摘要
目的:采用简易营养评估法(mininutritional assessment,MNA)对老年腹膜透析患者进行营养评估,并与传统的主观综合营养评估(subjective global assessment,SGA)方法进行比较。方法:采用横断面调查的方法,对我院腹膜透析中心的45例患者(60岁以上)进行问卷调查以及人体测量,分别用SGA与MNA两种方法,同时检测患者血液中白蛋白、前白蛋白水平、血常规,检测了与标化的蛋白质相当的总氮呈现率(nPNA),进行饮食调查。结果:(1)根据SGA,无营养不良22例(49%),轻至中度营养不良14例(31%),重度营养不良9例(20%);根据MNA,无营养不良18例(40%),存在营养不良风险17例(38%),营养不良10例(22%)。(2)依据SGA与MNA评分,分别在不同营养状态的三组间进行以下指标的比较:平均每日每公斤体重能量与蛋白质摄入(DEI、DPI)、血白蛋白、nPNA、透析月龄、残余肾功能,透析充分性指标(Kt/V、Ccr)差异均有显著性统计学意义(P<0.05)。但无营养不良组的DEI、DPI异常率在SGA评分时达到了64%,而MNA评分时降至28%(P<0.05);存在营养不良的两组患者,血白蛋白与前白蛋白的正常率,SGA评分时为43%与60%,MNA评分为44%与59%。存在明显营养不良时,两种评分的指标异常均明显升高。(3)无论采用SGA还是MNA方法,两种分类法的统计学结果是一致的。(4)在评估结果与各指标相关性研究中,发现SGA与MNA评分结果与一系列客观指标显著相关,MNA法较优。结论:(1)SGA与MNA皆是评价老年腹膜透析营养状况的简单有效方法,但还需结合其它的营养评估指标,如DEI、DPI、血白蛋白、前白蛋白、nPNA。(2)在某些方面,MNA评估法优于SGA评分。SGA对于评价已有的营养不良有效,而MNA更有利于早期发现需要营养干预的患者。MNA评估法简单易行,值得推广,需进一步研究。
Objective： The DOQI 2000 recommends the subjective global assessment （SGA） for the nutritional evaluation in patient with continuous ambulatory peritoneal dialysis （CAPD）. In 1990s, the mini nutritional assessment （MNA） has been used successfully in the evaluation of the nutrition status in the frail elder person. Is it more suitable for MNA than SGA in assessment the nutrition of elder CAPD patient.7 In this study, we compared the MNA method with the traditional SGA in the evaluating the nutritional status in elder CAPD patients. Methodology：We used the cross-sectional study with selection of the patient. Forty-five elder CAPD patients, 21 male and 24 female with more than 60 years old, were enrolled in this study. SGA and MNA questionnaire, anthropometric parameters and laboratory test were investigated in those patients. The normalized protein equivalent of total nitrogen appearance （nPNA） was calculated. Results： 1 ） These patients were classified into three nutritional classes according to the SGA （ i. e. normal nutrition SGA considered as A, mild-to-moderate malnutrition SGA as B, and severe malnutrition SGA as C）. The correspond/rig classification according to the MNA was normal nutrition （ MNA1 ） , at risk of malnutrition （ MNA2 ）, and severe malnutrition （ MNA 3 ）. In the SGA classification, 49% were assessed as A, 31% in B and 20% in C, while the corresponding figures in MNA was 40% in MNA 1, 38% in MNA 2 and 22% in MNA 3. Either in SGA or in MNA assessment, the dietary protein intake （DPI）, dietary energy intake （DEI）, serum albumin （Alb）, nPNA, months on CAPD, residual renal function （RRF）, and the adequacy indices （Kt/v, Cer ） were siguifieantly different among three groups （P 〈0. 05 ）. The abnormal rates of measures in normal nutrition group were 64% for DEI or DPI, Alb 27% with SGA, the corresponding figure with MNA were 28% （ P 〈 0. 05 ） and 22% （ P 〉 0.05 ）. Only in severe malnutrition group, both in SGA and MNA, the abnormal rates of all measures were above 80% for DEI or DPI and Alb, except for Pre-albumin. 2） There were no siguifieant differenees between the elasses, irrespeetive of methods. The kappa test, was used to eompare the result of two methods, and the kappa value was 0. 545 5 （ P 〈 0.05 ）. 3 ） Pearson correlation coefficients between the SGA and serum albumin concentration （r=0. 347）, nPNA （r =0. 329） and months on CAPD （r = -0. 360） were all siguifieant, whereas the MNA had significant correlation with serum albumin concentration （r = 0. 362 ）, nPNA （r = 0. 394）, months on CAPD（ r = -0. 335 ） and RRF（ r = 0. 576）. Conclusion：The MNA method like the SGA can be performed to assess simply and reliably for nutritional status in elder CAPD patients. But other nutrition parameters are also needed. The ehoiee of SGA or MNA will depend upon whether the nutritional assessment is aiming at prevention or treatment. The MNA is more suitable in prevention malnutrition than the SGA in elder patients.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2008年第2期113-118,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
上海市卫生局青年课题基金(131014Y4)
关键词
腹膜透析
营养状况
简易营养评估法
主观综合营养评估法
nutritional assessment subjeetive global assessment mini nutritional assessment eontinuous ambulatory peritoneal dialysis
