综合性营养评分与维持性腹膜透析患者预后的相关性研究

发布时间：2018-08-30 15:16

【摘要】：透析人群中营养不良的存在是致残率和死亡率的重要因素。没有任何一个单一的指标能全面反映营养状况,应谨慎结合各种临床和生化指标综合评估。国际肾脏营养及代谢学会(International Society of Renal Nutrition and Metabolism,ISRNM)建议慢性肾脏病(chronic kidney disease,CKD)患者的营养评估应包括以下四个方面:血清生化标志物、体重、肌肉量以及膳食摄入。因此,需要综合性的营养评分系统,同时纳入主观和客观的营养指标,并具有临床可行性和实用性,能区分不同程度营养不良的患者,预测患者的死亡率和致残率。目的:单中心回顾性研究由主观综合性营养评分(SGA)、身高体重指数(BMI)、白蛋白(ALB)、总胆固醇(TC)、中臂围(MAC)、肱三头肌皮褶厚度(TSF)组成的综合性营养评分及等级对腹膜透析患者全因死亡率、心血管死亡率、感染相关死亡率、转为血透治疗及接受肾移植比例、住院总次数及住院总天数的影响,建立我中心腹膜透析患者全面、实用的综合性营养评分体系,预测患者预后,指导临床治疗。方法:纳入2005年1月1日至2015年12月31日期间在浙江大学医学院附属第一医院肾脏病中心置入腹透导管行维持性腹膜透析治疗的患者共924例,按SGA、BMI、ALB、TC、MAC、TSF进行综合性营养评分,总分为8至24分。按综合性营养评分得分进行分级,第一级(Grade 1):8-15分(n=83);第二级(Grade 2):16-19分(n=347);第三级(Grade3):20-24分(n=494),比较各级全因死亡率、心血管相关死亡率、转血透率、转移植率及住院总次数、住院总天数的差异。结果:全因死亡率和住院总天数随综合性营养等级的上升而降低,转移植率随营养等级上升而升高(P0.05)。心血管相关死亡率、住院总次数随营养等级上升有降低趋势,但差异不具有统计学意义(P0.05)。分模型矫正混杂因素后,发现综合性营养等级(1-3级)(HR:0.56,95%CI:0.41-0.78)及综合性营养评分(8-24分)(HR:0.87,95%CI:0.80-0.94)均是腹透患者全因死亡率的独立保护因素。结论:综合性营养等级(1-3级)能鉴别高死亡及高住院风险的营养不良患者,从而指导临床进行干预和治疗,提高患者生存率。综合性营养评分(8-24分)能独立地预测患者的死亡率,与其任一组分相比预测预后的准确性更强。
[Abstract]:Malnutrition is an important cause of disability and mortality in dialysis population. No single indicator can fully reflect the nutritional status, and should be carefully combined with a variety of clinical and biochemical indicators of comprehensive evaluation. The International Society for Renal Nutrition and Metabolism (International Society of Renal Nutrition and Metabolism,ISRNM) recommends that the nutritional assessment of patients with chronic kidney disease (chronic kidney disease,CKD) should include the following four aspects: serum biochemical markers, body weight, muscle mass and dietary intake. Therefore, it is necessary to have a comprehensive nutrition scoring system, including subjective and objective nutritional indicators, and it has clinical feasibility and practicability, which can distinguish the patients with different levels of malnutrition and predict the mortality and disability rate of the patients. Objective: to retrospectively study the comprehensive nutritional score of (MAC), triceps skinfold thickness (TSF) in arm circumference of (MAC), in patients with peritoneal dialysis (PD), which was composed of subjective comprehensive nutrition score (SGA), (BMI), albumin total cholesterol (ALB),) total cholesterol (TC), (GBI), and the overall mortality rate of the patients with peritoneal dialysis (PD). The effects of cardiovascular mortality, infection related mortality, the proportion of hemodialysis treatment and kidney transplantation, the total number of hospitalization and the total length of stay on the total mortality, the establishment of a comprehensive and practical comprehensive nutritional scoring system for patients with peritoneal dialysis in our center were established. To predict the prognosis of patients and guide clinical treatment. Methods: from January 1, 2005 to December 31, 2015, a total of 924 patients were enrolled in the renal center of the first affiliated Hospital of Zhejiang University Medical College for maintenance peritoneal dialysis. The patients were assessed with comprehensive nutrition score according to SGA,BMI,ALB,TC,MAC,TSF. The total score is 8 to 24. They were graded according to the comprehensive nutrition score (Grade 1): 8-15 points (NC83); Grade 2: 16-19 scores (NN347); Grade3: 20-24 scores (nr494) to compare all levels of all-cause mortality, cardiovascular related mortality, blood transfer rate, and total number of hospitalizations. The difference of total length of stay. Results: the total mortality rate and total length of hospitalization decreased with the increase of comprehensive nutrition grade, and the transfer rate increased with the increase of nutritional grade (P0.05). Cardiovascular mortality, total number of hospitalizations with the increase of nutritional grade has a downward trend, but the difference is not statistically significant (P0.05). After correction of confounding factors by submodel, comprehensive nutrition grade (HR:0.56,95%CI:0.41-0.78) and comprehensive nutrition score (HR:0.87,95%CI:0.80-0.94) were found to be independent protective factors of all-cause mortality in patients with abdominal dialysis. Conclusion: comprehensive nutrition grade (grade 1-3) can differentiate malnutrition patients with high mortality and high hospital risk, so as to guide clinical intervention and treatment, and improve the survival rate of patients. Comprehensive nutrition score (8-24) can independently predict the mortality of patients, and is more accurate than any of its components in predicting prognosis.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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