CAJ | 학술논문

目的探讨维持性血液透析(MHD)患者营养和炎性反应状态与其住院和死亡情况的关系,并寻找能够反映MHD患者住院和死亡风险的营养及炎性反应指标.方法随访观察1年我院血透中心MHD患者的营养和炎性反应状况,比较住院和非住院患者的营养及炎性反应状态的差别；并通过Cox比例风险模型寻找能够反映患者1年内首次住院及死亡风险的营养及炎性反应指标.结果入组患者118例,轻、中、重度营养不良的住院率分别为32.93％、56.67％和83.33％;病死率分别为3.66％、6.67％和80.00％；存在微炎性反应状态和不存在微炎性反应状态患者的住院率分别为56.45％和46.43％,病死率分别为14.29％和1.61％.住院患者营养不良-炎性反应评分(8.36比5.86,P＜0.05)和改良主观营养评价得分(14.49比12.88,P＜ 0.05)均高于未住院患者,差异有统计学意义.与非住院患者比较,住院患者Scr (886.83 μmol/L比991.76 μmol/L,P＜ 0.05)、白蛋白(38.57g/L比40.27g/L,P＜0.05)较低,差异有统计学意义.住院患者TNF-α高于非住院患者(65.41 μg/L比59.76 μg/L,P＜ 0.05),差异有统计学意义.Cox比例风险模型显示营养不良炎性反应评分(MIS)和TNF-α 与患者首次住院的危险性有关,其值越大,1年内首次住院的危险性越大.结论 MHD患者营养不良与炎性反应状态的程度越重,其住院和死亡的风险越大.营养不良-炎性反应评分和TNF-α水平越高,1年内首次住院的危险性越大.
목적 탐토유지성혈액투석(MHD)환자영양화염성반응상태여기주원화사망정황적관계,병심조능구반영MHD환자주원화사망풍험적영양급염성반응지표.방법 수방관찰1년아원혈투중심MHD환자적영양화염성반응상황,비교주원화비주원환자적영양급염성반응상태적차별；병통과Cox비례풍험모형심조능구반영환자1년내수차주원급사망풍험적영양급염성반응지표.결과 입조환자118례,경、중、중도영양불량적주원솔분별위32.93％、56.67％화83.33％;병사솔분별위3.66％、6.67％화80.00％；존재미염성반응상태화불존재미염성반응상태환자적주원솔분별위56.45％화46.43％,병사솔분별위14.29％화1.61％.주원환자영양불량-염성반응평분(8.36비5.86,P＜0.05)화개량주관영양평개득분(14.49비12.88,P＜ 0.05)균고우미주원환자,차이유통계학의의.여비주원환자비교,주원환자Scr (886.83 μmol/L비991.76 μmol/L,P＜ 0.05)、백단백(38.57g/L비40.27g/L,P＜0.05)교저,차이유통계학의의.주원환자TNF-α고우비주원환자(65.41 μg/L비59.76 μg/L,P＜ 0.05),차이유통계학의의.Cox비례풍험모형현시영양불량염성반응평분(MIS)화TNF-α 여환자수차주원적위험성유관,기치월대,1년내수차주원적위험성월대.결론 MHD환자영양불량여염성반응상태적정도월중,기주원화사망적풍험월대.영양불량-염성반응평분화TNF-α수평월고,1년내수차주원적위험성월대.
Objective To investigate the impact and the associated parameters of malnutrition and inflammation status on hospitalization and mortality of maintenance hemodialysis (MHD) patients. Method A total of 118 MHD patients were included in the study with 1 year's follow-up.The malnutrition and inflammation parameters were compared between the hospitalized patients and out-patients.Cox's proportional hazard regression model was used to explore the malnutrition and inflammation parameters which could forecast the risk of hospitalization and mortality. Result The hospitalization rate of MHD patients with mild,moderate and severe malnuttition was 32.93％,56.67％ and 83.33％ respectively,and the mortality was 3.66％,6.67％ and 80.00％ respectively.The hospitalization rate of MHD patients with or without microinflammation status was 56.45％ and 46.43％,and the mortality was 14.29％ and 1.61％.Inpatients had a higher malnutrition-inflammation score(MIS,8.36 vs 5.86,P＜0.05) and subjective global assessment of nutrition (MQSGA,14.49 vs 12.88,P＜0.05),a lower creatinine level (886.83 μmol/L vs 991.76 μmol/L,P＜0.05 ) and a lower albumin level (38.57 g/L vs 40.27 g/L,P＜0.05) than out-patients.Inpatients also had a higher level of TNF-α (65.41 μg/L vs 59.76 μg/L,P＜0.05) than out-patients.Cox proportional hazard model analysis showed that MIS and TNF-α were associated with patient's first hospitalization risk. Conclusions For the MHD patients,the more severe the malnutrition and micro-inflammation status is,the worse the clinical outcome is.The higher levels of MIS and TNF-α result in greater risk of hospitalization.