新進血液透析病人接受營養諮詢後營養不良發炎分數之改變

Changes in the Malnutrition-Inflammation Score in Patients New to Hemodialysis After Nutrition Counseling

劉欣怡(Hsin-Yi Liu) ； 張書華(Shu-Hua Chang)

《臺灣膳食營養學雜誌》 11卷2期 (2019/12) Pp. 15-26

https://doi.org/10.6709/TJD.201912_11(2).0002

摘要

營養不良與發炎反應常見於長期血液透析（maintenance hemodialysis, MHD）的病人。營養不良與發炎反應並存下會引發營養不良與發炎綜合症候群（malnutrition-inflammation complex syndrome, MICS），MHD病人如發生MICS，可能導致死亡率提高，應及早診斷並給予營養介入以避免營養狀況持續惡化。本研究目的為探討新進MHD病人經過營養師諮詢2次並給予衛教，評估其營養不良發炎分數（malnutrition-inflammation score, MIS）、體位、血液生化指標及飲食攝取量在接受衛教後之改變。研究結果發現營養諮詢與衛教後，病人之熱量（1490.4 ± 396.1 vs. 1739.4 ± 326.4 kcal, p ＜ 0.001）與蛋白質攝取量（58.4 ±20.6 vs. 72.6 ± 15.3 g, p ＜ 0.001）、血清白蛋白濃度（3.5 ± 0.5 vs. 3.8 ± 0.4 g/dL,p ＜ 0.001）、血色素（9.0 ± 1.2 vs. 10.1 ± 0.9 g/dL, p ＜ 0.001）與血比容（28.0 ± 3.4 vs. 31.0 ± 2.5%, p ＜ 0.001）均顯著提升，MIS分數亦顯著降低（3.8 ± 2.1 vs. 2.6 ± 1.9, p ＜ 0.001）。受試者營養介入前、後之體位、血液鈣、鉀、磷、三酸甘油酯、總膽固醇、尿酸皆維持在正常濃度。除常規的血液生化值檢驗外，應定期營養評估，而MIS應可作為MHD病人定期營養評估的良好工具之一，用以監測MHD病人營養狀況，必要時立即給予營養介入。

關鍵字

血液透析 ； 營養不良發炎分數 ； 營養諮詢

並列摘要

Malnutrition and inflammation are common in patients on maintenance hemodialysis (MHD). Malnutrition and inflammation can cause malnutrition-inflammation complex syndrome (MICS). MICS in patients on MHD may lead to increased mortality. Early diagnosis and nutritional intervention should be emphasized to avoid continued deterioration of nutritional status. The purpose of this study was to investigate changes in the malnutrition-inflammation score (MIS), dietary records, and blood-biochemistry values of patients new to hemodialysis who had consulted with dieticians twice and received counseling. The results revealed that after nutrition counseling, the patients' calories (1490.4 ± 396.1 vs. 1739.4 ± 326.4 kcal, p ＜ 0.001), protein intake (58.4 ± 20.6 vs. 72.6 ± 15.3 g, p ＜ 0.001), serum albumin concentration (3.5 ± 0.5 vs. 3.8 ± 0.4 g/dL, p ＜ 0.001), hemoglobin (9.0 ± 1.2 vs. 10.1 ± 0.9 g/dL, p ＜ 0.001), and hematocrit (28.0 ± 3.4 vs. 31.0 ± 2.5%, p ＜ 0.001) were significantly increased. Additionally, the patients' MIS was significantly reduced (3.8 ± 2.1 vs. 2.6 ± 1.9, p ＜ 0.001). The blood calcium, potassium, phosphorus, triglycerides, total cholesterol, and uric acid levels were maintained at normal concentrations before and after nutrition counseling. In addition to routine blood biochemical tests, regular nutritional assessment should be conducted on patients on MHD. Moreover, the MIS is a suitable tool for the regular nutritional assessment of patients on MHD to monitor their nutritional status and provide immediate nutritional intervention if necessary.

並列關鍵字

hemodialysis ； malnutrition-inflammation score ； nutrition counseling