主观全面营养评价法在腹膜透析患者中的应用

目的与方法：用主观全面营养评价（ＳｕｂｊｅｃｔｉｖｅＧｌｏｂａｌＡｓｓｅｓｓｍｅｎｔ，ＳＧＡ）结合部分生化指标对３３例持续性不卧床腹膜透析（ＣｏｎｔｉｎｕｏｕｓＡｍｂｕｌａｔｏｒｙＰｅｒｉｔｏｎｅａｌＤｉａｌｙｓｉｓ，ＣＡＰＤ）患者进行了５５例次营养评价。结果：营养良好的患者血清白蛋白、氮表现率相当蛋白（ＮｏｒｍａｌｉｚｅｄＰｒｏｔｅｉｎＥｑｕｉｖａｌｅｎｔｏｆＮｉｔｒｏｇｅｎＡｐｐｅａｒａｎｃｅＲａｔｅ，ＮＰＮＡ）较高。各组间上臂围、三头肌皮褶厚度、上臂肌围无明显差别。ＳＧＡ评分与血清白蛋白（ｒ＝－０．７１，Ｐ＜０．０１）、转铁蛋白（ｒ＝－０．３２，Ｐ＜０．０５）、前白蛋白（ｒ＝－０．３６，Ｐ＜０．０５）浓度和ＮＰＮＡ（ｒ＝－０．４３，Ｐ＜０．０５）明显相关。Ｋａｐｐａ检验发现ＳＧＡ与血清白蛋白浓度评价结果比较一致（Ｋａｐｐａ＝０．５４１，Ｐ＜０．０５）且ＳＧＡ能够发现早期的营养不良。

SUBJECTIVE GLOBAL ASSESSMENT OF NUTRITIONAL STATUS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

ubjective global assessment(SGA)described by Detsky in 1987,has been proved to be a simple inexpensive reliable method for the diagnosis of malnutrition in uremic patients.However this method has never been valid in Chinese dialysis patients.We performed SGA on 33 CAPD patients on 55 occasions and found that well-nourished patients had higher serum albumin level,higher dietary protein intake(DPI)evaluated from normalized protein equivalent of nitrogen appearance rate(NPNA),however there were no differences of anthropometry among the three groups of patients.Spearman regression showed a strong association in SGA score with serum albumin(r=-0.71,P<0.01),transferrin(r=-0.32 P<0.05),prealbumin(r=-0.36,P<0.05)levels and NPNA(r=-43,P<0.05).Kappa analysis showed that the results of nutritional status assessed by SGA and serum albumin level were rather in accordance with each other,but malnutrition could be found more earlier by SGA,as compared with serum albumin level.The results indicate that SGA is well suited for diagnosis of malnutrition in Chinese CAPD patients.