维持性血液透析患者营养状态对预后影响的临床研究

目的 观察维持性血液透析患者营养状态,评价各种营养指标对预后的影响.方法 入选2006年6月在北京大学第三医院维持性血液透析患者97例,资料收集包括一般资料、主观综合营养评估(subjective global assessment,SGA)、饮食记录和分析、体测量、生化指标.随访截止时间 2009年6月,记录生存、退出透析或死亡等结局.Cox回归模型分析不同营养指标对预后的影响,ROC 曲线分析各因素预测死亡的效果.结果 36个月后,97例维持性血液透析患者中有3例转为肾移植,1例转为腹膜透析,23例死亡,共27例(28%)退出血液透析.主观营养评估SGA评分良好组生存率明显高于SGA营养不良组(P=0.000),SGA、饮食蛋白摄入、血白蛋白、胆固醇和体质量指数是影响预后的独立危险因素.SGA预测死亡的ROC曲线下面积(0.76)最大,是预测死亡效果最好的营养指标.结论 维持性血液透析患者营养状态良好者生存率明显高于营养不良者,SGA是最有效预测患者死亡的指标,而且简单易行,适合维持性血液透析患者营养的评估.

Impact of nutritional status on prognosis in Chinese hemodialysis patients

Objective The aims of this study were to observe nutritional status in hemodialysis(HD) patients,and to evaluate the impact of different nutritional parameters on their prognosis.Subjects and methods We recruited 97 HD patients with clinically stable state and treated in the HD Center of Peking University Third Hospital during the period from January to June,2006.Subjective global assessment(SGA),dietary protein intake,biochemistry and anthropometry parameters were collected.They were followed up for 36 months,and outcomes including survival,discontinuing dialysis or death were recorded.Results During the 36 months of follow-up period,3 patents were treated with kidney transplantation,one patient changed to peritoneal dialysis,23 patients died,and 27 patients(28%) withdrew from dialysis.Malnourished patients had significantly higher mortality than well nourished patients(P=0.000).SGA,albumin,dietary protein intake,serum cholesterol,and body-weight index were the independent prognostic risk factors.Area under the ROC curve of SGA was 0.76,and SGA was the best prognostic marker.Results Malnourished HD patients had significantly higher mortality than well nourished patients.SGA,albumin,dietary protein intake,serum cholesterol,and body-weight index were independently associated with mortality.SGA is the most effective prognostic marker,and is simple for nutrition assessment in maintenance hemodialysis patients.