改良主观全面营养评价法在慢性肾脏病患者中的应用

目的应用改良主观全面营养评价(SGAN)法对慢性肾脏病(CKD)门诊患者的营养状态进行评价,并观察所得结果与临床常用营养指标的关联性。方法对129例CKD患者应用改良SGAN法进行营养评估,同时测定身高、体质量、握力等人体测量学指标和血常规、生化肌酐(Cr)、尿素氮(BUN)、白蛋白(ALB)、总胆固醇(CHOL)、甘油三酯(TG)、超敏C反应蛋白(hs-CRP)、总铁结合力(TIBC)]等实验室指标,并进行相关性分析。结果 129例患者改良SGAN法评分(MS)在7～17分之间,7～10分的患者占88.37%。实验室指标,贫血24例(男性<120 g/L,女性<110 g/L);低蛋白血症9例(<35 g/L);低体质指数(BMI)5例(<18.5)。MS值与性别、身高、平均握力、肾小球滤过率(eG-FR)、血红蛋白(Hb)、BUN、ALB、hs-CRP均有相关关系(P<0.05)。进行多元相关分析,在去除年龄、身高、体质量的影响后,MS值与Hb、BUN、ALB和平均握力仍存在相关性,偏相关系数r分别为-0.239、0.231、-0.303、-0.216(P均<0.05)。结论随访的CKD患者普遍营养状态良好;改良SGAN法对CKD患者具有良好的营养评价作用,是一种经济、有效的营养不良筛选方法。

The application of modified subjective global assessment of nutrition (SGAN) in patients with chronic kidney diseases

Objective To apply modified subjective global assessment of nutrition（SGAN） in evaluation of the nutritional status of patients with chronic kidney diseases（CKD）,and to observe the relevance between its results and some clinically commonly applied markers.Methods The nutritional status of 129 patients with CKD had been estimated by using modified SGAN and anthropometrical measurement（body height,body weight,grip strength,etc）,blood routine,biochemical parameterscreatinine（Cr）,urea nitrogen（BUN）,albumin（ALB）,cholesterol（CHOL）,triglyceride（TG）,high sensitive C-reactive protein（hs-CRP）and total iron-binding capacity（TIBC）]were measured.Then the correlation among them were evaluated.Results Malnutrition scores（MS）and assessment of the value of modified SGAN showed significant correlation with sex,body height,average grip strength,estimated glomerular filtration rate（eGFR）,and levels of hemoglobin（Hb）,BUN,ALB and hs-CRP（P〈005）.After controlling the variables of age,weight,height,partial correlation showed significant correlation between MS and the combination of Hb,BUN,ALB and average grip strength（P〈0.05）,and their partial correlation coefficient r was-0.239,0.231,-0.303 and-0.216 respectively（P〈0.05）.Conclusion The modified SGAN is an economical and effective screening measure for detecting early malnutrition of patients with CKD and a good approach for evaluation of their nutritional status.