「簡易營養評估量表」與「萬用營養不良篩選工具」篩選台灣血液透析病患營養不良之功能

目的－本研究的目的在探討台灣修訂版MNA (Mini-Nutritional Assessment) 與MUST (Malnutrition Universal Screening Tool) 運用於評估血液透析(hemodialysis, HD) 病患營養不良篩選的功能，並分析影響營養不良之預測因子。方法－本研究採立意取樣，對中部某醫院門診HD病患共152名(男78位；女74位)病患進行問卷訪談，體位測量及生化檢測。以SGA (Subjective Global Assessment) 量表及血清白蛋白與透析前肌酸酐為標準，比較台灣修訂一版(MNAT-T1) 及修訂二版(MNA-T2) 長式(LF) 及短式(SF) MNA與MUST兩量表的評估功能。以SPSS/Window12.0 統計軟體分析資料。以Friedman Test及Wilcoxon Signed-Rank Test分析兩量表評估結果之差異性，以Spearman’s correlation與cross- tabulation test比較量表之功能，以複回歸(Multiple Regression) 分析影響營養狀況的因素。結果－MNA-LF兩台灣修訂本(T1及T2) 分別判定40.8%及36.2%的個案有營養不良或具營養風險，MNA-SF則分別判定32.2%及24.3% ，MUST則分別判定20.3%及18.4%，SGA則判定47.4%的個案營養不良或具營養風險。MNA-LF兩版本與SGA評估結果之一致性分別為0.734及0.666，MNA-SF則分別為0.450及0.446，MUST則分別為0.172 (p<0.01)及0.265(其他皆p<0.001)。MNA-LF兩版本與白蛋白之一致性分別為0.450及0.479，MNA-SF則分別為0.267及0.356，MUST則分別為0.250及0.319，SGA則為0.414(皆p<0.001)。MNA-LF兩版本與肌酸酐之一致性分別為0.389及0.380，MNA-SF則分別為0.306及0.262，MUST則分別為0.088 (p>0.05)及0.179 (p<0.01)，SGA則為0.462(其他皆p<0.001)。複迴歸分析發現日常生活活動功能、規律運動、透析血流速、血清白蛋白、透析前肌酸酐皆為營養不良的預測因子。結論－本研究發現不論是以SGA或以生化指標為標準，MNA-LF兩台灣修訂版本，皆比同樣修訂的兩MUST版本更適用於評估台灣HD病患的營養不良風險。但，MNA-SF評估功能則明顯不如MNA-LF。因此本研究建議在未再加以修正之前，不宜以MNA-SF或MUST評估HD病患的營養狀況。而MNA-LF修訂二以小腿圍取代BMI也能有效判別HD病患的營養風險。此一修訂可以不必為了計算BMI值而測量個案之身高及體重，有助於提升護理人員工作效率及節省醫療成本，也能改善HD病患的生活品質，亦值得國內推展。

關鍵字

營養評估量表；營養狀況；血液透析病患；營養風險

並列摘要

Objective - The objective of this study was to determine the ability of the long-form (LF) and short-form (SF) of the MNA (Mini-Nutritional Assessment) Taiwan versions (T1 & T2) and the MUST (Malnutrition Universal Screening Tool) versions in assessing the nutritional status of patients on hemodialysis (HD) in Taiwan. Methods - Subjects of this study were 152 hemodialysis out-patients (78 men and 74 women) of a teaching hospital in Central Taiwan. The study included a structured questionnaire interview, anthropometric measurements and biochemical tests. The questionnaire included questions to elicit personal data and answers to the MNA, the MUST and the SGA (Subjective Global Assessment) scales. Results were analyzed wtih SPSS/Window12.0 Statistical software. Friedman Test and Wilcoxon Signed-Rank Test were used to determine the significance of results. Results - The two MNA-LF versions (T1 and T2) rated 40.8% and 36.2% of subjects malnourished or at risk of malnutrition, resspepctively; the two MNA-SF versions rated 32.2% and 24.3% at risk of malnutrition; the two MUST versions rated 20.3% and 18.4%, respectively whereas the SGA rated 47.4%. Using results rated with the SGA as the reference, the two MNA-LF versions had kappa =0.734 and 0.666, repectively; the two MNA-SF versions, 0.450 and 0.446; and the two MUST versions, 0.172 and 0.265, respectively. When serum albumin was the reference, the two MNA-LF versions had kappa=0.450 and 0.479; the two MNA-SF versions, 0.267 and 0.356; the two MUST versions, 0.250 and 0.319 and the SGA, 0.414. When serum creatinine was the reference, the MNA-LF had kappa=0.389 and 0.380; the two MNA-SF versions, 0.306 and 0.2620; the two MUST versions, 0.088 and 0.179; and the SGA 0.462. Conclusion - Results indicate that among the scales examined, both versions of the MNA-LF have the best ability in predicting the risk of malnutrion in Taiwanese patients on hemodialysis. The MNA-SF underrates the risk of malnutrition in these patients. Therefore, the MNA-SF should not be used for evaluating nutritional risk of patients on hemodialysis until the scale is further modified and validated.

並列關鍵字

nutritional assessment scale ； nutritional status ； hemodialysis patients ； nutritional risk

參考文獻

黃淑麗、楊忠煒(2004 )．長時期常規血液透析對尿毒症病患營養狀況的影響．健康管理學刊，2 (2)，201－208。

董萃英(2006)．血液透析患者之營養評估．台灣腎臟護理學會雜誌， 5 (1)，1-11。

Tsai, A. C., Ho, C. S., & Chang, M. C. (2007). Population-specific

Daugirdas, J. T., Blake, P. G., & Ing, T. S. (2001). Handbook of Dialysis, Philadelphia：Lippincott Williams and Wilkins.

Allison, S. P. (2000). Malnutrition, disease, and outcome. Nutrition, 16, 590-593.

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「簡易營養評估量表」與「萬用營養不良篩選工具」篩選台灣血液透析病患營養不良之功能

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