营养不良-炎症评分评估和判断维持性腹膜透析患者的营养不良-微炎症状态

目的探讨营养不良-炎症评分(malnutrition inflammation score,MIS)对维持性腹膜透析(peritoneal dialysis,PD)患者营养不良-微炎症状态的临床评价和判断。方法对上海解放军第四五五医院腹膜透析中心行维持性PD的患者的营养不良-炎症状态进行改良定量主观整体评估(modified quantitativesubjective global assessment,MQSGA)和MIS,同时检测PD患者人体测量指标、生化指标和微炎症指标,并分析MIS对营养不良-炎症状态的评价效能及与各项指标的相关性。结果符合纳入标准的PD患者共98例。按照MQSGA标准,营养不良者96例,占97.96%,其中轻度64例,占65.31%,中度27例,占27.55%,重度5例,占7.10%。按照MIS标准,98例PD患者全部为营养不良,占100%,其中轻度52例,占53.06%,中度39例,占39.80%,重度7例,占7.14%。MIS分值越高,患者年龄越大,营养状况越差,微炎症状态越严重。MIS与PD患者贫血指标、营养指标和人体测量指标显著负相关,差异有统计学意义(P0.05);与微炎症指标显著正相关,差异有统计学意义(P0.05),MIS与各指标的相关系数高于MQSGA。结论 MIS可准确评估和判断腹膜透析患者营养不良-微炎症状态,随着MIS分值的增加,患者的营养不良-炎症状态亦愈加严重,且高龄患者具有较高的MIS分值。

Malnutrition inflammation score can evaluate malnutrition-inflammation status in Chinese peritoneal dialysis patients

Objective The malnutrition inflammation complex syndrome （MICS） occurs commonly in end stage renal disease or dialysis patients. We used malnutrition-inflammation score （MIS） to evaluate malnutrition-inflammation status in Chinese peritoneal dialysis （PD） patients. Methods A total of 98 patients （47 males and 51 females; 59.1 ± 18.0 years of age） treated with PD for at least 3 months （4~13 months） in the Peritoneal Dialysis Center of Jimin Hospital during the period from Feb. 2009 to Sep.2009 were recruited in this study. MIS and the modified quantitative subjective global assessment （MQSGA） were assessed by an experienced physician. Observations also included anthropometry, biochemical assays, and the micro-inflammation parameters. We then analyzed the efficacy of MIS in the evaluation of malnutrition-inflammation status, and the correlation between MIS and these parameters. Results The morbidity of malnutrition was 97.96% based on the criteria of MQSGA, including 64 mild malnutrition cases （65.31%）, 27 moderate cases （27.55%）, and 5 severe cases （7.10%）. However, all patients was malnutritional if the criteria of MIS were used, including 52 mild malnutrition cases （53.06%）, 39 moderate cases （39.80%）, and 7 severe cases （7.14%）. Higher MIS score indicated the worse nutritional status and the more severe inflammation status. MIS score had a negative correlation to anthropometry and serum albumin, and a positive correlation to anemia and inflammation parameters. Elderly patients showed a higher MIS score with bad nutrition and inflammation parameters. MIS had a higher correlation coefficient with these parameters than MQSGA. Conclusions MIS is a useful tool for the estimation of malnutrition-inflammation status in Chinese PD patients. Higher MIS score indicates the presence of a severe malnutrition-inflammation status. Elderly patients usually have a higher MIS score.