耐药肺结核患者的营养状况调查及影响因素分析:一项多中心、大样本研究

doi:10.19982/j.issn.1000-6621.20230047

中国防痨杂志 ›› 2023, Vol. 45 ›› Issue (9): 826-832.doi: 10.19982/j.issn.1000-6621.20230047

耐药肺结核患者的营养状况调查及影响因素分析:一项多中心、大样本研究

丁芹¹, 张胜康², 任斐³, 陈晓红⁴, 胡春梅⁵, 陈薇¹(), 范琳⁶()

¹同济大学附属上海市肺科医院营养科,上海 200433
²湖南省胸科医院营养科,长沙 410013
³西安市胸科医院耐药结核科,西安 710061
⁴福州肺科医院结核科,福州 350008
⁵南京市第二医院结核科,南京 210003
⁶同济大学附属上海市肺科医院结核科/上海市结核病临床研究中心/上海市结核(肺)重点实验室,上海 200433

收稿日期:2023-02-27 出版日期:2023-09-10 发布日期:2023-09-01
通信作者: 范琳,Email:fanlinsj@163.com;陈薇,Email:niuangel@sina.com
基金资助:
国家自然科学基金(82170006);上海市科委基金(21Y11901000);上海市科委基金(20ZR1446700);上海市肺科医院临床研究基金(FKLY20017);上海市肺科医院临床研究基金(SKPY2021003)

Nutritional status of drug-resistant pulmonary tuberculosis patients and the influencing factors: a multi-center, large-sample study

Ding Qin¹, Zhang Shengkang², Ren Fei³, Chen Xiaohong⁴, Hu Chunmei⁵, Chen Wei¹(), Fan Lin⁶()

¹Department of Nutrition, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai 200433, China
²Department of Nutrition, Hunan Chest Hospital, Changsha 410013, China
³Department of Drug-resistance Tuberculosis, Xi’an Chest Hospital, Xi’an 710061, China
⁴Department of Tuberculosis, Fuzhou Pulmonary Hospital, Fuzhou 350008, China
⁵Department of Tuberculosis, the Second Hospital of Nanjing, Nanjing 210003, China
⁶Department of Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University/Shanghai Tuberculosis Clinical Research Center/Shanghai Key Laboratory of Tuberculosis (Lung), Shanghai 200433, China

Received:2023-02-27 Online:2023-09-10 Published:2023-09-01
Contact: Fan Lin, Email: fanlinsj@163.com;Chen Wei, Email: niuangel@sina.com
Supported by:
National Natural Science Foundation of China(82170006);Shanghai Science and Technology Committee Fund(21Y11901000);Shanghai Science and Technology Committee Fund(20ZR1446700);Clinical Research Foundation of Shanghai Pulmonary Hospital(FKLY20017);Clinical Research Foundation of Shanghai Pulmonary Hospital(SKPY2021003)

摘要/Abstract

摘要：

目的: 调查耐药肺结核患者的营养状况并分析其影响因素。方法: 采用回顾性研究方法,于2020年1月1日至2021年12月31日搜集中国17个省和2个直辖市共29家结核病专科医院的耐药肺结核患者作为研究对象,最终纳入1766例,年龄范围为18~90岁,平均年龄为(45.88±16.43)岁;平均体质量指数(body mass index,BMI)为20.03±3.25;其中,男性1255例(71.06%),女性511例(28.94%)。收集研究对象的人口学信息及临床特征资料;使用营养风险筛查简表(NRS-2002)评估研究对象是否存在营养风险,进一步的营养不良的评估及诊断参照全球营养不良领导倡议标准(global leadership initiative on malnutrition,GLIM)进行。采用多因素logistic回归分析耐药肺结核患者发生营养风险的影响因素。结果: 1766例研究对象NRS-2002评分波动于1~5分,得分中位数(四分位数)为3(1~4)分;共1103例(62.46%)研究对象存在营养风险(NRS-2002≥3分)。NRS-2002评分≥3分组中,60~79岁者占70.56%(254/360),≥80岁者占83.33%(25/30),BMI<18.5者占100.0%(602/602),均明显高于NRS-2002评分<3分组[分别占29.44%(106/360)、16.67%(5/30)、0],差异均有统计学意义(χ²值分别为6.256和1345.000,P值分别为0.012和<0.01)。多因素logistic回归分析显示,高龄(≥60岁)[以18~39岁组为参照,60~79岁组:OR(95%CI)=2.130(1.194~3.803);≥80岁组:OR(95%CI)=12.400(3.114~49.369)]和低BMI[以BMI≥20.5者为参照,BMI<18.5者:OR(95%CI)=56.937(26.537~122.161)]是耐药肺结核患者发生营养风险的危险因素。研究对象营养不良发生率为52.55%(928/1766),1103例存在营养风险者中,营养不良发生率为84.13%(928/1103)。结论: 耐药肺结核患者存在较高的营养风险,营养不良发生率较高,应对此类患者尽早行规范的营养风险筛查及营养不良的诊断,尤其关注高龄及低BMI患者。

