比较MQSGA及MIS对MHD患者营养不良—炎症状态的评估及其对生存质量影响的研究

发布时间：2018-05-16 07:52

本文选题：营养不良-炎症状态 + 营养不良-炎症评分　；参考：《昆明医科大学》2015年硕士论文

【摘要】：目的：研究维持性血液透析患者的营养不良-炎症状态的评估及其对生存质量的影响。方法：选择2014年1月-2015年1月在云南省肾脏病医院血液净化中心治疗≥3个月的符合入选标准的维持性血液透析患者130例为研究对象,行改良定量整体主观评估(MQSGA)和营养不良炎症评分(MIS),同时检测MHD患者的人体测量指标、生化指标、微炎症指标,运用生物电阻抗法行人体成分分析,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。利用SF-36量表评估患者的生存质量,分析不同程度的营养不良-炎症状态对生存质量的影响,并探讨其影响因素。结果：1.一般情况：入选MHD患者130例(男/女：84/46),平均年龄46.80±14.34岁,平均透析龄34.88±31.07个月。其中慢性肾小球肾炎87例(66.92%),糖尿病肾病18例(13.85%),良性肾小动脉硬化症18例(13.85%),其他7例(5.38%)。2.入选患者的营养状况：按MQSGA的标准,130例MHD患者中,营养不良的患者98例,占75.4%,其中轻、中度营养不良95例,占73.1%,重度营养不良3例,占2.3%。按照MIS的标准,入选患者全部为营养不良,其中轻度营养不良78例,占60%,中度营养不良45例,占34.6%,重度营养不良7例,占5.4%。3.比较MQSGA、MIS对营养-炎症状态的评估：MQSGA和MIS的得分均与MHD患者的营养指标体质量指数、肱三头肌皮褶厚度、上臂肌围、白蛋白、铁蛋白、去脂体重、肌肉量、体脂肪量、握力呈负相关,MIS还与前白蛋白呈负相关(P0.05)；MQSGA口MIS均与炎症指标hs-CRP、IL-6呈正相关(P0.05)；除肱三头肌皮褶厚度外,MIS与各营养指标及炎症指标的相关系数均高于MQSGA。4.入选患者的炎症指标及与营养指标的相关性分析：将hs-CRP、IL-6、TNF-α与相关的营养指标做线性相关分析,结果显示hs-CRP和握力、前白蛋白呈负相关；IL-6和上臂肌围、白蛋白、前白蛋白呈负相关；TNF-α和前白蛋白、血红蛋白呈负相关(P0.05)。5.营养不良-炎症状态对生存质量的影响：因MIS评分与各个营养指标和炎症指标的相关性更好,根据MIS得分将MHD患者的营养不良-炎症状态分为轻度、中度、重度三组,三组患者在SF-36总评分、PF、Pain、GH、EWB、SocF、Energ、生理领域、心理领域得分间的差异均有统计学意义,在RP、RE领域得分无统计学差异；进一步行两两比较,重度组在SF-36总评分、PF、Pain、GH、EWB、 SocF、Energ、PH、MH领域得分均低于轻度组和中度组,异均有统计学意义(P0.05),在RP、RE领域三组得分无统计学差异(P0.05)；轻度组在PH领域高于中度组,在SF-36总评分及其分支领域、MH领域得分均无统计学差异。6.影响MIS评分的自身因素的多因素分析：MIS得分与年龄、透析龄呈正相关,与BMI呈负相关,性别、原发病对MIS得分无影响,其中BMI对MIS得分的影响最大,其次是透析龄、年龄。结论：1.维持性血液透析患者普遍存在营养不良和炎症状态,且关系密切；2. MQSGA和MIS均能评估MHD患者的营养不良-炎症状态,但MIS与相关指标的相关性更好,能对其营养不良-炎症状态及严重程度做出更准确的评价；3.MIS分级越高,MHD患者生存质量的得分也越低,营养不良-炎症状态影响着MHD患者生存质量的多个领域,改善患者的营养不良-炎症状态可提高患者的生存质量；4.MIS得分与年龄、透析龄呈正相关,与BMI呈负相关,其中BMI对MIS得分的影响最大,其次是透析龄、年龄。
[Abstract]:Objective : To study the evaluation of malnutrition - inflammatory status in patients with maintenance hemodialysis and its effects on quality of life . Methods : In January 2014 to January 2015 , 130 patients ( male / female : 84 / 46 ) , with a mean age of 46.80 卤 14.34 years , were analyzed . There was a negative correlation between upper arm muscle circumference , albumin , ferritin , fat - free weight , muscle mass , body fat and grip , and MIS was negatively correlated with prealbumin ( P0.05 ) .
The MIS of MQSGA was positively correlated with the inflammatory markers hs - CRP and IL - 6 ( P0.05 ) .
In addition to the thickness of triceps skinfold , the correlation coefficient between MIS and each nutrient index and inflammatory index was higher than that of MQSGA . 4 . The correlation between the inflammatory index and the nutrition index was analyzed by the correlation between hs - CRP , IL - 6 and TNF - 伪 . The results showed that hs - CRP was negatively correlated with the grip and prealbumin .
There was a negative correlation between IL - 6 and upper arm muscle circumference , albumin and prealbumin .
There was a negative correlation between the levels of TNF - 伪 and pre - albumin and hemoglobin ( P0.05 ) . 5 . The effect of malnutrition - inflammatory state on quality of life was better than that of each nutrient index and inflammatory index . According to MIS score , the malnutrition - inflammatory status of MHD patients was divided into mild , moderate and severe three groups . The difference between the scores of SF - 36 , PF , Pain , GH , EWB , SocF , Energ , physiology and psychological field was statistically significant , and there was no statistical difference in the score of RP and RE .
The scores of SF - 36 , PF , Pain , GH , EWB , SocF , Energ , PH and MH in severe group were lower than those in mild and moderate groups ( P0.05 ) .
There was no statistical difference in the total score of SF - 36 and its branches , and the score in MH area was not statistically different .
2 . Both MQSGA and MIS can evaluate the malnutrition - inflammatory status of MHD patients , but MIS and related indexes have better correlation , and can make more accurate evaluation of malnutrition - inflammatory status and severity .
3 . The higher the MIS classification , the lower the score of the quality of life of MHD patients , the malnutrition - inflammation state affects the quality of life of MHD patients , and improves the patient ' s malnutrition - inflammatory state , which can improve the quality of life of patients ;
4 . MIS scores positively correlated with age , dialysis age , and negatively correlated with BMI , among which BMI had the greatest impact on MIS score , followed by dialysis age and age .

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692.5

【参考文献】