维持性血液透析患者蛋白质能量消耗的评估量表及危险因素分析

Analysis of Evaluation Scale and Risk Factors of Protein Energy Consumption in Maintenance Hemodialysis Patients

目的探讨MQSGA评分(modified quantitative subjective global assessment,MQSGA)、MIS评分(malnutrition-inflammation score,MIS)与蛋白质能量消耗(protein energy expenditure,PEW)的相关性,并分析维持性血液透析(maintenance hemodialysis,MHD)患者发生PEW的独立危险因素。方法纳入2020年9月~2021年9月在昆明医科大学第一附属医院透析中心接受MHD治疗的患者。收集患者的一般临床资料,根据PEW诊断标准,将患者分为PEW组和非PEW组。采用单因素相关分析研究MIS评分、MQSGA评分及其他指标与PEW发生的相关性,并采用Logistic回归分析探讨PEW发生的独立危险因素和ROC曲线判断评分量表及相关危险因素对PEW的预测效果。结果单因素分析发现,用MIS及MQSGA评分量表评估的营养不良的发生均与PEW的发生具有显著相关性,且MIS评分预测PEW的敏感度更高(82.9%);PEW的发生与年龄、总蛋白、血清铁、透析充分性、血尿酸、血红蛋白、上臂围相关。多因素回归分析发现,血清铁(OR=1.297,95%CI:1.070~1.573,P=0.008)、Kt/V(OR=245.110,95%CI:5.049~111898.060,P=0.005)、上臂围(OR=1.813,95%CI:1.302~2.525,P<0.001)为PEW的独立危险因素,其预测MHD患者PEW的AUC分别为71.9%、62.4%、78.9%(P<0.05)。结论MIS评分较MQSGA评分评估临床PEW发生的敏感度更高;血清铁、透析充分性、上臂围是影响PEW的独立危险因素,对PEW均具有良好的预测价值,有望作为判断MHD患者预后的指标。

Objective To explore the correlation between modified quantitative subjective global assessment(MQSGA score),malnutrition-inflammation score(MIS score)and protein energy expenditure(PEW),and to analyze the independent risk factors of PEW in maintenance hemodialysis(MHD)patients.Methods MHD patients treated in the Hemodialysis Center of the first affiliated Hospital of Kunming Medical University from September 2020 to September 2021 were included.The general clinical data were collected.According to the PEW diagnostic criteria,the patients were divided into PEW group and non-PEW group.Univariate correlation analysis was used to analyze the correlation between MIS score,MQSGA score,other indexes and the occurrence of PEW.Logistic regression was used to explore the independent risk factors of PEW.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of PEW.Results Univariate analysis showed that the occurrence of malnutrition assessed by MIS and MQSGA scale was significantly correlated with the occurrence of PEW,and MIS score was more sensitive to predict PEW(82.9%).PEW was associated with age,total protein,serum iron,dialysis adequacy,blood uric acid,hemoglobin and mid arm circumference(MAC).Logistic regression analysis showed that serum iron(OR=1.297,95%CI:1.070-1.573,P=0.008),Kt/V(OR=245.110,95%CI:5.049-111898.060,P=0.005),and MAC(OR=1.813,95%CI:1.302-2.525,P<0.001)were independent risk factors for PEW,and the area under the curve(AUC)predicted by PEW for MHD patients was 71.9%,62.4%and 78.9%,respectively(P<0.05).Conclusion MIS score is more sensitive than MQSGA score in the evaluation of clinical PEW;serum iron,dialysis adequacy and MAC are independent risk factors for PEW,which have good predictive value for PEW and are expected to be used as indicators for judging prognosis of patients with MHD.