本文選題：營養(yǎng)不良-炎癥狀態(tài) + 營養(yǎng)不良-炎癥評分��； 參考：《昆明醫(yī)科大學》2015年碩士論文

【摘要】：目的：研究維持性血液透析患者的營養(yǎng)不良-炎癥狀態(tài)的評估及其對生存質量的影響。方法：選擇2014年1月-2015年1月在云南省腎臟病醫(yī)院血液凈化中心治療≥3個月的符合入選標準的維持性血液透析患者130例為研究對象,行改良定量整體主觀評估(MQSGA)和營養(yǎng)不良炎癥評分(MIS),同時檢測MHD患者的人體測量指標、生化指標、微炎癥指標,運用生物電阻抗法行人體成分分析,分析MQSGA和MIS與各項指標的相關性,并比較兩種方法對營養(yǎng)不良-炎癥狀態(tài)的評價效能。利用SF-36量表評估患者的生存質量,分析不同程度的營養(yǎng)不良-炎癥狀態(tài)對生存質量的影響,并探討其影響因素。結果：1.一般情況：入選MHD患者130例(男/女：84/46),平均年齡46.80±14.34歲,平均透析齡34.88±31.07個月。其中慢性腎小球腎炎87例(66.92%),糖尿病腎病18例(13.85%),良性腎小動脈硬化癥18例(13.85%),其他7例(5.38%)。2.入選患者的營養(yǎng)狀況：按MQSGA的標準,130例MHD患者中,營養(yǎng)不良的患者98例,占75.4%,其中輕、中度營養(yǎng)不良95例,占73.1%,重度營養(yǎng)不良3例,占2.3%。按照MIS的標準,入選患者全部為營養(yǎng)不良,其中輕度營養(yǎng)不良78例,占60%,中度營養(yǎng)不良45例,占34.6%,重度營養(yǎng)不良7例,占5.4%。3.比較MQSGA、MIS對營養(yǎng)-炎癥狀態(tài)的評估：MQSGA和MIS的得分均與MHD患者的營養(yǎng)指標體質量指數(shù)、肱三頭肌皮褶厚度、上臂肌圍、白蛋白、鐵蛋白、去脂體重、肌肉量、體脂肪量、握力呈負相關,MIS還與前白蛋白呈負相關(P0.05)；MQSGA口MIS均與炎癥指標hs-CRP、IL-6呈正相關(P0.05)；除肱三頭肌皮褶厚度外,MIS與各營養(yǎng)指標及炎癥指標的相關系數(shù)均高于MQSGA。4.入選患者的炎癥指標及與營養(yǎng)指標的相關性分析：將hs-CRP、IL-6、TNF-α與相關的營養(yǎng)指標做線性相關分析,結果顯示hs-CRP和握力、前白蛋白呈負相關；IL-6和上臂肌圍、白蛋白、前白蛋白呈負相關；TNF-α和前白蛋白、血紅蛋白呈負相關(P0.05)。5.營養(yǎng)不良-炎癥狀態(tài)對生存質量的影響：因MIS評分與各個營養(yǎng)指標和炎癥指標的相關性更好,根據(jù)MIS得分將MHD患者的營養(yǎng)不良-炎癥狀態(tài)分為輕度、中度、重度三組,三組患者在SF-36總評分、PF、Pain、GH、EWB、SocF、Energ、生理領域、心理領域得分間的差異均有統(tǒng)計學意義,在RP、RE領域得分無統(tǒng)計學差異；進一步行兩兩比較,重度組在SF-36總評分、PF、Pain、GH、EWB、 SocF、Energ、PH、MH領域得分均低于輕度組和中度組,異均有統(tǒng)計學意義(P0.05),在RP、RE領域三組得分無統(tǒng)計學差異(P0.05)；輕度組在PH領域高于中度組,在SF-36總評分及其分支領域、MH領域得分均無統(tǒng)計學差異。6.影響MIS評分的自身因素的多因素分析：MIS得分與年齡、透析齡呈正相關,與BMI呈負相關,性別、原發(fā)病對MIS得分無影響,其中BMI對MIS得分的影響最大,其次是透析齡、年齡。結論：1.維持性血液透析患者普遍存在營養(yǎng)不良和炎癥狀態(tài),且關系密切；2. MQSGA和MIS均能評估MHD患者的營養(yǎng)不良-炎癥狀態(tài),但MIS與相關指標的相關性更好,能對其營養(yǎng)不良-炎癥狀態(tài)及嚴重程度做出更準確的評價；3.MIS分級越高,MHD患者生存質量的得分也越低,營養(yǎng)不良-炎癥狀態(tài)影響著MHD患者生存質量的多個領域,改善患者的營養(yǎng)不良-炎癥狀態(tài)可提高患者的生存質量；4.MIS得分與年齡、透析齡呈正相關,與BMI呈負相關,其中BMI對MIS得分的影響最大,其次是透析齡、年齡。
[Abstract]:Objective : To study the evaluation of malnutrition - inflammatory status in patients with maintenance hemodialysis and its effects on quality of life . Methods : In January 2014 to January 2015 , 130 patients ( male / female : 84 / 46 ) , with a mean age of 46.80 鹵 14.34 years , were analyzed . There was a negative correlation between upper arm muscle circumference , albumin , ferritin , fat - free weight , muscle mass , body fat and grip , and MIS was negatively correlated with prealbumin ( P0.05 ) .
The MIS of MQSGA was positively correlated with the inflammatory markers hs - CRP and IL - 6 ( P0.05 ) .
In addition to the thickness of triceps skinfold , the correlation coefficient between MIS and each nutrient index and inflammatory index was higher than that of MQSGA . 4 . The correlation between the inflammatory index and the nutrition index was analyzed by the correlation between hs - CRP , IL - 6 and TNF - 偽 . The results showed that hs - CRP was negatively correlated with the grip and prealbumin .
There was a negative correlation between IL - 6 and upper arm muscle circumference , albumin and prealbumin .
There was a negative correlation between the levels of TNF - 偽 and pre - albumin and hemoglobin ( P0.05 ) . 5 . The effect of malnutrition - inflammatory state on quality of life was better than that of each nutrient index and inflammatory index . According to MIS score , the malnutrition - inflammatory status of MHD patients was divided into mild , moderate and severe three groups . The difference between the scores of SF - 36 , PF , Pain , GH , EWB , SocF , Energ , physiology and psychological field was statistically significant , and there was no statistical difference in the score of RP and RE .
The scores of SF - 36 , PF , Pain , GH , EWB , SocF , Energ , PH and MH in severe group were lower than those in mild and moderate groups ( P0.05 ) .
There was no statistical difference in the total score of SF - 36 and its branches , and the score in MH area was not statistically different .
2 . Both MQSGA and MIS can evaluate the malnutrition - inflammatory status of MHD patients , but MIS and related indexes have better correlation , and can make more accurate evaluation of malnutrition - inflammatory status and severity .
3 . The higher the MIS classification , the lower the score of the quality of life of MHD patients , the malnutrition - inflammation state affects the quality of life of MHD patients , and improves the patient ' s malnutrition - inflammatory state , which can improve the quality of life of patients ;
4 . MIS scores positively correlated with age , dialysis age , and negatively correlated with BMI , among which BMI had the greatest impact on MIS score , followed by dialysis age and age .

【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R692.5

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