主观综合营养评估法在慢性肾脏病患者中的运用

目的探讨主观综合营养评估法(SGA)评价慢性肾脏病(CKD)患者营养状态的临床价值。方法对99例CKD非透析患者进行SGA评估,根据结果分为A组(营养良好)和B组(轻-中度营养不良)。测量患者的体质指数(BMI)、肱三头肌皮褶厚度(TSF)、上臂围(AC)、上臂肌围(AMC),收集白蛋白(Alb)检查结果,通过统计分析,比较两组间各指标的差异,同时比较SGA分组与BMI分组之间的关系。结果根据SGA的评价结果,纳入的CKD患者营养不良发生率为16.2%,CKD3～5期评分为B的患者比例较CKD1～2期高,但差异无统计学意义(P>0.05)。TSF、AC、BMI 3个指标A组均明显高于B组(P<0.01),AMC、Alb两组间差异无统计学意义(P>0.05)。BMI评定为超重或肥胖的38例中有37例(97.4%)SGA评估为A。结论 SGA评估CKD患者的营养状态具有一定临床参考价值,但主观性判断的特点使其对内脏蛋白质营养状态的评价欠准确,且对肥胖状态似乎无法评估。但简单经济、易于开展的优势使其仍值得在临床上运用。

The applicaiton of subjective global assessment in patients with chronic kidney disease

Objective To evaluate the application of subjective global assessment(SGA) in patients with chronic kidney disease(CKD) for nutritional status.Methods SGA assessment was performed on 99 CKD patients in our hospital and subsequently divided into two groups according to the result,Group A(good nutrition status) and Group B(malnutrition status).The body mass index(BMI),triceps skinfold(TSF),arm circumference(AC),arm muscle circumference(AMC),and recorded the albumin(Alb) were also recorded for analysis.Results According to SGA assessment,the malnutrition patients accounted 16.2% of the CKD patients,and the proportion of malnutrition in patients of CKD3~5 stage was higher than that in patients of CKD1~2 stage,though there was no significant difference(P>0.05).The TSF,AC,BMI in Group A were significantly higher than those in Group B(P<0.01),though no significant difference was revealed in AMC,Alb(P>0.05).However,there were 37 out of 38 overweight or obese patients(according to BMI) subjugated into Group A.Conclusion SGA is effective in clinical nutrition assessment,though it is still lack of sufficient assessment in protein nutrition state.Still obesity should be taking consideration using SGA.Besides these,SGA should be applied in clinic due to its conveniency and feasibility.