关键词: 结核,肺, 抗药性, 营养状况, 营养不良, 回顾性研究

Abstract:

Objective: To investigate the nutritional status of drug-resistant pulmonary tuberculosis patients and analyze the influencing factors. Methods: A retrospective study was conducted in 1766 drug-resistant pulmonary tuberculosis patients from 29 tuberculosis specialized hospitals in 17 provinces and 2 municipalities of China from January 1, 2020 to December 31, 2021. The age range of the patients was 18 to 90 years with the average age of (45.88±16.43) years, and the average body mass index (BMI) was 20.03±3.25. Among them, 1255 were male (71.06%) and 511 were female (28.94%). Demography information and clinical characteristics of the subjects were collected. The Nutritional Risk Screening-2002 (NRS-2002) was used to assess whether the subjects were at nutritional risk. Further assessment and diagnosis of malnutrition were conducted in accordance with the Global Leadership Initiative on Malnutrition (GLIM) standards. Multivariate logistic regression analysis was used to investigate the influencing factors of nutritional risk in drug-resistant pulmonary tuberculosis patients. Results: The NRS-2002 score of 1766 subjects fluctuated from 1 to 5, and the median score (Quartile) was 3 (1 to 4) points. A total of 1103 cases (62.46%) of the subjects had nutritional risks (NRS-2002 score ≥3 points). In the NRS-2002 score ≥3 group, 70.56% (254/360) of the patients aged 60-79 years old, 83.33% (25/30) aged ≥80 years old, and BMI of all the patients (100.0% (602/602)) <18.5, which were significantly higher than those in the NRS-2002 score <3 group (accounted for 29.44% (106/360), 16.67% (5/30), and 0, respectively)(χ² values were 6.256 and 1345.000, respectively; P values were 0.012 and <0.01). Multivariate logistic regression analysis showed that older age (with 18-39 years old group as reference, 60-79 years old group: OR (95%CI)=2.130 (1.194-3.803); ≥80 years old group: OR (95%CI)=12.400 (3.114-49.369)) and lower BMI (with BMI ≥20.5 as reference, BMI <18.5: OR (95%CI)=56.937 (26.537-122.161)) were risk factors for nutritional risk in drug-resistant pulmonary tuberculosis patients. The incidence of malnutrition among the study subjects was 52.55% (928/1766). Among 1103 individuals at risk for nutrition, the incidence of malnutrition was 84.13% (928/1103). Conclusion: Drug-resistant pulmonary tuberculosis patients have a higher nutritional risk and a higher incidence of malnutrition. Therefore, it is necessary to conduct standardized nutritional risk screening and diagnosis of malnutrition for such patients as early as possible, with special attention paid to elder and low BMI patients.

