Expert consensus on nutritional assessment and nutritional support treatment for patients with severe tuberculosis

doi:10.19982/j.issn.1000-6621.20220041

Abstract

Abstract:

There is a two-way relationship between tuberculosis and nutritional status, they are related to each other. Tuberculosis can lead to the occurrence of nutritional risk, and is easy to develop nutritional related diseases, such as lack of nutrition, low immune function, electrolyte imbalance and so on. And poor nutritional status can lead to lymphocytic reduction, low cellular immunity and susceptibility to tuberculosis and other infectious diseases. Malnutrition is an independent risk factor affecting the prognosis and mortality of adult patients with severe tuberculosis. However, the relevant guidance documents on nutritional assessment and nutritional support treatment for patients with severe tuberculosis is still lacking. Therefore, combined with the experience and methods of nutritional support therapy in China and the latest guidelines for enteral and parenteral nutrition in the United States and Europe, the Eighth Medical Center of Chinese PLA General Hospital and the Editorial Board of Chinese Journal of Antituberculosis jointly organized experts to draw up Expert consensus on nutrition assessment and nutritional support treatment for patients with severe tuberculosis, in order to get standardized individual nutritional assessment and nutritional support treatment for patients with severe tuberculosis, and improve the prognosis and reduce mortality. This consensus expounds the importance of nutritional assessment and nutritional support treatment for patients with severe tuberculosis, the types of commonly used nutritional agents, and gives recommendations on the principles and standards of nutritional assessment and nutritional support treatment, the types and ways of giving nutrition, the types of severe tuberculosis, the complications and the nutritional support for special populations.

Key words: Tuberculosis, Intensive care, Nutrition assessment, Nutritional support, Therapeutic uses, Consensus development conferences as topic

CLC Number:

R52
R151

CHEN Zhi, LIANG Jian-qin. Expert consensus on nutritional assessment and nutritional support treatment for patients with severe tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(5): 421-432. doi: 10.19982/j.issn.1000-6621.20220041

