温州市成年住院结核病患者营养状况调查及影响因素分析

doi:10.19982/j.issn.1000-6621.20230292

摘要/Abstract

摘要：

目的：分析温州市成年结核病住院患者营养状况及风险影响因素,为早期营养干预提供参考依据。方法：选择2023年1月1日至7月5日温州市中心医院感染科收治的住院时间超过24h、年龄≥18岁且诊断为结核病的患者740例。排除因平车或轮椅而无法获得体质量者4例、严重精神疾病者2例、检验数据不完整者18例,最终纳入研究患者716例。收集患者入院时的人口学、临床及实验室资料,包括性别、年龄、结核病诊断类型、治疗类型、合并症、体质量指数(BMI)、病变肺野数、结核分枝杆菌检出情况、耐药情况、营养风险筛查-2002(the nutritional risk screening-2002, NRS-2002)结果、血清总蛋白、白蛋白、前白蛋白、血红蛋白、淋巴细胞计数、中性粒细胞/淋巴细胞比值(NLR)、预后营养指数(PNI)等,对上述资料进行统计比较,分析患者营养风险发生情况及影响因素。结果：716例患者中,231例患者 NRS-2002评分≥3分,纳入营养风险组,485例患者NRS-2002评分<3分,纳入无营养风险组,患者营养风险发生率为32.26%(231/716)。多因素logistic回归分析显示,肺野病变数≥3个[OR(95%CI)=2.066(1.349~3.165)]、白蛋白<30g/L[OR(95%CI)=4.468(1.767~11.297)]、前白蛋白100~200g/L[OR(95%CI)=2.249(1.377~3.674)]、前白蛋白<100g/L[OR(95%CI)=5.585(2.841~10.981)]、血红蛋白91~119g/L[OR(95%CI)=2.205(1.458~3.335)]、血红蛋白≤90g/L[OR(95%CI)=2.882(1.374~6.047)]是患者营养风险发生的危险因素。结论：温州市成年住院结核病患者营养风险发生率较高,临床在治疗过程中应重视该类患者的营养状况,重点关注肺野病变数>3个、白蛋白降低、前白蛋白降低、血红蛋白降低的患者。

关键词: 结核, 营养状况, 危险因素

Abstract:

Objective: To analyze the nutritional status and risk factors of adult tuberculosis inpatients in Wenzhou City, so as to provide reference for early nutritional intervention. Methods: A total of 740 patients with tuberculosis diagnosed in the Infection Department of Wenzhou Central Hospital from January 1 to July 5, 2023 were selected. Excluding 4 patients who could not get measured for weight due to usage of trolley or wheelchair, 2 patients with severe mental illness and 18 patients with incomplete laboratory data, 716 patients were included in the study. Demographic, clinical and laboratory data on admission were collected, including sex, age, diagnostic type of tuberculosis, type of treatment, complication, BMI, number of affected lung fields, detection of Mycobacterium Tuberculosis, drug resistance, nutritional risk screening-2002 (NRS-2002) results, serum total protein, albumin, prealbumin, hemoglobin, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), prognostic nutrition index (PNI), etc. The above data were statistically compared, and the occurrence and influencing factors of nutritional risk were analyzed. Results: Among the 716 patients, 231 patients with NRS 2002 score ≥3 were included in the nutritional risk group, and 485 patients with NRS 2002 score <3 were included in the non-nutritional risk group. The incidence of nutritional risk was 32.26% (231/716). Multivariate logistic regression analysis showed the affected lung fields >3 (OR (95%CI)=2.066 (1.349-3.165)), albumin <30 g/L (OR (95%CI)=4.468 (1.767-11.297)), prealbumin ≤200 g/L (100-200 g/L: OR (95%CI)=2.249 (1.377-3.674), <100 g/L: OR (95%CI)=5.585 (2.841-10.981)), hemoglobin ≤120 g/L (91-119 g/L: OR (95%CI)=2.205 (1.458-3.335), ≤90 g/L: OR (95%CI)=2.882 (1.374-6.047)) were risk factors of nutritional risk in patients. Conclusion: The incidence of nutritional risk of adult inpatients with tuberculosis in Wenzhou City is high. In the course of treatment, more attention should be paid to the nutritional status of these patients, especially those with affected lung fields >3, low albumin/prealbumin/hemoglobin.