Key words: Tuberculosis, pulmonary, Drug resistance, Nutritional status, Malnutrition, Retrospective studies

中图分类号:

R52
R825.2

丁芹, 张胜康, 任斐, 陈晓红, 胡春梅, 陈薇, 范琳. 耐药肺结核患者的营养状况调查及影响因素分析:一项多中心、大样本研究[J]. 中国防痨杂志, 2023, 45(9): 826-832. doi: 10.19982/j.issn.1000-6621.20230047

Ding Qin, Zhang Shengkang, Ren Fei, Chen Xiaohong, Hu Chunmei, Chen Wei, Fan Lin. Nutritional status of drug-resistant pulmonary tuberculosis patients and the influencing factors: a multi-center, large-sample study[J]. Chinese Journal of Antituberculosis, 2023, 45(9): 826-832. doi: 10.19982/j.issn.1000-6621.20230047

图/表 3

表1

耐药肺结核患者营养风险筛查评分影响因素的单因素分析

因素		例数	NRS-2002评分≥3分	NRS-2002评分<3分	χ²值		P值
性别[例(构成比,%)]					0.918		0.338
男性		1255	775(61.75)	480(38.25)
女性		511	328(64.19)	183(35.81)
年龄组[例(构成比,%)]					6.256		0.012
18~39岁		674	422(62.61)	252(37.39)
40~59岁		702	401(57.12)	301(42.88)
60~79岁		360	254(70.56)	106(29.44)
≥80岁		30	25(83.33)	5(16.67)
体质量指数[例(构成比,%)]					1345.000		<0.01
<18.5		602	602(100.00)	0(0.00)
18.5~<20.5		405	400(98.77)	5(1.23)
≥20.5		759	109(14.36)	650(85.64)
耐药类型[例(构成比,%)]					0.572		0.903
单耐药		647	410(63.37)	237(36.63)
耐多药		897	558(62.21)	339(37.79)
多耐药		133	80(60.15)	53(39.85)
广泛耐药		89	55(61.80)	34(38.20)
糖尿病[例(构成比,%)]					33.190		<0.01
有		345	169(48.99)	176(51.01)
无		1421	934(65.73)	487(34.27)
脑血管意外[例(构成比,%)]					2.149		0.143
有		8	7(7/8)	1(1/8)
无		1758	1096(62.34)	662(37.66)
恶性肿瘤[例(构成比,%)]					2.149		0.143
有		8	7(7/8)	1(1/8)
无		1758	1096(62.34)	662(37.66)
重症肺炎[例(构成比,%)]					8.169		0.004
有		27	24(88.89)	3(11.11)
无		1739	1079(62.05)	660(37.95)
免疫抑制[例(构成比,%)]					1.621		0.203
有		7	6(6/7)	1(1/7)
无		1759	1097(62.36)	662(37.64)
其他肺部慢性疾病[例(构成比,%)]^a					13.730		<0.01
有		187	140(74.87)	47(25.13)
无		1579	963(60.99)	616(39.01)
治疗分类[例(构成比,%)]					9.260		0.002
初治		705	410(58.16)	295(41.84)
复治		1061	693(65.32)	368(34.68)
肺野受累[例(构成比,%)]						6.435	0.011
是	1077		687(63.79)	390(36.21)
否	689		398(57.76)	291(42.24)
受累肺野面积[例(构成比,%)]						10.040	0.002
≥50%	566		386(68.20)	180(31.80)
<50%	511		301(58.90)	210(41.10)
空洞[例(构成比,%)]						6.799	0.009
有	827		543(65.66)	284(34.34)
无	939		560(59.64)	379(40.36)
空洞直径[例(构成比,%)]						0.380	0.538
≥3cm	171		111(64.91)	60(35.09)
<3cm	616		384(62.34)	232(37.66)
空洞个数[例(构成比,%)]						2.018	0.156
≥3个	347		230(66.28)	117(33.72)
<3个	1214		754(62.11)	460(37.89)

