慢性肾脏病患者透析前营养状况及营养不良影响因素分析

目的 探讨慢性肾脏病(chronic kidney disease,CKD)患者透析前营养状况以及营养不良的影响因素。 方法 选择2018年9月—2019年3月在蚌埠医学院第一附属医院肾病科接受治疗的134例透析前CKD患者作为研究对象，采用主观整体评估量表(subjective global assessment,SGA)评估患者营养状况并分组，收集患者相关临床资料，包括一般资料、病史、营养宣教和治疗等情况，使用多因素有序logistic回归分析筛查CKD患者营养不良的危险因素。 结果 共纳入CKD患者134例，SGA营养状况评估结果:134例CKD患者中，营养良好者107例(79.9%)，轻中度营养不良者20例(14.9%)，重度营养不良者7例(5.2%)，CKD 1～5期营养不良发生率分别为2例(6.9%)、2例(5.4%)、7例(30.4%)、9例(39.1%)、7例(31.8%)，3组间血红蛋白、白蛋白、前白蛋白、肌酐及尿素差异有统计学意义(均P<0.05)，多因素有序logistic回归分析显示:年龄≥65岁、C-反应蛋白≥3 mg/L、CKD 3～5期及合并糖尿病为CKD患者营养不良的危险因素。 结论 透析前CKD患者营养不良患病率较高，尤其CKD 3～5期患者，其中年龄≥65岁、C-反应蛋白≥3 mg/L、CKD 3～5期及合并糖尿病是透析前CKD患者营养不良的独立危险因素，因此临床工作中应加强对透析前CKD患者营养不良的认识，注重上述危险因素的筛查，采取积极的营养治疗措施，降低透析前CKD患者营养不良的发生率，改善患者生活质量。 

Analysis of nutritional status and influencing factors of malnutrition before dialysis in chronic kidney disease patients

Objective To investigate the nutritional status of chronic kidney disease (CKD) patients before dialysis and the influencing factors of malnutrition. Methods A total of 134 patients with pre-dialysis CKD patients in the nephrology department of the First Affiliated Hospital of Bengbu Medical College from September 2018 to March 2019 were selected as the study subjects. Subjective Global Assessment (SGA) and laboratory tests were used to assess the nutritional status of CKD patients. Patients were grouped according to the results of SGA and the clinical data, including general information, medical history, nutrition education and treatment, were collected. Multivariate logistic regression analysis was used to screen the risk factors of malnutrition in CKD patients. Results Among 134 patients, 107(79.9%) were well-nourished, 20(14.9%) were moderately malnourished, 7(5.2%) were severely malnourished. The incidence of CKD stage 1-5 malnutrition was 6.9%, 5.4%, 30.4%, 39.1% and 31.8%, respectively. There were significant differences in hemoglobin, albumin, prealbumin, creatinine and urea among the three groups (all P<0.05). Multivariate logistic regression analysis showed that age (> 65 years old), C-reactive protein (≥3 mg/L), CKD 3-5 stage and diabetes mellitus were risk factors for malnutrition in CKD patients. Conclusion The prevalence of malnutrition in pre-dialysis CKD patients is high, especially in CKD 3-5 stage. The age (≥65 years old), C-reactive protein (≥3 mg/L), CKD 3-5 stage and diabetes mellitus are independent risk factors for malnutrition in pre-dialysis CKD patients. Therefore, we should strengthen the understanding of malnutrition in pre-dialysis CKD patients, pay attention to screen the above risk factors, take active nutritional treatment measures, reduce the incidence of malnutrition in CKD patients before dialysis, and improve the quality of life of patients.