益生菌联合肠内营养对肺结核与2型糖尿病共病伴营养不良患者治疗效果分析

doi:10.3969/j.issn.1000-6621.2021.10.010

摘要/Abstract

摘要：

目的探索益生菌联合肠内营养对肺结核与2型糖尿病共病(pulmonary tuberculosis-type 2 diabetes mellitus,PTB-T2DM)伴营养不良患者的治疗效果。方法自2018年1月5日开始按随机数字表将湖南省胸科医院收治的PTB-T2DM伴营养不良患者分别纳入观察组和对照组,至2020年12月15日观察组75例,平均年龄(60.8±8.6)岁;对照组72例,平均年龄(57.9±10.6)岁。对照组予以常规的抗结核治疗、降糖和低GI型肠内营养液治疗;观察组在对照组的治疗方案基础上联合益生菌治疗。观察两组患者营养治疗前与治疗14d后血红蛋白(Hb)、白蛋白(Alb)、体质量指数(BMI)等指标的变化。观察两组患者在营养治疗期间恶心、呕吐等胃肠道不良反应发生情况。结果营养治疗14d后,观察组Hb、Alb、BMI值分别为(104.69±16.37)g/L、(32.80±6.76)g/L、19.23±3.04,高于对照组的(100.80±15.59)g/L、(32.44±4.77)g/L、20.38±3.11,差异均有统计学意义(t值分别为2.667、2.023、2.288,P值分别为0.008、0.046、0.023)。观察组患者腹胀、便秘发生率分别为5.33%(4/75)、2.67%(2/75),低于对照组的18.06%(13/72)、12.50%(9/72),差异均有统计学意义(χ²值分别为5.841和5.131,P值分别为0.016和0.024)。观察组腹泻发生率为1.33%(1/75),低于对照组的9.72%(7/72),差异有统计学意义(Fisher精确概率法,P=0.031)。结论益生菌联合肠内营养能更好地改善PTB-T2DM伴营养不良患者的营养状况,改善患者预后,且不良反应少。

关键词: 结核, 肺, 糖尿病, 2型, 营养评价, 益生菌, 对比研究

Abstract:

Objective To assess the effects of probiotics combined with enteral nutrition on patients with comorbidity of pulmonary tuberculosis-type 2 diabetes mellitus (PTB-T2DM) with malnutrition. Methods Since January 5, 2018, patients with PTB-T2DM and malnutrition admitted in Hunan Chest Hospital were randomly allocated in observation group and control group using random number table. By December 15, 2020, 150 patients were enrolled in the study, 75 in the observation group (age: (60.8±8.6) years) and 72 in the control group (age: (57.9±10.6) years).The control group was treated with conventional anti-tuberculosis treatment, hypoglycemic diet and low GI enteral nutrition solution; the observation group was prescribed with probiotics additionally. Hemoglobin (Hb), albumin (Alb) and body mass index (BMI) were assessed before and after 14 days’ nutritional treatment. The occurrences of gastrointestinal adverse reactions such as nausea and vomiting during the nutritional treatment of those two groups were observed. Results After 14 days’ nutritional treatment, a significantly higher proportion of patients in the observation group had meaningful clinical response than in the control group based on the Hb, Alb and BMI ((104.69±16.37) g/L, (32.80±6.76) g/L and 19.23±3.04 vs (100.80±15.59) g/L, (32.44±4.77) g/L and 20.38±3.11, t values were 2.667, 2.023, 2.288, and P values were 0.008, 0.046, 0.023, respectively). The incidence of abdominal distension, diarrhea and constipation were lower in the observation group compared with the control group (5.33% (4/75), 2.67% (2/75) vs 18.06% (13/72), 12.50% (9/72), respectively, χ² of abdominal distension and constipation were 5.841 and 5.131, P values were 0.016, 0.024, respectively). The incidence of diarrhea was using performed by Fisher’s exact test, it shown that the observation group had lower incidence than control group (1.33% (1/75) vs 9.72% (7/72)). Conclusion Probiotics combined with enteral nutrition can significantly improve the nutritional status and prognosis of PTB-T2DM patients with malnutrition.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, type 2, Nutritional assessment, Probiotics, Comparative study

唐寒梅, 张胜康, 颜觅, 袁聃, 曹涵涓, 张小兵, 白丽琼, 易恒仲, 唐细良. 益生菌联合肠内营养对肺结核与2型糖尿病共病伴营养不良患者治疗效果分析[J]. 中国防痨杂志, 2021, 43(10): 1027-1031. doi: 10.3969/j.issn.1000-6621.2021.10.010

TANG Han-mei, ZHANG Sheng-kang, YAN Mi, YUAN Dan, CAO Han-juan, ZHANG Xiao-bing, BAI Li-qiong, YI Heng-zhong, TANG Xi-liang. Analysis of the therapeutic effect of probiotics combined with enteral nutrition on patients with comorbidity of tuberculosis and type 2 diabetes with malnutrition[J]. Chinese Journal of Antituberculosis, 2021, 43(10): 1027-1031. doi: 10.3969/j.issn.1000-6621.2021.10.010

图/表 2

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观察指标	观察组(75例)		t值	P值	对照组(72例)		t值	P值
观察指标	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
血红蛋白(g/L,$\bar{x}\pm s$)	97.99±17.15	104.69±16.37	5.024	0.000	98.12±15.86	100.80±15.59	3.234	0.002
血清白蛋白(g/L,$\bar{x}\pm s$)	30.61±4.88	32.80±6.76	3.952	0.000	31.47±5.20	32.44±4.77	3.137	0.002
血清总蛋白(g/L,$\bar{x}\pm s$)	58.91±6.28	61.39±6.92	4.342	0.000	58.83±5.86	61.08±5.96	4.273	0.000
体质量指数($\bar{x}\pm s$)	18.98±3.10	19.23±3.04	4.957	0.000	20.16±2.94	20.38±3.11	0.975	0.329

组别	例数	腹胀 [例,发生率(%)]	腹泻 [例,发生率(%)]	便秘 [例,发生率(%)]	恶心 [例,发生率(%)]	呕吐 [例,发生率(%)]
对照组	72	13(18.06)	7(9.72)	9(12.50)	6(8.33)	2(2.78)
观察组	75	4(5.33)	1(1.33)	2(2.67)	3(4.00)	0(0.00)
χ²值		5.841	-	5.131	1.200	-
P值		0.016	0.031	0.024	0.227	0.238