肺外结核患者的营养状况调查及影响因素分析

doi:10.19982/j.issn.1000-6621.20230221

中国防痨杂志 ›› 2023, Vol. 45 ›› Issue (9): 839-844.doi: 10.19982/j.issn.1000-6621.20230221

肺外结核患者的营养状况调查及影响因素分析

丁芹¹, 陈薇¹, 张胜康², 任斐³, 陈晓红⁴, 胡春梅⁵, 陈丹萍⁶, 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:2023-06-26 出版日期:2023-09-10 发布日期:2023-09-01
通信作者: 范琳,Email:fanlinsj@163.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)

Investigation of nutritional status and analysis of influencing factors in patients with extrapulmonary tuberculosis

Ding Qin¹, Chen Wei¹, Zhang Shengkang², Ren Fei³, Chen Xiaohong⁴, Hu Chunmei⁵, Chen Danping⁶, 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:2023-06-26 Online:2023-09-10 Published:2023-09-01
Contact: Fan Lin, Email: fanlinsj@163.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: 调查肺外结核患者的营养状况并分析其相关的影响因素。方法: 选取2020年1月1日至2021年12月31日期间6家结核病专科医院的住院肺外结核患者作为研究对象,共3223例,其中,男性1852例(57.46%),女性1371例(42.54%);年龄中位数(四分位数)为41(28,58)岁。收集研究对象一般人口学特征和临床特征资料(包括性别、年龄、身高、体质量、临床诊断、肺外结核部位、合并症、免疫状态、既往肺结核治疗史等),以及营养风险筛查-2002(NRS-2002)评分情况。研究对象病历资料信息均完整,明确诊断为肺外结核,并在其尚未得到有效抗结核治疗或控制的情况下进行营养风险筛查。分析研究对象营养风险发生情况,并采用多因素logistic回归模型分析肺外结核患者营养风险发生的影响因素。结果: 3223例研究对象中,仅累及1个肺外部位者占86.91%(2801/3223),累及2个部位及以上者占13.09%(422/3223)。研究对象NRS-2002得分波动于1~5分,得分中位数(四分位数)为3(1,4)分,共1814例(56.28%)患者存在营养风险(NRS-2002评分≥3分)。422例累及2个及以上肺外部位研究对象中存在营养风险者占63.74%(269/422);2801例累及单个肺外部位研究对象中存在营养风险者占55.16%(1545/2801)。多因素logistic回归分析显示,低体质量指数(体质量指数<18.5)[OR(95%CI)=20.641(19.745~26.307)]、合并免疫抑制[OR(95%CI)=1.182(1.023~1.421)],以及复治[OR(95%CI)=1.804(1.549~2.177)]是肺外结核患者发生营养风险的危险因素。结论: 肺外结核患者营养风险发生比例较高,临床治疗中应多关注其营养状况,尤其警惕低体质量指数、合并免疫抑制及复治患者。

关键词: 结核, 营养状况, 危险因素, 回顾性研究, 肺外结核

Abstract:

Objective: To investigate the nutritional status of patients with extrapulmonary tuberculosis and analyze the related factors. Methods: A total of 3223 inpatients with extrapulmonary tuberculosis from 5 tuberculosis specialized hospitals from January 1, 2020 to December 31, 2021 were selected as research subjects, including 1852 males (57.46%) and 1371 females (42.54%); the median (quartile) age was 41 (28,58) years old. The general demography characteristics and clinical characteristics of the subjects were collected (including gender, age, height, body mass, clinical diagnosis, location of extrapulmonary tuberculosis, complications, immune status, previous tuberculosis treatment history, etc.), as well as the nutrition risk screening-2002 (NRS-2002) score. All the subjects had complete medical records and information, and were definitely diagnosed with extrapulmonary tuberculosis. Nutritional risk screening was conducted when they had not yet received effective anti-tuberculosis treatment or control. The occurrence of nutritional risk in the subjects was analyzed and the influencing factors of nutritional risk in patients with extrapulmonary tuberculosis were analyzed using a multivariate logistic regression model. Results: Among the 3223 study subjects, 86.91% (2801/3223) involved only one extrapulmonary site, and 13.09% (422/3223) involved two or more sites. The NRS-2002 score of subjects fluctuated from 1 to 5, and the median (quartile) score was 3 (1, 4). A total of 1814 cases (56.28%) had nutritional risk (NRS-2002 score ≥3). Of the 422 study subjects with involvement in two or more extrapulmonary sites, 63.74% (269/422) were at nutritional risk; of the 2801 studies involving a single extrapulmonary site, 55.16% (1545/2801) had nutritional risks. Multivariate logistic regression analysis showed that low body mass index (body mass index <18.5)(OR (95%CI)=20.641 (19.745-26.307)), concomitant immunosuppression (OR (95%CI)=1.182 (1.023-1.421)), and retreatment (OR (95%CI)=1.804 (1.549-2.177)) were risk factors for nutritional risk in patients with extrapulmonary nodules. Conclusion: The incidence of nutritional risk in patients with extrapulmonary tuberculosis is relatively high, and more attention should be paid to their nutritional status in clinical treatment, especially for patients with low body mass index, combined immunosuppression, and retreatment.

