结核病并发糖尿病住院患者的营养风险及其影响因素

doi:10.3969/j.issn.1000-6621.2021.01.009

摘要/Abstract

摘要：

目的分析结核病并发糖尿病住院患者的营养风险及其影响因素,为早期营养干预提供依据。方法采用回顾性研究收集2018年4月1日至2019年8月31日在中山大学附属第五医院感染病防治中心诊断为结核病并发糖尿病的住院患者179例,排除并发恶性肿瘤9例、妊娠1例,最终纳入169例。收集患者临床相关资料,包括患者性别、年龄、并发症、结核病诊断类型、患者类型、结核分枝杆菌检出情况、病程、抗结核治疗时间、住院天数、营养风险筛查表2002(NRS 2002)评分、血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)、空腹血糖(FBS)、糖化血红蛋白(GHB)、中性粒细胞/淋巴细胞比值(NLR)、预后营养指数(PNI)和体质量,并采用多因素logistic回归模型分析结核病并发糖尿病患者发生营养风险的相关影响因素。结果根据NRS 2002评分结果, 35例患者评分≥3分被纳入有营养风险组,134例评分<3分被纳入无营养风险组,营养风险发生率为20.71%(35/169)。影响营养风险的多因素logistic回归分析显示,病程≥1个月是营养风险发生的危险因素[OR(95%CI)=6.003(1.662~21.688)];而白蛋白是营养风险发生的保护因素[OR(95%CI)=0.876(0.815~0.942)],即白蛋白越高,营养风险发生率越低。结论结核病并发糖尿病患者营养风险发生率为20.71%。营养风险的发生与病程和白蛋白相关,病程≥1个月营养风险发生率显著升高,而白蛋白与营养风险发生率呈负相关。

关键词: 结核, 糖尿病, 共病现象, 营养障碍, 营养风险筛查, 因素分析,统计学

Abstract:

Objective To analyze the nutritional risk and its influencial factors in patients with tuberculosis complicated with diabetes mellitus and provide evidence for early nutritional intervention. Methods Tuberculosis with diabetes mellitus inpatients admitted in the infectious disease prevention and control center of the fifth affiliated hospital of Sun Yat-sen University from April 1, 2018 to August 31, 2019 were enrolled. Clinical data was collected, including gender, age, complications, type of TB diagnosis, type of patients, mycobacterium tuberculosis detection, disease course, anti-tuberculosis treatment time, hospitalization days, score of nutritional risk screening 2002 (NRS 2002), hemoglobin (Hb), albumin (ALB), prealbumin (PAB), fasting blood sugar (FBS), glycosylated hemoglobin (GHB), neutrophil/lymphocyte ratio (NLR), prognosis of nutrition index (PNI) and weight. Multivariate logistic regression was used to analyze related factors of nutritional risk. Results According to the NRS-2002 score, 35 patients with scores ≥3 were included in the nutritional risk group, and 134 patients with scores <3 were included in the non-nutritional risk group, with an incidence of nutritional risk of 20.71% (35/169). Multivariate logistic regression analysis showed that disease course lasting over one month was a risk factor for the occurrence of nutritional risks (OR (95%CI)=6.003 (1.662,21.688)) while high blood albumin level was a protective factor (OR (95%CI)=0.876 (0.815,0.942)), the higher the albumin, the lower the incidence of nutritional risk. Conclusion The incidence of nutritional risk in patients with tuberculosis complicated with diabetes was 20.71%, associated with disease course and blood albumin. The incidence of nutritional risk for patients with disease course ≥1 month was significantly higher than those having <1 month disease courses, while blood albumin was negatively associated with the incidence of nutritional risk.