表1

表2

表3

耐药肺结核患者发生营养风险影响因素的多因素logistic回归分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
合并糖尿病	0.204	0.262	0.376	0.471	1.082(0.684~1.737)
合并其他肺部慢性疾病	0.098	0.331	0.088	0.766	1.103(0.576~2.113)
合并重症肺炎	0.496	1.113	0.199	0.656	1.642(0.185~14.547)
受累肺野	0.128	0.227	0.317	0.573	1.136(0.729~1.772)
有空洞	0.392	0.207	3.597	0.058	1.480(0.987~2.219)
复治	0.126	0.204	0.325	0.569	1.123(0.753~1.676)
年龄(以18~39岁为参照)
40~59岁	0.518	1.265	3.202	0.074	0.104(0.075~1.167)
60~79岁	0.756	0.296	6.545	0.011	2.130(1.194~3.803)
≥80岁	2.518	0.705	12.756	0.000	12.400(3.114~49.369)
体质量指数(以≥20.5为参照)
<18.5	6.345	0.389	26.534	0.000	56.937(26.537~122.161)
18.5~20.5	0.075	0.083	0.814	0.367	1.078(0.916~1.270)

表3

参考文献 23

[1]	Günther G, Ruswa N, Keller PM. Drug-resistant tuberculosis: advances in diagnosis and management. Curr Opin Pulm Med, 2022, 28(3): 211-217. doi:10.1097/MCP.0000000000000866. doi: 10.1097/MCP.0000000000000866 pmid: 35220372
[2]	Bagcchi S. WHO’s Global Tuberculosis Report 2022. Lancet Microbe, 2023, 4(1):e20. doi:10.1016/S2666-5247(22)00359-7. doi: 10.1016/S2666-5247(22)00359-7 URL
[3]	丁芹, 顾颖, 戚之燕, 等. 耐药肺结核患者营养状况调查及其对免疫指标的影响. 营养学报, 2021, 43(6):619-621. doi:10.3969/j.issn.0512-7955.2021.06.019. doi: 10.3969/j.issn.0512-7955.2021.06.019
[4]	许静涌, 杨剑, 康维明, 等. 营养风险及营养风险筛查工具营养风险筛查2002临床应用专家共识(2018版). 中华临床营养杂志, 2018, 26(3): 131-135. doi:10.3760/cma.j.issn.1674-635X.2018.03.001. doi: 10.3760/cma.j.issn.1674-635X.2018.03.001
[5]	Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition-A consensus report from the global clinical nutrition community. Clin Nutr, 2019, 38(1): 1-9. doi:10.1016/j.clnu.2018.08.002. doi: S0261-5614(18)31344-X pmid: 30181091
[6]	Correia MITD, Tappenden KA, Malone A, et al. Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review. Clin Nutr, 2022, 41(3):687-697. doi:10.1016/j.clnu.2022.01.018. doi: 10.1016/j.clnu.2022.01.018 pmid: 35151125
[7]	Mirzayev F, Viney K, Linh NN, et al. World Health Organization recommendations on the treatment of drug-resistant tuberculosis, 2020 update. Eur Respir J, 2021, 57 (6): 2003300. doi:10.1183/13993003.03300-2020. doi: 10.1183/13993003.03300-2020 URL
[8]	Chakaya J, Khan M, Ntoumi F, et al. Global Tuberculosis Report 2020-Reflections on the Global TB burden, treatment and prevention efforts. Int J Infect Dis, 2021, 113 Suppl 1 (Suppl 1): S7-S12. doi:10.1016/j.ijid.2021.02.107. doi: 10.1016/j.ijid.2021.02.107
[9]	Miyata S, Tanaka M, Ihaku D. The prognostic significance of nutritional status using malnutrition universal screening tool in patients with pulmonary tuberculosis. Nutr J, 2013, 12: 42. doi:10.1186/1475-2891-12-42. doi: 10.1186/1475-2891-12-42 pmid: 23565890
[10]	谢雯霓, 邓国防, 施汶言, 等. 肺结核患者营养风险和营养指标相关性分析. 新医学, 2018, 49(10):740-744. doi:10.3969/j.issn.0253-9802.2018.10.010. doi: 10.3969/j.issn.0253-9802.2018.10.010
