MIS评分对血透患者营养不良-炎症状态及住院/死亡风险的相关性

目的：采用营养不良-炎症评分（malnutrition inflammation score,MIS）系统,观察透析患者营养-炎症状态,分析与住院和死亡风险的关系。方法：对141例行维持性血液（maintenance hemodialysis,MHD）患者进行MIS评分,了解其营养和炎症状况,包括：人体测量学指标、生化指标（包括血清白蛋白、前白蛋白、转铁蛋白、铁蛋白、未饱和铁,总胆固醇、肾功能等）及血常规（红细胞、血红蛋白）、炎症指标（包括超敏C反应蛋白、白细胞介素-6、肿瘤坏死因子-α等）。统计患者进入观察期12个月内其住院和死亡的情况,分析MIS评分与住院风险及死亡风险之间的关系,及与炎症和营养状态的相关性。结果：本组患者MIS评分增高者,存在较高的住院频率和病死率。MIS每升高10分（轻、中、重度）,其住院频率分别为1.68±2.43、2.37±2.57、4.46±3.73（次）,其住院率分别为29.26%、45.95%和83.33%,病死率分别为3.66%、10.81%和75%。较高的MIS与较低的血清白蛋白、转铁蛋白水平及肌肉蛋白储备下降有关,MIS升高者存在更显著的炎症和贫血状态。相关分析显示MIS与住院频率、透析龄、铁蛋白、超敏C反应蛋白、白细胞介素-6水平正相关,与人体测量指标、前白蛋白、白蛋白、转铁蛋白、总铁结合力以及肌酐水平负相关。结论：MIS评分系统可以有效评价MHD患者的营养不良-炎症状态,并与患者住院频率和死亡风险相关,MIS分级越高,营养不良和炎症状态越严重,其住院和死亡风险越大。

Malnutrition-Inflammation Score (MIS) Reflect the Malnutrition - Inflammation Status and Relation to the Hospitalization and Morbidity in Maintenance Hemodialysis Patients

Objective：The Malnutrition inflammation complex syndrome（MICS） occurs commonly in maintenance hemodialysis（MHD） patients and may correlate with increased morbidity and mortality.We used the new comprehensive Malnutrition-Inflammation Score（MIS） to measure MHD clinical status of nutrition and inflammation,as well as prospective hospitalization and mortality.Methods：141 patients（76 men,65 women;age 26～81 years） came from Blood Purification Center of The Jimin Hospital,who took MHD from Nov.2007 toJuly.2009 for at least 3 months（13～33 months）,were evaluated at the beginning of this study and followed up for 1 year.The MIS were assessed simultaneously on all patients by a trained physician.We detected the status of nutrition and inflammation,which including Anthropometry,Biochemical assays（such as serum albumin,prealbumin,transferrin,ferritin,total iron binding capacity,serum creatinine,urea nitrogen,uric acid and haemoglobin,etc）,and the Inflammatory parameters such as high sensitive C reactive protein（hs-CRP）,interleukin-6（IL-6） and tumor necrosis factor alpha（TNF-α）.The MIS scores were compared with 12-month prospective frequency of hospitalization and mortality rates.We also analyzed the clinic character which related to anthropometric measure,laboratory measure including biochemical and inflammation.Results：The MIS appears to be a comprehensive scoring system with significantly associations with prospective hospitalization and mortality.When the MIS increased each 10 units（mild,middle or severe）,the frequency of hospitalization was 1.68±2.43、2.37±2.57、4.46±3.73 respectively;the hospitalization rate was 29.26%、45.95% and 83.33% respectively;the mortality was 3.66%,10.81% and 75% accordingly.The level of MIS score was correlation to a severely malnutrition statues which showed decreasing Alb,transferrin and the body muscle mass.They also had a bad anemia and a micro-inflammation status.The MIS score had a and a positive correlation to the frequency of hospitalization,ferritin,CRP,IL-6;and a negative correlation to Anthropometry,Alb,transferrin,total iron binding capacity,and serum cretinine.Conclusion：The MIS appears to be a comprehensive scoring system to measure the statues of malnutrition-inflammation in MHD patients.A higher score means a worse nutrition and anemia,as well as a higher hospitalization and mortality.MIS might be a predictor of dialysis outcome and an indicator of MICS.