改進短式MNA量表以便有效的評估血液透析患者的營養風險

Modifying the Short-form Mini-Nutritional Assessment to Improve its Predictive Ability in Hemodialysis Patients

許智怡(HSU CHIH-YI)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2011年)

摘要

背景與目的：簡易營養評估量表(Mini-Nutritional Assessment, MNA)是一套廣效性的量表，但使用於血液透析患者時，因短式量表易低估營養不良的風險而使MNA的適用性受存疑。本研究的目的在改良MNA使其更適用於血液透析患者的營養評估。
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位；女57位)為實驗對象。經同意後，以長式、短式及改良的短式MNA評估營養狀況，並與生化指標比較。短式MNA的改良是依血液透析患者之飲食特性及MNA的完整性為考量，分析各量表組合後，如O題取代D題，並檢定其改良成效。以Wilconxon Signed-Rank Test進行事後檢定，比較改良MNA-T2-SF各版本與MNA-T2-LF的評佔成果。以Pearson相關性係數分析MNA-T2-LF、MNA-T2-SF原版及改良版本總分與血清白蛋白濃度之相關性。以MNA-T2-LF為標準分析MNA-SF各改良版本之敏感度(sensitivity)、特異度(specificity)及ㄧ致性(Kappa)。
結果：本研究發現，原台灣版MNA用於評估血液透析病患時短式MNA確實有低估營養不良的情形。但以O題(自評營養狀況)取代D題(精神壓力) 或以O題取代E題(失智) (即兩題位置互換)後，則可恢復其正常功能，且其評估成果與長式MNA相當一致。
結論：本研究的結果顯示各種量表的使用必需考量其適用性，如族群、場域、年齢、疾病等因素。此簡單的改良，將使MNA量表特別適用於血液透析病患。其功能良好又保持其原有的方便性。此改良版應用於慢性腎臟病(CKD)患者的可行性則尚待評估。

關鍵字

血液透析 ； 迷你營養評估量表 ； 營養風險

並列摘要

Background and Purpose: Malnutrition is common in patients on hemodialysis and routine monitoring of their nutritional status is important for preventing protein-calorie malnutrition in these patients. Although the Mini-Nutritional Assessment (MNA) is a multifunctional nutritional assessment scale, the short-form underestimates the risk of malnutrition when used in hemodialysis patients. The purpose of this study was to modify the MNA so that it would be suitable for use in hemodialysis patients.
Methods: Subjects were 100 hemodialysis outpatients (18-97 years, 43 men and 57 women) from a district hospital in Central Taiwan. After obtaining their consent, subjects were interviewed and rated with the long form-MNA, short form-MNA, and modified short-form MNA and determined for biochemical values. The modification was done on the basis of the dietary characteristics of hemodialysis patients. In order to maintain the integrity of MNA, the modification was limited to exchanging non-short-form items for short-form items. The ability of the short-form versions to predict the long-form MNA (T2) was tested with Wilconxon Signed-Rank Test, Pearson's correlation analysis and the cross-tabulation test.
Results: The study showed that the original short-form MNA did underestimate the risk of malnutrition in patients on hemodialysis. However, a modified short-form version by exchanging item O (self-rated nutritional status) for item D (stress) or item O for item E (dementia) restored its predictive ability. The modified short-form performed relatively well compared to the long-form MNA-T2.
Conclusions: Results suggest that a simple modification of the MNA can greatly improve the predictive ability of the scale in patients on hemodialysis. This modified short-form version should be useful for routine monitoring of nutritional risk of patients on hemodialysis. However, its applicability to patients on peritoneal dialysis and chronic kidney patients remains to be determined.

並列關鍵字

Hemodialysis patients ； Nutritional assessment ； Mini Nutritional Assessment

參考文獻

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