[11]	陈薇, 丁芹, 顾颖, 等. 上海市900例老年住院结核病患者营养状况调查分析. 中国防痨杂志, 2020, 42(7):725-730. doi:10.3969/j.issn.1000-6621.2020.07.015. doi: 10.3969/j.issn.1000-6621.2020.07.015
[12]	吴世幸, 吴桂辉, 彭晓莉, 等. 成都市公共卫生临床医疗中心129例耐药结核病成年住院患者营养不良的危险因素. 临床肺科杂志, 2022, 27(2): 230-236. doi:10.3969/j.issn.1009-6663.2022.02.015. doi: 10.3969/j.issn.1009-6663.2022.02.015
[13]	Khawbung JL, Nath D, Chakraborty S. Drug resistant Tuberculosis: A review. Comp Immunol Microbiol Infect Dis, 2021, 74:101574. doi:10.1016/j.cimid.2020.101574. doi: 10.1016/j.cimid.2020.101574 URL
[14]	Chandrasekaran P, Saravanan N, Bethunaickan R, et al. Malnutrition: Modulator of Immune Responses in Tuberculosis. Front Immunol, 2017, 8:1316. doi:10.3389/fimmu.2017.01316. doi: 10.3389/fimmu.2017.01316 pmid: 29093710
[15]	Chopra KK, Matta S, Arora VK. Drug resistant tuberculosis among elderly: Challenges. Indian J Tuberc, 2022, 69 Suppl 2: S202-S204.doi:10.1016/j.ijtb.2022.10.022. doi: 10.1016/j.ijtb.2022.10.022 URL
[16]	Reber E, Gomes F, Vasiloglou MF, et al. Nutritional Risk Screening and Assessment. J Clin Med, 2019, 8(7): 1065. doi:10.3390/jcm8071065. doi: 10.3390/jcm8071065 URL
[17]	Frediani JK, Sanikidze E, Kipiani M, et al. Macronutrient intake and body composition changes during anti-tuberculosis therapy in adults. Clin Nutr, 2016, 35(1):205-212. doi:10.1016/j.clnu.2015.02.007. doi: S0261-5614(15)00050-3 pmid: 25753551
[18]	Kant S, Gupta H, Ahluwalia S. Significance of nutrition in pulmonary tuberculosis. Crit Rev Food Sci Nutr, 2015, 55(7):955-963. doi:10.1080/10408398.2012.679500. doi: 10.1080/10408398.2012.679500 pmid: 24915351
[19]	Nobs SP, Zmora N, Elinav E. Nutrition Regulates Innate Immunity in Health and Disease. Annu Rev Nutr, 2020, 40:189-219. doi:10.1146/annurev-nutr-120919-094440. doi: 10.1146/annurev-nutr-120919-094440 pmid: 32520640
[20]	阮晓莉, Rena Nakyeyune, 沈艺, 等. 结直肠癌患者营养相关症状与GLIM和生活质量的相关性研究. 肿瘤代谢与营养电子杂志, 2022, 9(1):39-48.
[21]	李文成, 张帆, 牛励, 等. GLIM在胃癌病人营养不良诊断和预后评估中的价值研究及生存预测列线图模型的构建. 肠外与肠内营养, 2021, 28(6):324-331. doi:10.16151/j.1007-810x.2021.06.002. doi: 10.16151/j.1007-810x.2021.06.002
[22]	Huo Z, Chong F, Yin L, et al. Accuracy of the GLIM criteria for diagnosing malnutrition: A systematic review and meta-analysis. Clin Nutr, 2022, 41(6):1208-1217. doi:10.1016/j.clnu.2022.04.005. doi: 10.1016/j.clnu.2022.04.005 pmid: 35504163
[23]	Barazzoni R, Jensen GL, Correia MITD, et al. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition. Clin Nutr, 2022, 41(6):1425-1433. doi:10.1016/j.clnu.2022.02.001. doi: 10.1016/j.clnu.2022.02.001 pmid: 35450768

变量	赋值	变量	赋值
因变量		糖尿病	无=0;有=1
营养风险评分	NRS-2002评分≥3分=1;NRS-2002评分<3分=0	重症肺炎	无=0;有=1
自变量		其他肺部慢性疾病	无=0;有=1
年龄组	18~39岁=0;40~59岁=1;60~79岁=2;≥80岁=3	复治	否=0;是=1
年龄组	18~39岁=0;40~59岁=1;60~79岁=2;≥80岁=3	肺野受累	否=0;是=1
体质量指数	≥20.5=0;18.5~<20.5=1;<18.5=2	空洞	无=0;有=1

