上海市900例老年住院结核病患者营养状况调查分析

doi:10.3969/j.issn.1000-6621.2020.07.015

摘要/Abstract

摘要：

目的分析上海市老年结核病住院患者营养状况及其风险因素,为早期营养干预老年结核病住院患者提供依据。方法连续性收集2018年8月1日至2019年8月1日同济大学附属上海市肺科医院结核病区住院超过24 h且确诊为结核病的1100例≥65岁老年患者,剔除无体质量记录、严重糖尿病、严重高血压、肝肾功能不全,以及神志不清者,最终纳入900例。对纳入患者的临床相关资料[包括患者性别、年龄、临床诊断、并发症、治疗次数、出入院日期、营养风险筛查量表(NRS 2002)分值]及营养相关指标[血红蛋白(Hb)、血清总蛋白(TP)、血清白蛋白(ALB)、血清前白蛋白(PAB)、视黄醇结合蛋白(RBP)、预后营养指数(PNI)、中性粒细胞/淋巴细胞比值(NLR)等因素]进行统计,分析影响老年结核病患者营养风险发生的危险因素。900例老年结核病患者中,443例(49.22%)NRS 2002≥3分者纳入有营养风险组,457例(50.78%)NRS 2002<3分者纳入无营养风险组。结果因素分析显示,有营养风险组患者在75~和80~90岁组[18.28%(81/443)和18.51%(82/443)]、BMI<18.5[40.41%(179/443)]、治疗2次及以上[25.51%(113/443)]、结核性胸膜炎[21.67%(96/443)]方面的分布均明显高于无营养风险组[分别为9.19%(42/457)和8.75%(40/457)、0.00%(0/457)、17.51%(80/457)、13.13%(60/457)](χ²=51.350,299.500, 8.818, 16.280;P=0.000,0.000,0.012,0.000)。营养相关临床指标检测结果显示,有营养风险组患者的TP[(64.88±0.34)g/L]、ALB[(34.15±0.23)g/L]、PAB[(138.60±3.26)g/L]、Hb[(113.60±0.84)g/L]、RBP[(26.32±0.50)g/L]、PNI[(39.61±0.35)]均低于无营养风险组患者[分别为(67.30±0.28)g/L、(38.18±0.16)g/L、(194.10±3.22)g/L、(126.70±0.79)g/L、(34.32±0.22)g/L、(45.51±0.26)][F=19.496, 79.334, 34.030, 22.808,21.326, 72.464;P值均=0.000];而NLR(5.44±0.32)和住院时间[(6.61±0.17)d]明显高于无营养风险组患者[分别为(3.29±0.14),(5.53±0.13)d][F=6.335, P=0.012;F=5.994,P=0.015]。结论老年结核病患者营养风险发生率较高,且与年龄、治疗次数呈正相关、与BMI呈负相关,并表现为有营养风险组患者的TP、ALB、PAB、Hb、RBP、PNI均明显低于无营养风险组患者,严重影响临床治疗效果、延长住院时间。

关键词: 结核, 老年人, 营养评价, 营养调查, 因素分析, 统计学

Abstract:

Objective To investigate the nutritional status of elderly tuberculosis inpatients in Shanghai and its impact on clinical treatment and provide a reference for early nutrition intervention for elderly tuberculosis inpatients. Methods Of the 1100 elderly tuberculosis inpatients admitted in Shanghai Pulmonary Hospital Affiliated of Tongji University over 24 hours from August 1st, 2018 to August 1st, 2019 were, 900 patients without serious diabetes, serious hypertension, liver and kidney dysfunction, or unconsciousness were collected, and their BMI were recorded. Clinical data, including gender, age, diagnosis, complication, times of treatments, date of discharge and admission, NRS 2002 score and nutrition relative indicators (Hb, TP, ALB, PAB, RBP, PNI, and NLR), were compared to analyze the risk factors of elderly tuberculosis inpatients. The 900 elderly tuberculosis patients were divided into nutritional risk group (n=443 (49.22%), NRS 2002 score ≥3) and non-nutritional risk group (n=457 (50.78%), NRS 2002 score<3). Results The constituent ratio of nutritional risks in the nutritional risk group with patients aged 75- and 80-90 years old, BMI<18.5,2 or more times of treatments,tuberculous pleurisy were significantly higher than the non-nutritional risk group (18.28% (81/443) and 18.51% (82/443) vs.9.19% (42/457) and 8.75% (40/457), (40.41% (179/443) vs. 0.00% (0/457),25.51% (113/443) vs. 17.51% (80/457),21.67% (96/443) vs. 13.13% (60/457);χ²=51.350,299.500, 8.818, 16.280;P=0.000,0.000,0.012,0.000). The TP, ALB, PAB, Hb, RBP, PNI in nutritional risk group were lower than those in non-nutritional risk group ((64.88±0.34) g/L vs. (67.30±0.28) g/L, (34.15±0.23) g/L vs. (38.18±0.16) g/L, (138.60±3.26) g/L vs. (194.10±3.22) g/L, (113.60±0.84) g/L vs. (126.70±0.79) g/L, (26.32±0.50) g/L vs. (34.32±0.22) g/L, (39.61±0.35) vs. (45.51±0.26); F=19.496, 79.334, 34.030, 22.808, 21.326, 72.464, respectively; all P=0.000). However, the NLR and duration of inhospital in nutritional risk group were significantly higher than those in non-nutritional risk group ((5.44±0.32) vs. (3.29±0.14), F=6.335, P=0.012; (6.61±0.17) d vs. (5.53±0.13) d, F=5.994,P=0.015). Conclusion Elderly tuberculosis patients have high incidence of nutritional risk and the incidence increase with age, times of treatment, decrease with BMI. The TP, ALB, PAB, Hb, RBP and PNI in nutritional risk group were significantly lower than those in non-nutritional risk group, which seriously affects the clinical treatment and leads to longer hospital stays directly.

