微型营养评定简表在老年慢性肾脏病患者中的应用

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摘要目的探讨微型营养评定简表（MNA-SF）在评价老年慢性肾脏病（CKD）患者营养状况中的临床应用价值。方法选取2018年1月1日～12月31日湖南省株洲市中心医院收治的300 例老年CKD 患者作为研究对象，在入院后48 h 内用新版MNA-SF 评估患者的营养状态，按照MNA-SF 评分将患者分为营养正常组（n=87）、营养不良风险组（n=170）及营养不良组（n=43）。通过Cronbach′s α 系数评估MNA-SF 的信度；通过Kaiser-Meyer-Olkin（KMO）与巴特利特球形检验评估MNA-SF 各指标的相关性程度。比较三组患者的营养相关指标如血清清蛋白（ALB）、前清蛋白（PA）、转铁蛋白（TF）、血红蛋白（Hb）、血糖（Glu）和C-反应蛋白（CRP）等。通过受试者工作特征（ROC）曲线分析MNA-SF 评价营养状况的价值。结果内部一致性分析显示，MNA-SF 的Cronbach′s α 系数值为0.723>0.7，提示MNA-SF 的信度较好。通过KMO 与巴特利特球形检验，KMO=0.819>0.5，能够进行因子分析；巴特利特球形检验χ2=26.439（P<0.05），表明球形假设被拒绝，各个指标间并不是独立的，而是有一定的相关性，适合采用因子分析。在MNA-SF 中有7 个因子[近90 d 的饮食变化、活动能力、神经精神疾病、体重减轻情况、体重指数（BMI）、小腿围（CC）、应激或急性疾病情况]的特征值均>1，累计方差贡献率84.07%，提示该量表的结构较为合理。老年CKD 患者中营养不良发生率为14.33%（43/300）。营养不良风险组及营养不良组患者的年龄大于营养正常组，男性比例高于营养正常组，差异有统计学意义（P<0.05）。营养不良风险组及营养不良组患者的BMI、CC、ALB、PA、TF 及Hb 均低于正常组，差异有统计学意义（P<0.05）。三组患者的Glu 和CRP 比较，差异无统计学意义（P>0.05）。结论 MNA-SF 的信、效度均较好，可作为临床上评估老年CKD 患者营养状态的工具，对其早期营养代谢干预的改善预后具有积极的临床意义。

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	黎碧辉

关键词 ：微型营养评定简表, 老年慢性肾脏病, 营养状态, Cronbach&prime, s &alpha, 系数

Abstract：Objective To explore the clinical application value of mini nutrition assessment short form (MNA-SF) in evaluating the nutritional status of elderly patients with chronic kidney disease (CKD). Methods A total of 300 elderly patients with CKD who were admitted to Zhuzhou Central Hospital of Hu′nan Province from January 1 to December 31,2018 were selected as the research objects and the nutritional status of the patients was evaluated by the new MNA-SF within 48 hours after admission. The patients were divided into the normal nutrition group (n=87), malnutrition risk group (n=170) and malnutrition group (n=43) according to the MNA-SF score. The reliability of MNA-SF was evaluated by Cronbach′s α coefficient, and the degree of correlation of each index of MNA-SF was evaluated by Kaiser Meyer Olkin (KMO) and Bartlett spherical test. Nutrition-related indicators such as serum albumin (ALB), prealbumin (PA),transferrin (TF), hemoglobin (Hb), glucose (Glu), and C-reactive protein (CRP) were compared among the three groups.The value of MNA-SF in assessing nutritional status was analyzed using the receiver operating characteristic (ROC)curve. The internal consistency analysis of MNA-SF showed that the Cronbach′s α coefficient of MNA-SF was 0.723>0.7, which indicated that MNA-SF had a stable reliability. The KMO and Bartlett spherical test showed that KMO=0.819>0.5, indicated that the factor analysis could be carried out. Bartlett spherical test χ2=26.439 (P<0.05), indicated that the spherical hypothesis was rejected, and each index was not independent, and had a certain correlation, which was suitable for factor analysis. The characteristic values of 7 factors in MNA-SF (diet change, activity ability, neuropsychiatric disease, body mass reduction, body mass index [BMI], calf circumference [CC], stress or acute disease)were >1, and the contribution rate of cumulative variance was 84.07%, showed that the structure of MNA-SF was reasonable. The incidence of malnutrition in elderly patients with CKD was 14.33% (43/300). The age of patients in the malnutrition risk group and the malnutrition group was higher than that in the normal nutrition group, and the proportion of males was higher than that in the normal nutrition group, and the differences were statistically significant(P<0.05). BMI, CC, ALB, PA, TF and Hb in the risk group and the malnutrition group were lower than those in the normal group, and the differences were statistically significant (P<0.05). There were no statistically significant differences in Glu and CRP among the three groups (P>0.05). Conclusion MNA-SF has stable reliability and validity. It can be used as a tool to evaluate the nutritional status of elderly CKD patients, and has positive clinical significance for improving the prognosis of early nutritional metabolism intervention.

Key words： Mini nutrition assessment short form Chronic kidney disease of the elderly Nutritional status Cronbach′s &alpha coefficient

作者简介: 黎碧辉（1982-），女，湖南长沙人，硕士，主治医师，主要从事肾小球及血液净化方面的研究

引用本文:

黎碧辉. 微型营养评定简表在老年慢性肾脏病患者中的应用[J]. 中国当代医药, 2021, 28(3): 119-122.
LI Bi-hui. Application of mini nutrition assessment short form in the elderly patients with chronic kidney disease. 中国当代医药, 2021, 28(3): 119-122.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I3/119

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