摘要
目的:采用营养不良-炎症评分(malnutrition inflammation score,MIS)系统,观察透析患者营养-炎症状态,分析与住院和死亡风险的关系。方法:对141例行维持性血液(maintenance hemodialysis,MHD)患者进行MIS评分,了解其营养和炎症状况,包括:人体测量学指标、生化指标(包括血清白蛋白、前白蛋白、转铁蛋白、铁蛋白、未饱和铁,总胆固醇、肾功能等)及血常规(红细胞、血红蛋白)、炎症指标(包括超敏C反应蛋白、白细胞介素-6、肿瘤坏死因子-α等)。统计患者进入观察期12个月内其住院和死亡的情况,分析MIS评分与住院风险及死亡风险之间的关系,及与炎症和营养状态的相关性。结果:本组患者MIS评分增高者,存在较高的住院频率和病死率。MIS每升高10分(轻、中、重度),其住院频率分别为1.68±2.43、2.37±2.57、4.46±3.73(次),其住院率分别为29.26%、45.95%和83.33%,病死率分别为3.66%、10.81%和75%。较高的MIS与较低的血清白蛋白、转铁蛋白水平及肌肉蛋白储备下降有关,MIS升高者存在更显著的炎症和贫血状态。相关分析显示MIS与住院频率、透析龄、铁蛋白、超敏C反应蛋白、白细胞介素-6水平正相关,与人体测量指标、前白蛋白、白蛋白、转铁蛋白、总铁结合力以及肌酐水平负相关。结论:MIS评分系统可以有效评价MHD患者的营养不良-炎症状态,并与患者住院频率和死亡风险相关,MIS分级越高,营养不良和炎症状态越严重,其住院和死亡风险越大。
Objective：The Malnutrition inflammation complex syndrome（MICS） occurs commonly in maintenance hemodialysis（MHD） patients and may correlate with increased morbidity and mortality.We used the new comprehensive Malnutrition-Inflammation Score（MIS） to measure MHD clinical status of nutrition and inflammation,as well as prospective hospitalization and mortality.Methods：141 patients（76 men,65 women;age 26～81 years） came from Blood Purification Center of The Jimin Hospital,who took MHD from Nov.2007 toJuly.2009 for at least 3 months（13～33 months）,were evaluated at the beginning of this study and followed up for 1 year.The MIS were assessed simultaneously on all patients by a trained physician.We detected the status of nutrition and inflammation,which including Anthropometry,Biochemical assays（such as serum albumin,prealbumin,transferrin,ferritin,total iron binding capacity,serum creatinine,urea nitrogen,uric acid and haemoglobin,etc）,and the Inflammatory parameters such as high sensitive C reactive protein（hs-CRP）,interleukin-6（IL-6） and tumor necrosis factor alpha（TNF-α）.The MIS scores were compared with 12-month prospective frequency of hospitalization and mortality rates.We also analyzed the clinic character which related to anthropometric measure,laboratory measure including biochemical and inflammation.Results：The MIS appears to be a comprehensive scoring system with significantly associations with prospective hospitalization and mortality.When the MIS increased each 10 units（mild,middle or severe）,the frequency of hospitalization was 1.68±2.43、2.37±2.57、4.46±3.73 respectively;the hospitalization rate was 29.26%、45.95% and 83.33% respectively;the mortality was 3.66%,10.81% and 75% accordingly.The level of MIS score was correlation to a severely malnutrition statues which showed decreasing Alb,transferrin and the body muscle mass.They also had a bad anemia and a micro-inflammation status.The MIS score had a and a positive correlation to the frequency of hospitalization,ferritin,CRP,IL-6;and a negative correlation to Anthropometry,Alb,transferrin,total iron binding capacity,and serum cretinine.Conclusion：The MIS appears to be a comprehensive scoring system to measure the statues of malnutrition-inflammation in MHD patients.A higher score means a worse nutrition and anemia,as well as a higher hospitalization and mortality.MIS might be a predictor of dialysis outcome and an indicator of MICS.
出处
《中国中西医结合肾病杂志》
2010年第8期695-699,共5页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
上海市启明星跟踪基金资助项目(No.07QH14020)
