关键词: 结核, 肺, 结核, 抗多种药物性, 药物疗法, 联合, 营养状况, 营养支持, 疗效比较研究

Abstract:

Objective To investigate the clinical effects of enteral nutrition on patients with multidrug-resistant tuberculosis (MDR-PTB) complicated by malnutrition.Methods A total of 128 patients with MDR-PTB complicated by malnutrition who accepted special drug resistance treatment in Hunan Provincial Tuberculosis Control Institute from November 2016 to November 2018 were collected as subjects, including 103 males (80.5%) and 25 females (19.5%), the age range was between 21 to 72 years, with the average of (48.48±13.10) years. Patients were divided into observation group (64 cases) and control group (64 cases) according to random number table method. Patients in the observation group were given enteral nutrition therapy combined with conventional diet, and in the control group were given a regular diet. Differences between the two groups on indexes such as serum total protein (TP), serum albumin (ALB), hemoglobin (Hb), percentage change in ideal body weight, and body mass index (BMI), were compared before treatment and after two weeks of treatment, as well as differences on hospital stay, infection efficacy, and hospitalization costs.Results After two weeks of treatment, the Hb, ALB, TP and BMI of the observation group were higher than that before treatment (before treatment: (106.00±18.08)g/L, (32.74±3.88)g/L, (64.54±5.09)g/L, 16.88±2.25, respectively; after treatment: (113.61±14.62)g/L, (35.65±3.64)g/L, (67.76±5.04)g/L, 17.36±2.08), respectively; and the difference was statistically significant (t values were 5.23, 9.44, 5.02, 6.91, respectively, and P values were all <0.01). The BMI level after two week of treatment in the control group (17.63±1.89) was significantly higher than that before treatment (17.50±1.94), and the difference was statistically significant (t=2.97, P=0.004). After two weeks of treatment, the levels of Hb, ALB and TP in the observation group were higher than those in the control group ((100.36±12.96)g/L, (32.43±5.08)g/L, (62.65±6.99)g/L)), the difference was statistically significant (t values were 5.43, 4.12, 4.74, and P values were all <0.01). The percentage change in ideal body weight (M(Q₁, Q₃)) in the observation group was 2.04% (0.00%, 3.95%), higher than that in the control group (0.00% (0.00%, 1.81%)), and the difference was statistically significant (U=1092.50, P<0.01). After two weeks of treatment, the improvement rate of patients complicated by other pulmonary infection in the control group (34.9%, 15/43) was lower compared with the observation group (56.5%, 26/46), and the difference was statistically significant (χ ²=4.12, P=0.041). The hospital stay (M(Q₁,Q₃)) in the observation group was 34.00 (28.25, 38.00)d, less than that in the control group (37.00 (29.25, 45.00)d), and the difference was statistically significant (U=1601.00, P=0.033); the hospitalization cost (M(Q₁,Q₃)) in the observation group was 24.1 (20.6, 26.6) thousand yuan, less than the control group (25.2 (22.8, 33.4) thousand yuan), the difference was statistically significant (U=1416.00, P=0.003). Conclusion MDR-PTB patients with malnutrition have high clinical value by adopting enteral nutrition therapy, which can effectively improve the nutritional index of patients, increase the BMI of patients, and shorten hospitalization time and hospitalization expenses.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Drug therapy, combination, Nutritional status, Nutritional support, Comparative effectiveness research