Key words: Tuberculosis, Diabetes mellitus, Comorbidity, Nutrition disorders, Nutritional risk screening, Factor analysis,statistical

罗小青, 段思雨, 林铭钰, 邓珣, 刘碧芬, 黎连, 唐慧雯, 丁立. 结核病并发糖尿病住院患者的营养风险及其影响因素[J]. 中国防痨杂志, 2021, 43(1): 42-46. doi: 10.3969/j.issn.1000-6621.2021.01.009

LUO Xiao-qing, DUAN Si-yu, LIN Ming-yu, DENG Xun, LIU Bi-fen, LI Lian, TANG Hui-wen, DING Li. Nutritional risk screening and influencial factor analysis in hospitalized patients with comorbidity of tuberculosis and diabetes mellitus[J]. Chinese Journal of Antituberculosis, 2021, 43(1): 42-46. doi: 10.3969/j.issn.1000-6621.2021.01.009

图/表 2

表1

影响结核病并发糖尿病患者发生营养风险的单因素分析

因素	无营养风险组(134例)	有营养风险组(35例)	统计检验值	P值
性别[例数(构成比,%)]			χ²=0.938	0.333
男	106(79.10)	25(71.43)
女	28(20.90)	10(28.57)
年龄组(岁)[例数(构成比,%)]			χ²=2.332	0.506
20~	9(6.72)	2(5.72)
40~	57(42.54)	13(37.14)
60~	64(47.76)	17(48.57)
80~90	4(2.98)	3(8.57)
BMI[例数(构成比,%)]			χ²=55.899	0.000
<18.5	0(0.00)	13(37.14)
18.5~	93(69.40)	19(54.29)
≥24	41(30.60)	3(8.57)
结核类型[例数(构成比,%)]			χ²=0.245	0.881
肺结核	123(91.79)	33(94.28)
肺外结核	5(3.73)	1(2.86)
肺结核并发肺外结核	6(4.48)	1(2.86)
患者类型[例数(构成比,%)]			χ²=0.000	0.984
初治	107(79.85)	28(80.00)
复治	27(20.15)	7(20.00)
结核分枝杆菌检出情况[例数(构成比,%)]			χ²=0.018	0.895
菌阴	33(24.63)	9(25.71)
菌阳	101(75.37)	26(74.29)
并发症[例数(构成比,%)]			χ²=0.389	0.533
有	61(45.52)	18(51.43)
无	73(54.48)	17(48.57)
病程(T₁)[例数(构成比,%)]			χ²=20.262	0.000
T₁≤1个月	57(42.54)	3(8.57)
T₁>1个月	77(57.46)	32(91.43)
抗结核治疗时间(T₂))[例数(构成比,%)]			χ²=0.813	0.666
未进行抗结核治疗	73(54.48)	20(57.14)
0<T₂≤2个月	57(42.54)	13(37.14)
T₂>2个月	4(2.98)	2(5.72)
Hb[g/L,M(Q₁,Q₃)]	133.50(119.25,146.00)	119.00(105.25,127.00)	U=-3.838	0.000
ALB[g/L,M(Q₁,Q₃)]	40.45(35.83,43.05)	34.30(28.63,38.93)	U=-4.244	0.000
PAB(g/L, $x ˉ$ ±s)	187.01±32.42	127.78±39.76	t=4.051	0.000
FBS[mmol/L,M(Q₁,Q₃)]	7.45(6.20,10.50)	8.75(6.55,9.78)	U=-0.333	0.739
GHB [%,M(Q₁,Q₃)]	8.05(6.93,10.48)	7.30(6.48,9.73)	U=-0.217	0.828
NLR[M(Q₁,Q₃)]	2.98(2.45,4.35)	3.73(2.22,5.25)	U=-2.405	0.016
PNI[M(Q₁,Q₃)]	46.68(42.73,50.39)	40.98(35.39,47.45)	U=-4.215	0.000
体质量[kg,M(Q₁,Q₃)]	60.00(55.00,68.98)	57.15(48.75,68.50)	U=-4.032	0.000
平均BMI[M(Q₁,Q₃)]	22.34(20.30,24.00)	21.39(18.27,23.84)	U=-4.424	0.000
住院天数[d,M(Q₁,Q₃)]	8.00(6.00,12.00)	8.50(7.00,11.25)	U=-1.777	0.076

表1

表2

影响结核病并发糖尿病营养风险的多因素logistic回归分析

影响因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
病程	1.792	0.655	7.480	0.006	6.003(1.662~21.688)
白蛋白	-0.154	0.040	12.786	0.000	0.876(0.815~0.942)
常量	2.019	1.425	2.007	0.157	7.528

表2

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