修正簡易營養評估量表（MNA）以改善其評估血液透析患者營養風險之效能

Modifying the Short-form Mini-Nutritional Assessment to Improve the Prediction of Nutritional Risk in Patients on Hemodialysis

許智怡(Chih-Yi Hsu) ； 蔡仲弘(Alan C. Tsai)

《台灣公共衛生雜誌》 31卷2期 (2012/04) Pp. 176-183

https://doi.org/10.6288/TJPH2012-31-02-09

摘要

目標：改良MNA（Mini-Nutritional Assessment）使其更適用於血液透析（hemodialysis, HD）患者的營養評估。方法：本研究徵求中部某地區醫院門診洗腎中心血液透析患者100名（18－97歲，男43女57名）。經同意後，以短式及長式MNA－台灣二版評估營養狀況並與生化指標比較。MNA台灣二版為採用台灣老人體位指標的改良版。版本之修正以選擇較能反應HD病情的非短式題項（如O題）與較不反應HD病情的短式題項（如E題）互換題位，並檢定其改良成效。以Wilcoxon Signed-Rank Test進行事後檢定，比較短式MNA台灣二版各改良版本與長式MNA台灣二版的評估結果。以Pearson's相關分析長式及各短式MNA台灣二版的總分與血清白蛋白、血清肌酸酐、住院天數、及急診次數的相關性。結果：本研究發現短式MNA台灣二版用於評估血液透析病患時，以量表O題（自評營養狀況）取代（對換）E題（失智），最能改進評估功能，且其評估成果與長式MNA台灣二版相當一致。結論：本研究的結果顯示MNA量表以O題（自評營養狀況）取代（對換）E題（失智）或D題（精神壓力）最能改進其血液透析患者的評估功能。此簡單的改良，使短式MNA量表可適用於台灣的血液透析患者。

關鍵字

血液透析病患 ； 營養評估 ； 簡易營養評估量表

並列摘要

Objectives: To modify the Mini-Nutritional Assessment (MNA) so that it would be suitable for use in hemodialysis (HD) patients. Methods: Subjects were 100 HD outpatients (18-97 years of age, 43 men and 57 women) recruited from a district hospital in Central Taiwan. With their consent, we rated the nutritional status of each subject with the long-, short-, and modified short-form versions of the MNA and measured their biochemical values. We examined various alternative short-form versions of the MNA based on the dietary characteristics of HD patients. The study used the Wilcoxon Signed-Rank Test, Pearson's correlation analysis and the crosstabulation test to evaluate the ability of the short-form versions to predict the long-form MNA (T2). Results: Results showed that a modified short-form version that exchanged item O (selfrated nutritional status) for item E (dementia) improved the predictive ability of the MNA in HD patients. The modified short-form performed well compared to the long-form. Conclusions: The study demonstrated that replacing item O for E or D in the MNA can best improve the functionality of the MNA. This simple revision makes the short-form suitable for assessing the risk of malnutrition in patients on hemodialysis.

並列關鍵字

Hemodialysis patients ； Nutritional assessment ； Mini Nutritional Assessment

參考文獻

Cooper, B. A.,Penne, E. L.,Bartlett, L. H.,Pollock, C. A.(2004).Protein malnutrition and hypoalbuminemia as predictors of vascular events and mortality in ESRD.Am J Kidney Dis.43,61-6.

How, P. P.,Lau, A. H.(2004).Malnutrition in patients undergoing hemodialysis: is intradialytic parenteral nutrition the answer?.Pharmacotherapy.24,1748-58.

Foley, R. N.,Parfirey, P. S.,Harnett, J. D.,Kent, G. M.,Murray, D. C.,Barre, P.(1996).Hypoalbuminemia, cardiac morbidity, and mortality in end-stage renal disease.J Am Soc Nephrol.7,728-36.

Feroze, U.,Noori, N.,Kovesdy, C. P.(2011).Quality-of-life and mortality in hemodialysis patients: roles of race and nutritional status.Clin J Am Soc Nephrol.6,1100-11.

de Castro, M. C.,de Oliveira, F. C.,da Silveira, A. C.(2010).Importance of the monthly biochemical evuluation to identify patients on hemodialysis with malnutrition.J Bras Nefrol.32,349-54.