老年血液透析病人营养状况以及主观综合营养评估法与透析营养客观评分法评估效果比较

doi:10.3969/j.issn.1003-9198.2023.12.013

摘要/Abstract

摘要： 目的探讨老年血液透析病人的营养水平,并比较主观综合营养评估法(SGA)与透析营养客观评分法(OSND)评估老年血液透析病人营养状况的效果。方法选取120例老年血液透析病人作为观察组,另选取120例健康体检老年人作为对照组,检测并比较2组病人的营养成分相关指标与血生化指标。分别采用SGA和OSND评估老年血液透析病人的营养水平,并分析SGA和OSND与营养成分相关指标及血生化指标的相关性。结果观察组病人的hs-CRP水平高于对照组(P<0.01),体脂肪、体脂率、蛋白质、Hb、BUN、HDL-C、白蛋白(Alb)、TC、TG水平均低于对照组(P<0.01)。老年血液透析病人根据SGA评价标准:营养状态良好者3例(2.50%),营养不良者117例(97.50%);根据OSND标准:营养正常者5例(4.17%),营养不良者115例(95.83%),2种方法营养评估结果差异无统计学意义(P>0.05)。相关分析显示,在老年血液透析病人中,SGA与体脂率、蛋白质、HDL-C、Alb、TC、LDL-C呈负相关(P<0.05);OSND与体脂肪、体脂率、HDL-C、Alb、TC、LDL-C、TG、Hb、BUN呈负相关(P<0.05),与蛋白质、hs-CRP呈正相关(P<0.05)。结论 SGA、OSND都适用于老年血液透析病人的营养评价,老年血液透析病人营养水平较差,需要及早进行干预。

关键词: 老年人, 血液透析, 营养状况, 主观综合营养评估法, 透析营养客观评分法

Abstract: Objective To explore the nutrition status in the elderly patients undergoing hemodialysis,and to compare the efficiency of subjective global assessment (SGA) and Objective Score of Nutrition on Dialysis (OSND)in evaluating the nutritional status. Methods A total of 120 elderly hemodialysis patients were enrolled in the observation group, and 120 healthy elderly receiving physical examination were enrolled in the control group. The nutrient composition-related indicators and blood biochemical indicators of the two groups were detected and compared. SGA and OSND were used to assess the nutritional status of the elderly patients undergoing hemodialysis. The correlations of SGA and OSND with nutritional indexes and blood biochemial indicators were analyzed. Results The level of high-sensitivity C-reaction protein (hs-CRP) in observation group was higher than that in the control group (P<0.01); The levels of body fat, body fat ratio, protein, hemoglobin (Hb), blood urea nitrogen(BUN), high-density lipoprotein cholesterol (HDL-C), albumin (Alb), total cholesterol (TC) and triglyceride(TG)in the observation group were lower than those in the control group (P<0.01). Among 120 elderly hemodialysis patients, 3 cases (2.50%) presented with normal nutrition and 117 cases (97.50%) presented with malnutrition according to SGA evaluation criteria; According to the OSND standard, 5 cases (4.17%) presented with normal nutrition and 115 cases (95.83%) presented with malnutrition. Correlation analysis showed that SGA was negatively correlated with body fat ratio, the levels of protein, HDL-C, Alb, TC and low-density lipoprotein cholesterol (LDL-C) (P<0.05); OSND was negatively correlated with body fat ratio, the levels of body fat,HDL-C, Alb, TC, LDL-C, TG, Hb, BUN(P<0.05), and positively correlated with the levels of protein and hs-CRP(P<0.05). Conclusions SGA and OSND are suitable for nutritional evaluation in the elderly hemodialysis patients. The nutrition status of elderly hemodialysis patients is poor, and it is necessary to conduct comprehensive intervention timely.

Key words: aged, hemodialysis, nutrition status, subjective global assessment, Objective Score of Nutrition on Dialysis

中图分类号:

R 692.5

韩梦玲, 马逊, 徐玮, 王咪, 杨家慧. 老年血液透析病人营养状况以及主观综合营养评估法与透析营养客观评分法评估效果比较[J]. 实用老年医学, 2023, 37(12): 1242-1245.

HAN Meng-ling, MA Xun, XU Wei, WANG Mi, YANG Jia-hui. Nutrition status and the efficiency comparison of subjective global assessment and Objective Score of Nutrition on Dialysis in evaluating the nutritional status of elderly patients undergoing hemodialysis[J]. Practical Geriatrics, 2023, 37(12): 1242-1245.

