發(fā)布時(shí)間：2018-08-30 15:16

【摘要】：透析人群中營(yíng)養(yǎng)不良的存在是致殘率和死亡率的重要因素。沒(méi)有任何一個(gè)單一的指標(biāo)能全面反映營(yíng)養(yǎng)狀況,應(yīng)謹(jǐn)慎結(jié)合各種臨床和生化指標(biāo)綜合評(píng)估。國(guó)際腎臟營(yíng)養(yǎng)及代謝學(xué)會(huì)(International Society of Renal Nutrition and Metabolism,ISRNM)建議慢性腎臟病(chronic kidney disease,CKD)患者的營(yíng)養(yǎng)評(píng)估應(yīng)包括以下四個(gè)方面:血清生化標(biāo)志物、體重、肌肉量以及膳食攝入。因此,需要綜合性的營(yíng)養(yǎng)評(píng)分系統(tǒng),同時(shí)納入主觀和客觀的營(yíng)養(yǎng)指標(biāo),并具有臨床可行性和實(shí)用性,能區(qū)分不同程度營(yíng)養(yǎng)不良的患者,預(yù)測(cè)患者的死亡率和致殘率。目的:單中心回顧性研究由主觀綜合性營(yíng)養(yǎng)評(píng)分(SGA)、身高體重指數(shù)(BMI)、白蛋白(ALB)、總膽固醇(TC)、中臂圍(MAC)、肱三頭肌皮褶厚度(TSF)組成的綜合性營(yíng)養(yǎng)評(píng)分及等級(jí)對(duì)腹膜透析患者全因死亡率、心血管死亡率、感染相關(guān)死亡率、轉(zhuǎn)為血透治療及接受腎移植比例、住院總次數(shù)及住院總天數(shù)的影響,建立我中心腹膜透析患者全面、實(shí)用的綜合性營(yíng)養(yǎng)評(píng)分體系,預(yù)測(cè)患者預(yù)后,指導(dǎo)臨床治療。方法:納入2005年1月1日至2015年12月31日期間在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院腎臟病中心置入腹透導(dǎo)管行維持性腹膜透析治療的患者共924例,按SGA、BMI、ALB、TC、MAC、TSF進(jìn)行綜合性營(yíng)養(yǎng)評(píng)分,總分為8至24分。按綜合性營(yíng)養(yǎng)評(píng)分得分進(jìn)行分級(jí),第一級(jí)(Grade 1):8-15分(n=83);第二級(jí)(Grade 2):16-19分(n=347);第三級(jí)(Grade3):20-24分(n=494),比較各級(jí)全因死亡率、心血管相關(guān)死亡率、轉(zhuǎn)血透率、轉(zhuǎn)移植率及住院總次數(shù)、住院總天數(shù)的差異。結(jié)果:全因死亡率和住院總天數(shù)隨綜合性營(yíng)養(yǎng)等級(jí)的上升而降低,轉(zhuǎn)移植率隨營(yíng)養(yǎng)等級(jí)上升而升高(P0.05)。心血管相關(guān)死亡率、住院總次數(shù)隨營(yíng)養(yǎng)等級(jí)上升有降低趨勢(shì),但差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。分模型矯正混雜因素后,發(fā)現(xiàn)綜合性營(yíng)養(yǎng)等級(jí)(1-3級(jí))(HR:0.56,95%CI:0.41-0.78)及綜合性營(yíng)養(yǎng)評(píng)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獨(dú)立保護(hù)因素。結(jié)論:綜合性營(yíng)養(yǎng)等級(jí)(1-3級(jí))能鑒別高死亡及高住院風(fēng)險(xiǎn)的營(yíng)養(yǎng)不良患者,從而指導(dǎo)臨床進(jìn)行干預(yù)和治療,提高患者生存率。綜合性營(yíng)養(yǎng)評(píng)分(8-24分)能獨(dú)立地預(yù)測(cè)患者的死亡率,與其任一組分相比預(yù)測(cè)預(yù)后的準(zhǔn)確性更強(qiáng)。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R692.5

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