Key words: Tuberculosis, Nutritional status, Risk factors

中图分类号:

R52
R151

吴联朋, 夏丹丹, 徐克. 温州市成年住院结核病患者营养状况调查及影响因素分析[J]. 中国防痨杂志, 2024, 46(1): 100-105. doi: 10.19982/j.issn.1000-6621.20230292

Wu Lianpeng, Xia Dandan, Xu Ke. Investigation and analysis of nutritional status and its influencing factors of adult inpatients with tuberculosis in Wenzhou City[J]. Chinese Journal of Antituberculosis, 2024, 46(1): 100-105. doi: 10.19982/j.issn.1000-6621.20230292

图/表 4

表1

表2

表3

表4

患者发生营养风险的多因素logistic回归分析

临床指标	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
病变肺野数≥3个	0.726	0.218	11.125	0.001	2.066	1.349~3.165
白蛋白(以>40g/L为参照)
30~40g/L	0.377	0.433	0.755	0.385	1.457	0.623~3.408
<30g/L	1.497	0.473	10.005	0.002	4.468	1.767~11.297
前白蛋白(以>200g/L为参照)
100~200g/L	0.810	0.250	10.480	0.001	2.249	1.377~3.674
<100g/L	1.720	0.345	24.869	<0.001	5.585	2.841~10.981
血红蛋白(以≥120g/L为参照)
91~119g/L	0.791	0.211	14.030	<0.001	2.205	1.458~3.335
≤90g/L	1.058	0.378	7.837	0.005	2.882	1.374~6.047

表4

参考文献 18

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NRS 2002评分得分	例数	构成比(%)
0	231	32.26
1	189	26.40
2	65	9.08
3	136	18.99
4	67	9.36
5	16	2.23
6	12	1.68

因素	营养风险组(231例)		无营养风险组(485例)		χ²值	P值
因素	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别					1.330	0.249
男性	165	71.43	366	75.46
女性	66	28.57	119	24.54
年龄(岁)					32.386	<0.001
18~40	56	24.24	110	22.68
41~60	58	25.11	202	41.65
61~80	87	37.66	154	31.75
81~95	30	12.99	19	3.92
BMI					397.827	<0.001
<18.50	152	65.80	3	0.62
18.50~23.99	73	31.60	367	75.67
≥24.00	6	2.60	115	23.71
结核病类型					10.263	0.006
肺结核	208	90.04	444	91.55
肺外结核	6	2.60	27	5.57
肺结核合并肺外结核	17	7.36	14	2.88
治疗类型					2.456	0.117
初治	207	89.61	414	85.36
复治	24	10.39	71	14.64
合并症					9.614	0.002
有	188	81.39	342	70.52
无	43	18.61	143	29.48
病变肺野数(个)					31.501	<0.001
<3	44	19.05	195	40.21
≥3	187	80.95	290	59.79
结核分枝杆菌检出情况					3.302	0.069
菌阳	204	88.31	403	83.09
菌阴	27	11.69	82	16.91
结核分枝杆菌耐药情况					0.390	0.532
耐药	28	12.12	67	13.81
敏感	203	87.88	418	86.19
TP(g/L)					48.909	<0.001
<65	142	61.47	164	33.81
≥65	89	38.53	321	66.19
ALB(g/L)					154.627	<0.001
<30	130	56.28	62	12.78
30~40	94	40.69	356	73.40
>40	7	3.03	67	13.82
PAB(mg/L)					131.954	<0.001
<100	77	33.33	28	5.77
100~200	126	54.55	237	48.87
>200	28	12.12	220	45.36
Hb(g/L)					102.636	<0.001
≤90	35	15.15	18	3.71
91~119	126	54.55	131	27.01
≥120	70	30.30	336	69.28
LYM(×10⁹/L)					41.322	<0.001
<1.1	132	57.14	155	31.96
≥1.1	99	42.86	330	68.04
NLR					45.800	<0.001
<4	83	35.93	305	62.89
≥4	148	64.07	180	37.11
PNI					103.726	<0.001
<40	176	76.19	176	36.29
40~45	39	16.88	160	32.99
>45	16	6.93	149	30.72

变量	赋值	变量	赋值
是否存在营养风险	否=0;是=1	白蛋白(g/L)	>40=0;30~40=1;<30=2
是否存在营养风险	否=0;是=1	前白蛋白(g/L)	>200=0;100~200=1;<100=2
结核病类型	单纯肺结核=0;肺外结核=1;肺结核合并肺外结核=2	前白蛋白(g/L)	>200=0;100~200=1;<100=2
结核病类型	单纯肺结核=0;肺外结核=1;肺结核合并肺外结核=2	血红蛋白(g/L)	≥120=0;91~119=1;≤90=2
合并症	无=0;有=1	血红蛋白(g/L)	≥120=0;91~119=1;≤90=2
合并症	无=0;有=1	淋巴细胞计数(×10⁹/L)	≥1.1=0;<1.1=1
病变肺野数	病变肺野数<3个=0;病变肺野数≥3个=1	淋巴细胞计数(×10⁹/L)	≥1.1=0;<1.1=1
病变肺野数	病变肺野数<3个=0;病变肺野数≥3个=1	NLR	<4=0;≥4=1
总蛋白(g/L)	≥65=0;<65=1	NLR	<4=0;≥4=1
总蛋白(g/L)	≥65=0;<65=1	PNI	>45=0;40~45=1;<40=2