评价老年营养风险指数(the geriatric nutritional risk index，GNRI)的年度变化(ΔGNRI)与维持性血液透析(maintenance hemodialysis，MHD)患者全因死亡率之间的关系。方法 回顾性分析2010年10月～2013年7月在温州医科大学附属第二医院接受血液透析的398例老年患者的病例资料。采集患者的人口学和临床数据，计算患者基线期和1年后GNRI的变化差值(ΔGNRI)。将患者分为4组：第1组(G1)，GNRI ≥91.2且ΔGNRI≥0%；G2组：GNRI≥91.2且ΔGNRI＜0%；G3组：GNRI＜91.2和ΔGNRI≥0%；G4组：GNRI＜91.2且ΔGNRI＜0%。考察ΔGNRI和基线GNRI之间的相关性，分析各组患者的全因死亡率组间差异。多元COX回归模型计算各组死亡率的调整风险比(adjusted hazard ratio，aHR)和95% CI。结果 ΔGNRI中位数为0.16(0.07,0.46)。ΔGNRI与基线GNRI呈负相关(ρ=0.199， P =0.005)。中位随访3.7(1.9,6.9)年，期间共有108例患者死亡。基线GNRI＜91.2[aHR(95% CI):2.59(1.54～4.33)，P＜0.001]和ΔGNRI＜0%[aHR(95% CI):2.33(1.32～4.32)，P=0.003]是全因死亡率的独立预测因子。G1、G2、G3和G4组10年生存率分别为69.8%、43.2%、39.9%和19.2%(Log rank检验： χ2=18.654，P＜0.001)。以G1组为参照，G4组全因死亡率的aHR(95% CI)为3.88(1.62～9.48)， P=0.003。 结论 GNRI的年度变化与基线GNRI呈负相关，能较为准确预测MHD患者的全因死亡率。
bjective To evaluate the relationship between annual changes in geriatric nutritional risk index (ΔGNRI) and all-cause mortality and cardiovascular mortality in elderly patients undergoing maintenance hemodialysis (MHD). Methods A total of 398 elderly patients who received hemodialysis in our hospital from October 2010 to July 2013 were retrospectively analyzed. Demographic and clinical data of the patients were collected, and ΔGNRI was calculated from the difference between GNRI at baseline and the value after one year. Patients were then divided into four groups: G1 group, GNRI ≥91.2 and ΔGNRI ≥0%; G2 group: GNRI ≥91.2 and ΔGNRI < 0%; G3 group, GNRI ＜91.2 and ΔGNRI ≥0%; G4 group, GNRI ＜91.2 and ΔGNRI ＜0%. The correlation between ΔGNRI and baseline GNRI was examined. The differences in all-cause mortality and cardiovascular mortality among the four groups were analyzed. The adjusted hazard ratio (aHR) and 95% confidence interval (CI) of mortality were calculated by multivariate Cox regression model. Results The median ΔGNRI was 0.16 (0.07, 0.46). ΔGNRI was negatively correlated with baseline GNRI (ρ=0.199, P=0.005). During a follow-up period of 3.7 (1.9, 6.9) years, 108 patients died. Baseline GNRI < 91.2 [aHR 95% CI: 2.59 (1.54~4.33), P<0.001] and ΔGNRI < 0% [aHR 95% CI: 2.33 (1.32~4.32), P=0.003] were the independent predictors for all-cause mortality. The 10-year survival rates in G1, G2, G3 and G4 groups were 69.8%, 43.2%, 39.9% and 19.2%, respectively (log rank test: χ2=18.654, P<0.001). With G1 group as the reference, the aHR for all-cause mortality in G4 group was 3.88 (95% CI : 1.62~9.48, P=0.003). Conclusions Annual changes in GNRI (ΔGNRI) were negatively correlated with baseline, and can accurately predict all-cause mortality and cardiovascular mortality in MHD patients.
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