主觀性整體評估於血液透析患者營養狀態之應用

Application of Subjective Global Assessment for Nutritional Status of Hemodialysis Patients

本研究目的主要利用營養評估工具來評估營養狀態，且確認和透析病人營養不良的相關因子。以義大醫院的長期血液透析病患為受試者，共收案87位(男性51位、女性36位)，平均年齡59.55 ±11.87歲(28歲~80歲)。對這些受試者執行主觀性整體評估(subjective global assessment, SGA)、二十四小時飲食回憶記錄(24-hour dietary recall)、人體測量和血液生化檢驗。結果顯示，SGA 篩選出32.2%營養不良的病患(SGA ≤ 5分)，另外利用t檢定分析營養良好組與營養不良組在熱量及蛋白質攝取百分位的比較(91.24±20.51%、95.12±28.02% vs 71.71 ±19.25%、71.79±26.15%)具有明顯之差異(P < 0.05)。在年齡為57.61±11.74 vs 63.64±11.29；在人體測量學如乾體重(dry weight, DW)59.90±10.91 vs 53.31±9.09kg、身體質量指數(body mass index, BMI)23.19±3.32 vs 21.21 ±3.33、理想體重百分比(ideal body weight percentage, IBW%)105.37±15.10 vs 96.46±15.27%、中臂圍(mid-arm circumference, MAC)26.88±2.81 vs 25.17±3.26cm、中臂肌肉環圍(mid-arm muscle circumference, MAMC) 22.00±2.93 vs 20.62±2.61cm及血液生化數值如前白蛋白(pre-albumin, PA) 38.68±8.25 vs 31.49±10.52mg/dL、白蛋白(albumin, Alb)4.01±0.22 vs 3.85± 0.38g/dL、肌酸酐(creatinine, Cr)11.40±2.50 vs 9.16±2.54 mg/dL、C反應蛋白(C-reactive protein, CRP)6.85±9.92 vs 16.68±32.04 mg/L、尿酸(uric acid, UA)7.98±1.28 vs 7.09±1.63mg/dL、麩胺酸草醋酸轉移酶(glutamic oxaloacetic transaminase, GOT)21.59±11.84 vs 31.00±25.32 U/L方面，都有顯著性差異(P < 0.05)。另外以性別及年齡在人體測量學及血液生化數值的分析上，也都有不同的差異性。因此，本研究顯示SGA對於長期血液透析病患的營養評估，有相當顯著的價值。藉由各種營養檢測指標與SGA可提高評估病患在營養狀況測量結果的敏感性和專一性，能有效確認營養不良的狀態，並及時給予適當飲食調整與提供醫師治療之根據，以促進病患趨向健康。

The aims of this study were to evaluate nutritional status using variable methods, and to identify the risk factors associated with poor nutritional status in chronic hemodialysis patients. We included 87 hemodialysis patients (51 males and 36 females) from E-DA hospital, average age 59.55±11.87 years old (28~80 years old). We assessed dialysis patients’ nutritional status with subjective global assessment (SGA), 24-hour dietary recall, anthropometric measures and biochemical analysis. Using SGA assessment, 32.2 % patients showed malnutrition as SGA ≤ 5. Statistical analysis showed significant difference between good-nutrition and malnutrition patient groups in calorie and protein intake percentage (91.24±20.51%, 95.12±28.02% vs 71.71±19.25%, 71.79± 26.15%, P < 0.05). Moreover, significant difference also presented in dry weight (DW) 59.90±10.91 vs 53.31±9.09 kg, body mass index (BMI) 23.19± 3.32 vs 21.21±3.33, ideal body weight percentage (IBW%) 105.37±15.10 vs 96.46±15.27%, mid-arm circumference (MAC) 26.88±2.81 vs 25.17±3.26 cm, and mid-arm muscle circumference (MAMC) 22.00±2.93 vs 20.62±2.61 cm of anthropometric measures and pre-albumin (PA) 38.68±8.25 vs 31.49± 10.52 mg/dL. albumin (Alb) 4.01±0.22 vs 3.85±0.38 g/dL, creatinine (Cr) 11.40±2.50 vs 9.16±2.54 mg/dL, C-reactive protein (CRP) 6.85±9.92 vs 16.68±32.04 mg/L, uric acid (UA) 7.98±1.28 vs 7.09±1.63 mg/dL, and glutamic oxaloacetic transaminase (GOT) 21.59±11.84 vs 31.00±25.32 U/L of biochemical analysis. In addition, both gender and age had significant effects on anthropometric measures and biochemical analysis. In a word, our study demonstrated that SGA shows a significant role on nutritional assessment in chronic hemodialysis patients. Nutrition status measured by SGA and variable nutrition indexes can increase sensitivity and specificity to identify malnutrition. So, by providing these data, clinical doctors can do well and provide adequate diet, patients can thereby make better health.