Key words: Tuberculosis, Aged, Nutrition assessment, Nutrition surveys, Factor analysis, statistical

陈薇, 丁芹, 顾颖, 戚之燕, 陈燕红, 范琳. 上海市900例老年住院结核病患者营养状况调查分析[J]. 中国防痨杂志, 2020, 42(7): 725-730. doi: 10.3969/j.issn.1000-6621.2020.07.015

CHEN Wei, DING Qin, GU Ying, QI Zhi-yan, CHEN Yan-hong, FAN Lin. Analysis of nutritional status of 900 elderly inpatients with tuberculosis in Shanghai[J]. Chinese Journal of Antituberculosis, 2020, 42(7): 725-730. doi: 10.3969/j.issn.1000-6621.2020.07.015

图/表 2

表1

表2

老年结核病住院患者营养风险相关临床后指标检测结果在两组患者间的比较

临床指标	无营养风险组(457例)	营养风险组(443例)	F值	P值
TP(g/L, $x ˉ$ ±s)	67.30±0.28	64.88±0.34	19.496	0.000
ALB(g/L, $x ˉ$ ±s)	38.18±0.16	34.15±0.23	79.334	0.000
PAB(g/L, $x ˉ$ ±s)	194.10±3.22	138.60±3.26	34.030	0.000
Hb(g/L, $x ˉ$ ±s)	126.70±0.79	113.60±0.84	22.808	0.000
RBP(g/L, $x ˉ$ ±s)	34.32±0.22	26.32±0.50	21.326	0.000
NLR( $x ˉ$ ±s)	3.29±0.14	5.44±0.32	6.335	0.012
PNI( $x ˉ$ ±s)	45.51±0.26	39.61±0.35	72.464	0.000
住院天数(d, $x ˉ$ ±s)	5.53±0.13	6.61±0.17	5.994	0.015

表2

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因素	合计	无营养风险组(457例)	营养风险组(443例)	χ²值	P值
性别				0.502	0.478
男	628(69.78)	314(68.71)	314(70.88)
女	272(30.22)	143(31.29)	129(29.12)
年龄组(岁)				51.350	0.000
65~	415(46.11)	258(56.46)	157(35.44)
70~	240(26.67)	117(25.60)	123(27.77)
75~	123(13.67)	42(9.19)	81(18.28)
80~90	122(13.55)	40(8.75)	82(18.51)
诊断类型				16.280	0.000
浸润性肺结核	359(39.89)	189(41.36)	170(38.37)
空洞性肺结核	223(24.78)	110(24.07)	113(25.51)
结核性胸膜炎	156(17.33)	60(13.13)	96(21.67)
其他肺外结核	162(18.00)	98(21.44)	64(14.45)
并发症或基础疾病				0.045	0.830
有	688(76.44)	348(76.15)	340(76.75)
无	212(23.56)	109(23.85)	103(23.25)
治疗次数				8.818	0.012
初治	707(78.55)	377(82.49)	330(74.49)
第2次	97(10.78)	42(9.19)	55(12.42)
≥3次	96(10.67)	38(8.32)	58(13.09)
BMI				299.500	0.000
<18.5	179(19.89)	0(0.00)	179(40.41)
18.5~	543(60.33)	295(64.55)	248(55.98)
24~	150(16.67)	137(29.98)	13(2.93)
28~	28(3.11)	25(5.47)	3(0.68)