本文選題：營(yíng)養(yǎng)不良-炎癥狀態(tài) + 營(yíng)養(yǎng)不良-炎癥評(píng)分　； 參考：《昆明醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：研究維持性血液透析患者的營(yíng)養(yǎng)不良-炎癥狀態(tài)的評(píng)估及其對(duì)生存質(zhì)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(gè)月的符合入選標(biāo)準(zhǔn)的維持性血液透析患者130例為研究對(duì)象,行改良定量整體主觀(guān)評(píng)估(MQSGA)和營(yíng)養(yǎng)不良炎癥評(píng)分(MIS),同時(shí)檢測(cè)MHD患者的人體測(cè)量指標(biāo)、生化指標(biāo)、微炎癥指標(biāo),運(yùn)用生物電阻抗法行人體成分分析,分析MQSGA和MIS與各項(xiàng)指標(biāo)的相關(guān)性,并比較兩種方法對(duì)營(yíng)養(yǎng)不良-炎癥狀態(tài)的評(píng)價(jià)效能。利用SF-36量表評(píng)估患者的生存質(zhì)量,分析不同程度的營(yíng)養(yǎng)不良-炎癥狀態(tài)對(duì)生存質(zhì)量的影響,并探討其影響因素。結(jié)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(gè)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(dòng)脈硬化癥18例(13.85%),其他7例(5.38%)。2.入選患者的營(yíng)養(yǎng)狀況：按MQSGA的標(biāo)準(zhǔn),130例MHD患者中,營(yíng)養(yǎng)不良的患者98例,占75.4%,其中輕、中度營(yíng)養(yǎng)不良95例,占73.1%,重度營(yíng)養(yǎng)不良3例,占2.3%。按照MIS的標(biāo)準(zhǔn),入選患者全部為營(yíng)養(yǎng)不良,其中輕度營(yíng)養(yǎng)不良78例,占60%,中度營(yíng)養(yǎng)不良45例,占34.6%,重度營(yíng)養(yǎng)不良7例,占5.4%。3.比較MQSGA、MIS對(duì)營(yíng)養(yǎng)-炎癥狀態(tài)的評(píng)估：MQSGA和MIS的得分均與MHD患者的營(yíng)養(yǎng)指標(biāo)體質(zhì)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(fù)相關(guān),MIS還與前白蛋白呈負(fù)相關(guān)(P0.05)；MQSGA口MIS均與炎癥指標(biāo)hs-CRP、IL-6呈正相關(guān)(P0.05)；除肱三頭肌皮褶厚度外,MIS與各營(yíng)養(yǎng)指標(biāo)及炎癥指標(biāo)的相關(guān)系數(shù)均高于MQSGA。4.入選患者的炎癥指標(biāo)及與營(yíng)養(yǎng)指標(biāo)的相關(guān)性分析：將hs-CRP、IL-6、TNF-α與相關(guān)的營(yíng)養(yǎng)指標(biāo)做線(xiàn)性相關(guān)分析,結(jié)果顯示hs-CRP和握力、前白蛋白呈負(fù)相關(guān)；IL-6和上臂肌圍、白蛋白、前白蛋白呈負(fù)相關(guān)；TNF-α和前白蛋白、血紅蛋白呈負(fù)相關(guān)(P0.05)。5.營(yíng)養(yǎng)不良-炎癥狀態(tài)對(duì)生存質(zhì)量的影響：因MIS評(píng)分與各個(gè)營(yíng)養(yǎng)指標(biāo)和炎癥指標(biāo)的相關(guān)性更好,根據(jù)MIS得分將MHD患者的營(yíng)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(píng)分、PF、Pain、GH、EWB、SocF、Energ、生理領(lǐng)域、心理領(lǐng)域得分間的差異均有統(tǒng)計(jì)學(xué)意義,在RP、RE領(lǐng)域得分無(wú)統(tǒng)計(jì)學(xué)差異；進(jìn)一步行兩兩比較,重度組在SF-36總評(píng)分、PF、Pain、GH、EWB、 SocF、Energ、PH、MH領(lǐng)域得分均低于輕度組和中度組,異均有統(tǒng)計(jì)學(xué)意義(P0.05),在RP、RE領(lǐng)域三組得分無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；輕度組在PH領(lǐng)域高于中度組,在SF-36總評(píng)分及其分支領(lǐng)域、MH領(lǐng)域得分均無(wú)統(tǒng)計(jì)學(xué)差異。6.影響MIS評(píng)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(guān),與BMI呈負(fù)相關(guān),性別、原發(fā)病對(duì)MIS得分無(wú)影響,其中BMI對(duì)MIS得分的影響最大,其次是透析齡、年齡。結(jié)論：1.維持性血液透析患者普遍存在營(yíng)養(yǎng)不良和炎癥狀態(tài),且關(guān)系密切；2. MQSGA和MIS均能評(píng)估MHD患者的營(yíng)養(yǎng)不良-炎癥狀態(tài),但MIS與相關(guān)指標(biāo)的相關(guān)性更好,能對(duì)其營(yíng)養(yǎng)不良-炎癥狀態(tài)及嚴(yán)重程度做出更準(zhǔn)確的評(píng)價(jià)；3.MIS分級(jí)越高,MHD患者生存質(zhì)量的得分也越低,營(yíng)養(yǎng)不良-炎癥狀態(tài)影響著MHD患者生存質(zhì)量的多個(gè)領(lǐng)域,改善患者的營(yíng)養(yǎng)不良-炎癥狀態(tài)可提高患者的生存質(zhì)量；4.MIS得分與年齡、透析齡呈正相關(guān),與BMI呈負(fù)相關(guān),其中BMI對(duì)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(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R692.5

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本文編號(hào)：1896063