运用主观评估法评价α酮酸对老年透析患者营养的改善作用

目的本研究采用主观评估（微型营养评估法与主观全面评估法）与客观指标结合的综合评估方法,初步探讨复方α酮酸制剂对于透析患者蛋白营养不良的治疗作用。方法选择上海交通大学附属第一人民医院透析中心血清白蛋白低于35g/L老年血液透析及腹膜透析患者各24例,透析时间均大于一年,其中,血液透析组及腹膜透析组各设对照组12例。除对照组外,所有患者均服用开同6个月。营养评估采用综合评估法,即客观营养指标结合主观营养评估。客观指标包括：体重指数（BMI）、血白蛋白（Alb）、血前白蛋白和平均每日每公斤体重能量与蛋白质摄入（DEI、DPI）。主观评估采用了两种评分方法：即通用的主观全面评估法（Subject Global Assessment,SGA）与专门用于老年患者的微型营养评估法（Mini NutritionalAssessment,MNA）,同时测定了患者饮食中的蛋白质与能量摄入情况。结果①伴营养不良的患者普遍存在SGA与MNA评分偏低,提示主客观的评估一致性较好;②与对照组相比,应用酮酸制剂治疗的透析患者3个月后,蛋白质与能量的摄入明显上升,虽体重指数改变不明显,但血清白蛋白水平明显升高,;治疗6个月以后,SGA评分、MNA评分明显上升;低血清白蛋白血症进一步改善,而蛋白质与能量的摄入未进一步增加,患者的体重指数BMI、透析充分性、C反应蛋白（CRP）、血脂改变仍不明显。结论复方酮酸制剂能够提高血清白蛋白水平,改善营养状况,微型营养评估法更适合老年透析患者的营养评估。

Oral supplementation of á-ketoacid improves nutritional status in elderly dialysis patients

Objective There are only a few studies on the supplement of β-ketoacid for the improvement of nutritional status in dialysis patients evaluated by the subjective methods. In this study, we used the objective parameters and the subjective nutritional assessment for the evaluation of β-ketoacid to the nutrition status of dialysis patients. Methods Twelve hemodialysis patients and 12 CAPD patients, who were 〉60 years old with serum albumin 〈35g/L, received daily oral supplemental β-ketoacid for 6 months. Their body mass index （BMI）, serum albumin, prealbumin, C-reactive protein, cholesterol and triglycerides, Kt/V, dietary protein intake （DPI） and dietary energy intake （DEI） were monitored. Meanwhile, we used the Subjective Global Assessment （SGA） and the Mini Nutritional Assessment （MNA） for the evaluation of nutritional status in these patients. Results （1） In the malnutrition patients, the scores from SGA and MNA were lower, indicating the consistency between the two results from the objective and subjective methods. （2） After the β-ketoacid treatment, their appetite and serum albumin were improved. These effects began after 3 months, and further improvement was found after 6 months of the treatment. After the β-ketoacid supplementation, DPI and DEI increased, and scores from SGA and MNA rose, suggesting the improvement of their nutritional status. Conclusion Oral supplemental α-ketoacid significantly improves the low serum albumin and the overall nutritional status in elderly and malnutritional dialysis patients.