Key words: Tuberculosis, Nutritional status, Risk factors, Retrospective studies, Extrapulmonary tuberculosis

中图分类号:

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. doi: 10.19982/j.issn.1000-6621.20230221

Ding Qin, Chen Wei, Zhang Shengkang, Ren Fei, Chen Xiaohong, Hu Chunmei, Chen Danping, Fan Lin. Investigation of nutritional status and analysis of influencing factors in patients with extrapulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(9): 839-844. doi: 10.19982/j.issn.1000-6621.20230221

图/表 5

表1

表2

表3

表4

表5

肺外结核患者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
体质量指数(以≥20.5为参照)
<18.5	6.818	0.193	15.119	0.000	20.641(19.745~26.307)
18.5~<20.5	0.484	0.496	0.954	0.329	1.078(0.916~1.270)
合并恶性肿瘤	0.387	0.946	0.167	0.683	1.639(0.618~2.772)
合并免疫抑制	1.775	1.069	5.755	0.018	1.182(1.023~1.421)
合并糖尿病	0.376	0.263	2.037	0.154	1.558(0.993~1.918)
复治	28.423	2.155	173.967	0.000	1.804(1.549~2.177)
累及2个及以上肺外部位	0.201	0.226	0.794	0.373	1.055(0.659~1.691)

表5

参考文献 26

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类型	例数	构成比(%)
累及2个及以上肺外部位	422	13.09
累及单个肺外部位	2801	86.91
结核性胸膜炎	905	32.31
淋巴结结核	330	11.80
结核性脑膜炎	125	4.46
结核性腹膜炎	54	1.93
肠结核	48	1.71
泌尿系统结核	34	1.21
骨与关节结核	99	3.53
皮肤结核	11	0.39
支气管结核	1090	38.91
结核性心包炎	19	0.68
喉结核	58	2.07
其他部位结核	28	1.00
合计	3223	100.00

类型	例数	NRS-2002评分≥3分		NRS-2002评分<3分
类型	例数	例数	构成比(%)	例数	构成比(%)
累及单个肺外部位	2801	1545	55.16	1256	44.84
结核性胸膜炎	905	525	58.01	380	41.99
淋巴结结核	330	158	47.88	172	52.12
结核性脑膜炎	125	80	64.00	45	36.00
结核性腹膜炎	54	33	61.11	21	38.89
肠结核	48	37	77.08	11	22.92
泌尿系统结核	34	13	38.24	21	61.76
骨与关节结核	99	53	53.54	46	46.46
皮肤结核	11	1	9.09	10	90.91
支气管结核	1090	589	54.04	501	45.96
结核性心包炎	19	10	52.63	9	47.37
喉结核	58	30	51.72	28	48.28
其他部位结核	28	16	57.14	12	42.86
两个及以上肺外部位	422	269	63.74	153	36.26
合计	3223	1814	56.28	1409	43.72

因素	NRS-2002评分≥3分		NRS-2002评分<3分		χ²值	P值
因素	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别					3.661	0.056
男性	1069	58.93	783	55.57
女性	745	41.07	626	44.43
年龄组(岁)					4.020	0.004
18~39	898	49.50	648	45.99
40~59	441	24.31	502	35.63
60~79	399	22.00	227	16.11
≥80	76	4.19	32	2.27
体质量指数					2432.000	<0.01
<18.5	852	46.97	0	0.00
18.5~<20.5	758	41.79	17	1.21
≥20.5	204	11.24	1392	98.79
合并糖尿病					6.414	0.010
是	146	8.05	150	10.65
否	1668	91.95	1259	89.35
合并恶性肿瘤					58.370	<0.01
是	828	45.64	456	32.36
否	986	54.36	953	67.64
合并免疫抑制					5.467	0.020
是	564	31.09	493	34.99
否	1250	68.91	916	65.01
治疗分类					15.120	<0.01
初治	1112	61.30	957	67.92
复治	702	38.70	452	32.08
累及肺外部位					10.990	<0.01
单个	1545	85.17	1256	89.14
2个及以上	269	14.83	153	10.86

变量	赋值
因变量
营养风险评分	NRS-2002评分≥3分=1;NRS-2002评分<3分=0
自变量
年龄组	18~39岁=0;40~59岁=1;60~79岁=2;≥80岁=3
体质量指数	≥20.5=0;18.5~<20.5=1;<18.5=2
合并糖尿病	否=0;是=1
合并恶性肿瘤	否=0;是=1
合并免疫抑制	否=0;是=1
治疗分类	初治=0;复治=1
累及肺外部位	单个=0;2个及以上=1

肺外结核患者的营养状况调查及影响因素分析

Investigation of nutritional status and analysis of influencing factors in patients with extrapulmonary tuberculosis

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