skinfold thickness, upper arm circumference and upper arm muscle circumference of triceps brachii in group B were lower than those in group A(P< 0. 05). BIA test showed that the water ratio and body fat percentage of the whole body, trunk and lower limbs were higher than the normal value(P<0. 05), and showed an upward trend with the decrease of glomerular filtration rate(GFR)(P<0. 05). 【Conclusion】 The incidence of anemia and hypoproteinemia was high innon-dialysis CKD patients, and emaciation and central obesity were existed simultaneously. The traditional methods may underestimate the incidence of malnutrition, and BIA showed application value in assessing water retention and body fat in CKD patients.