Tirmentajn-Janković Biserka, Dimković Nada
Odeljenje nefrologije i hemodijalize, Zdravstveni centar Zajecar, Zajecar.
Med Pregl. 2004 Sep-Oct;57(9-10):439-44. doi: 10.2298/mpns0410439t.
Protein-energy malnutrition is common in chronic hemodialysis patients and is strongly associated with increased morbidity and mortality. While determination of the nutritional status is often based on objective measurements such as biochemical parameters and anthropometric measurements, there is no single measurement that can reliably identify risk for malnutrition.
A subjective global assessment (SGA) was performed to evaluate the nutritional status in 43 chronic dialysis patients (27 men and 16 women). Anthropometric measurements including body weight (BW), body mass index (BMI), skin-fold thickness (triceps-TS, biceps-BS, subscapular-SSS, suprailiac-SIS), midarm circumference (MAC); mid-arm muscle circumference (MAMC); body fat percentage (%BF); total body fat (TBF); lean body mass (LBM) and laboratory parameters (total proteins, albumins, transferrin, hemoglobin, lymphocytes.
According to SGA, patients were divided into three groups: first group of 23 pts with a normal nutritional status, second group of 11 pts with mild malnutrition and third group of 9 pts with moderate or severe malnutrition. In examined groups there was a significant decrease in total protein (p = 0.02), serum albumin (p = 0.000) and hemoglobin (p = 0.04) levels with an increase in SGA scores (oneway ANOVA). In the same way, SGA was correlated with the number of anthropometric parameters (BW, BMI, TS, SSS, SIS, MAC, MAMC, % BF, TBF, LBM).
Our data confirmed a high prevalence of malnutrition in hemodialysis patients and showed that SGA closely correlated with more objective measures. Being an inexpensive method of well-proven realibility, SGA can be recommended for a more frequent assessment of nutritional status in dialysis patients.
蛋白质能量营养不良在慢性血液透析患者中很常见，并且与发病率和死亡率的增加密切相关。虽然营养状况的确定通常基于诸如生化参数和人体测量等客观测量，但没有单一的测量方法能够可靠地识别营养不良风险。
对43例慢性透析患者（27例男性和16例女性）进行主观全面评定（SGA）以评估营养状况。人体测量包括体重（BW）、体重指数（BMI）、皮褶厚度（肱三头肌TS、肱二头肌BS、肩胛下SSS、髂上SIS）、上臂围（MAC）；上臂肌肉围（MAMC）；体脂百分比（%BF）；全身脂肪（TBF）；瘦体重（LBM）以及实验室参数（总蛋白、白蛋白、转铁蛋白、血红蛋白、淋巴细胞）。
根据SGA，患者被分为三组：第一组23例营养状况正常，第二组11例轻度营养不良，第三组9例中度或重度营养不良。在各研究组中，随着SGA评分增加（单因素方差分析），总蛋白（p = 0.02）、血清白蛋白（p = 0.000）和血红蛋白（p = 0.04）水平显著降低。同样，SGA与多个人体测量参数（BW、BMI、TS、SSS、SIS、MAC、MAMC、%BF、TBF、LBM）相关。
我们的数据证实血液透析患者中营养不良的患病率很高，并且表明SGA与更客观的测量密切相关。作为一种经充分验证且可靠性良好的廉价方法，SGA可被推荐用于更频繁地评估透析患者的营养状况。