参考文献

[1] FERET W, SAFRANOW K, KWIATKOWSKA E, et al. Malnutrition and erythropoietin resistance among patients with end-stage kidney disease: where is the perpetrator of disaster[J]. Nutrients, 2022, 14(24):5318.
[2] YAO W, SHEN Y, HUANG H, et al. A retrospective study from a single center in China to develop a nomogram to predict one-year mortality in patients with end-stage renal disease who are receiving hemodialysis[J]. Med Sci Monit, 2022, 28(20):93-96.
[3] ASGHARIAN M, GHOLIZADEH P, SAMADI KAFIL H, et al. Correlation of inflammatory biomarkers with the diversity of Bacteroidaceae, Bifidobacteriaceae, Prevotellaceae and Lactobacillaceae families in the intestinal microbiota of patients with end stage renal disease[J]. Adv Med Sci, 2022, 67(2):304-310.
[4] MOTA A P, AREDES M A, DE OLIVEIRA MIGUEL J, et al. Nutritional status assessed by Patient-Generated Subjective Global Assessment is associated with toxicity to chemoradiotherapy in women with cervical cancer: a prospective study[J]. Eur J Clin Nutr, 2022, 76(12):1740-1747.
[5] BLUMBERG BENYAMINI S, BARNEA Z, CERNES R, et al. Association of nutrition status at dialysis start with long-term survival: a 10-year retrospective study[J]. J Ren Nutr, 2022, 32(6):758-765.
[6] National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification[J]. Am J Kidney Dis, 2002, 39(2 Suppl 1):S1-S266.
[7] ENIA G, SICUSO C, ALATI G, et al. Subjective global assessment of nutrition in dialysis patients[J]. Nephrol Dial Transplant, 1993, 8(10):1094-1098.
[8] BEBERASHVILI I, AZAR A, SINUANI I, et al. Objective Score of Nutrition on Dialysis (OSND) as an alternative for the malnutrition-inflammation score in assessment of nutritional risk of haemodialysis patients[J]. Nephrol Dial Transplant, 2010, 25(8):2662-2671.
[9] STOJSAVLJEVIC A, RISTIC-MEDIC D, KRSTIC D-, et al. Circulatory imbalance of essential and toxic trace elements in pre-dialysis and hemodialysis patients[J]. Biol Trace Elem Res, 2022, 200(7):3117-3125.
[10] BALESTRACCI A, CAPONE M A, MENI BATTAGLIA L, et al. Erythropoietin in children with hemolytic uremic syndrome: a pilot randomized controlled trial[J]. Pediatr Nephrol, 2022, 37(10):2383-2392.
[11] SINGH A K, CIZMAN B, CARROLL K, et al. Efficacy and safety of daprodustat for treatment of anemia of chronic kidney disease in incident dialysis patients: a randomized clinical trial[J]. JAMA Intern Med, 2022, 182(6):592-602.
[12] DIMAS A, POLITI A, BARGIOTA A, et al. The gestational effects of maternal bone marker molecules on fetal growth, metabolism and long-term metabolic health: a systematic review[J]. Int J Mol Sci, 2022, 23(15):8328.
[13] MORGAN C G, NEIDERT L E, OZUNA K M, et al. Pre-hospital plasma is non-inferior to whole blood for restoration of cerebral oxygenation in a rhesus macaque model of traumatic shock and hemorrhage[J]. Shock, 2023, 15(2):33-35.
[14] DAI Y, QUAN J, XIONG L, et al. Probiotics improve renal function, glucose, lipids, inflammation and oxidative stress in diabetic kidney disease: a systematic review and meta-analysis[J]. Ren Fail, 2022, 44(1):862-880.
[15] WONG W K, CHAN W K, GANAPATHY S S, et al. Metabolic dysfunction-associated fatty liver disease(MAFLD) and advanced liver fibrosis among hemodialysis patients in a multiethnic urban population in Malaysia[J]. Semin Dial, 2023, 36(2):107-116.
[16] OTTINGER C R, TUFANO J J, COCHRANE-SNYMAN K C, et al. Offset loading in a bilateral squatting movement pattern influences ground-reaction force and muscle activity in the dominant and nondominant limb[J]. Int J Sports Physiol Perform, 2023, 18(5):523-529.