耐药肺结核患者的营养状况调查及影响因素分析:一项多中心、大样本研究

Nutritional status of drug-resistant pulmonary tuberculosis patients and the influencing factors: a multi-center, large-sample study

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 23

相关文章 15

编辑推荐

Metrics

本文评价

友情链接

[1]	范琳. 营养治疗:结核病化学治疗最重要的辅助治疗方法之一[J]. 中国防痨杂志, 2023, 45(9): 823-825.
[2]	丁芹, 陈薇, 张胜康, 任斐, 陈晓红, 胡春梅, 陈丹萍, 范琳. 肺外结核患者的营养状况调查及影响因素分析[J]. 中国防痨杂志, 2023, 45(9): 839-844.
[3]	车贝贝, 王小平, 邱青, 陈诚, 郑旭彬, 赵琦, 徐飚. 2009—2020年江苏省南通市耐多药/利福平耐药肺结核诊疗服务特征的纵向研究[J]. 中国防痨杂志, 2023, 45(9): 864-871.
[4]	杜毓, 张海鹏, 王鹏. 分枝杆菌噬菌体的研究现状及应用进展[J]. 中国防痨杂志, 2023, 45(9): 897-903.
[5]	任汝颜, 薛毅, 梁倩, 黄海荣. 堪萨斯分枝杆菌临床分离株对异烟肼敏感性差异机制研究[J]. 中国防痨杂志, 2023, 45(8): 728-733.
[6]	王庆, 丁彩红, 高绪胜, 解丹, 蒋培培, 熊瑜. 含贝达喹啉方案治疗非结核分枝杆菌病三例[J]. 中国防痨杂志, 2023, 45(8): 814-817.
[7]	王嫩寒, 田丽丽, 陈双双, 赵琰枫, 樊瑞芳, 陈昊, 任怡宣, 张洁, 易俊莉, 杨新宇, 于兰, 丁北川, 李传友, 代小伟. 荧光PCR探针熔解曲线技术检测痰标本结核分枝杆菌利福平耐药性的研究[J]. 中国防痨杂志, 2023, 45(6): 583-588.
[8]	王泊宁, 李涛, 陈伟. 耐药结核病经济负担研究进展[J]. 中国防痨杂志, 2023, 45(6): 607-612.
[9]	付亮, 任坦坦, 张培泽, 卢水华. 世界卫生组织《结核病整合指南模块4:耐药结核病治疗2022年更新版》解读[J]. 中国防痨杂志, 2023, 45(4): 336-348.
[10]	吴塔娜, 李玉红, 刘小秋. 依托基本公共卫生服务对老年人开展肺结核主动筛查策略的可行性研究[J]. 中国防痨杂志, 2023, 45(4): 372-376.
[11]	朱玉梅, 夏子涵, 李金莉, 何慧珊, 王峰. 多色探针熔解曲线分析技术检测准广泛耐药肺结核的应用价值[J]. 中国防痨杂志, 2023, 45(4): 406-411.
[12]	徐静, 姜爽爽, 郑海伦, 罗萍. 290例耐药肺结核高危人群耐药情况及治疗结果分析[J]. 中国防痨杂志, 2023, 45(3): 323-327.
[13]	王红红, 郭少晨, 周文强, 刘忠泉, 朱慧, 陆宇. 耐药结核病患者利奈唑胺血药浓度对血液系统毒性发生的影响[J]. 中国防痨杂志, 2023, 45(2): 165-171.
[14]	杨虹, 马进宝, 任斐, 李荣, 武延琴, 张耀辉. 15例耐药肺结核患者家庭接触者发展为活动性肺结核的临床特征分析[J]. 中国防痨杂志, 2023, 45(2): 172-180.
[15]	尚园园, 聂文娟, 黄海荣, 初乃惠. 抗结核药物贝达喹啉与氯法齐明耐药的研究现状[J]. 中国防痨杂志, 2023, 45(1): 116-122.