Figures/Tables 1

References 71

[1]	Loh WJ, Yu Y, Loo CM, et al. Factors associated with mortality among patients with active pulmonary tuberculosis requiring intensive care. Singapore Med J, 2017, 58(11): 656-659. doi: 10.11622/smedj.2016160. doi: 10.11622/smedj.2016160 URL
[2]	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490. doi: 10.1136/bmj.328.7454.1490. doi: 10.1136/bmj.328.7454.1490 URL
[3]	Goldbloom RB. Weighting the evidence: the Canadian experience. Am J Clin Nutr, 1997, 65(2 Suppl): 584S-586S. doi: 10.1093/ajcn/65.2.584S. doi: 10.1093/ajcn/65.2.584S URL
[4]	Silva DR, Menegotto DM, Schulz LF, et al. Mortality among patients with tuberculosis requiring intensive care: a retrospective cohort study. BMC Infect Dis, 2010, 10: 54. doi: 10.1186/1471-2334-10-54. doi: 10.1186/1471-2334-10-54 URL
[5]	张胜康, 童照威, 唐寒梅, 等. 必须重视结核病患者的营养治疗. 中国防痨杂志, 2020, 42(12): 1272-1275. doi: 10.3969/j.issn.1000-6621.2020.12.004. doi: 10.3969/j.issn.1000-6621.2020.12.004
[6]	Sinha P, Lönnroth K, Bhargava A, et al. Food for thought: addressing undernutrition to end tuberculosis. Lancet Infect Dis, 2021, 21(10): e318-e325. doi: 10.1016/S1473-3099(20)30792-1. doi: 10.1016/S1473-3099(20)30792-1 URL
[7]	Sinha P, Hochberg NS. Controlling for undernutrition in epidemiological studies of tuberculosis. Lancet Infect Dis, 2020, 20(5): 540-541. doi: 10.1016/S1473-3099(20)30267-X. doi: 10.1016/S1473-3099(20)30267-X URL
[8]	Kimura H, Imaizumi K. Progress in management of severe tuberculosis or tuberculosis with severe complication. Kekkaku, 2014, 89(5): 571-582.
[9]	Kim CW, Kim SH, Lee SN, et al. Risk factors related with mortality in patient with pulmonary tuberculosis. Tuberc Respir Dis (Seoul), 2012, 73(1): 38-47. doi: 10.4046/trd.2012.73.1.38. doi: 10.4046/trd.2012.73.1.38 URL
[10]	中华医学会结核病学分会重症专业委员会. 结核病营养治疗专家共识. 中华结核和呼吸杂志, 2020, 43(1): 17-26. doi: 10.3760/cma.j.issn.1001-0939.2020.01.006. doi: 10.3760/cma.j.issn.1001-0939.2020.01.006
[11]	章志俊, 谭守勇. 营养风险筛查在结核病治疗中应用. 中国防痨杂志, 2015, 37(9): 971-974. doi: 10.3969/j.issn.1000-6621.2015.09.011. doi: 10.3969/j.issn.1000-6621.2015.09.011
[12]	Heyland DK, Dhaliwal R, Jiang X, et al. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care, 2011, 15(6): R268. doi: 10.1186/cc10546. doi: 10.1186/cc10546 URL
[13]	马皎洁, 安军, 贺红, 等. 结核病患者营养状况及营养支持研究进展. 中国防痨杂志, 2016, 38(11): 995-999. doi: 10.3969/j.issn.1000-6621.2016.11.020. doi: 10.3969/j.issn.1000-6621.2016.11.020
[14]	Koethe JR, von Reyn CF. Protein-calorie malnutrition, macronutrient supplements, and tuberculosis. Int J Tuberc Lung Dis, 2016, 20(7): 857-863. doi: 10.5588/ijtld.15.0936. doi: 10.5588/ijtld.15.0936 pmid: 27287634
[15]	WEIR JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol, 1949, 109(1/2): 1-9. doi: 10.1113/jphysiol.1949.sp004363. doi: 10.1113/jphysiol.1949.sp004363
[16]	Kan MN, Chang HH, Shen WF, et al. Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status. Crit Care, 2003, 7(5): R108-R115. doi: 10.1186/cc2366. doi: 10.1186/cc2366 URL
[17]	Grau Carmona T, López Martínez J, Vila García B, et al. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: respiratory failure. Nutr Hosp, 2011, 26 Suppl 2: 37-40. doi: 10.1590/S0212-16112011000800008. doi: S0212-16112011000100004 pmid: 21519728
[18]	石汉平, 许红霞, 李苏宜, 等. 营养不良的五阶梯治疗. 肿瘤代谢与营养电子杂志, 2015, 2(1): 29-33.
[19]	Bozzetti F, Arends J, Lundholm K, et al. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr, 2009, 28(4): 445-454. doi: 10.1016/j.clnu.2009.04.011. doi: 10.1016/j.clnu.2009.04.011 pmid: 19477052
[20]	Arends J, Bodoky G, Bozzetti F, et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr, 2006, 25(2): 245-259. doi: 10.1016/j.clnu.2006.01.020. doi: 10.1016/j.clnu.2006.01.020 pmid: 16697500
[21]	Berger MM, Reintam-Blaser A, Calder PC, et al. Monitoring nutrition in the ICU. Clin Nutr, 2019, 38(2): 584-593. doi: 10.1016/j.clnu.2018.07.009. doi: S0261-5614(18)31211-1 pmid: 30077342
[22]	Dossett LA, Cao H, Mowery NT, et al. Blood glucose variability is associated with mortality in the surgical intensive care unit. Am Surg, 2008, 74(8): 679-685. doi: 10.1177/000313480807400802. doi: 10.1177/000313480807400802
[23]	Hermanides J, Vriesendorp TM, Bosman RJ, et al. Glucose variability is associated with intensive care unit mortality. Crit Care Med, 2010, 38(3): 838-842. doi: 10.1097/CCM.0b013e3181cc4be9. doi: 10.1097/CCM.0b013e3181cc4be9 pmid: 20035218
[24]	Egi M, Krinsley JS, Maurer P, et al. Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality. Intensive Care Med, 2016, 42(4): 562-571. doi: 10.1007/s00134-016-4216-8. doi: 10.1007/s00134-016-4216-8 URL
[25]	Ichai C, Preiser JC, Société Française d’Anesthésie-Réanimation, et al. International recommendations for glucose control in adult non diabetic critically ill patients. Crit Care, 2010, 14(5): R166. doi: 10.1186/cc9258. doi: 10.1186/cc9258 URL
[26]	中国医师协会内分泌代谢科医师分会, 中国住院患者血糖管理专家组. 中国住院患者血糖管理专家共识. 中华内分泌代谢杂志, 2017, 33(1):1-10. doi: 10.3760/cma.j.issn.1000-6699.2017.01.001. doi: 10.3760/cma.j.issn.1000-6699.2017.01.001
[27]	von Haehling S. ICU-acquired weakness and recovery from critical illness. N Engl J Med, 2014, 371(3): 287. doi: 10.1056/NEJMc1406274. doi: 10.1056/NEJMc1406274 URL
[28]	Singer P, Hiesmayr M, Biolo G, et al. Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target. Clin Nutr, 2014, 33(2): 246-251. doi: 10.1016/j.clnu.2013.12.004. doi: 10.1016/j.clnu.2013.12.004 URL
[29]	Barazzoni R, Deutz NEP, Biolo G, et al. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin Nutr, 2017, 36(2): 355-363. doi: 10.1016/j.clnu.2016.09.010. doi: S0261-5614(16)31248-1 pmid: 27686693
[30]	Burke JF, Wolfe RR, Mullany CJ, et al. Glucose requirements following burn injury. Parameters of optimal glucose infusion and possible hepatic and respiratory abnormalities following excessive glucose intake. Ann Surg, 1979, 190(3): 274-285. doi: 10.1097/00000658-197909000-00002. doi: 10.1097/00000658-197909000-00002 pmid: 485602
[31]	Boulétreau P, Chassard D, Allaouchiche B, et al. Glucose-lipid ratio is a determinant of nitrogen balance during total parenteral nutrition in critically ill patients: a prospective, randomized, multicenter blind trial with an intention-to-treat analysis. Intensive Care Med, 2005, 31(10): 1394-1400. doi: 10.1007/s00134-005-2771-5. doi: 10.1007/s00134-005-2771-5 URL
[32]	Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr, 2019, 38(1): 48-79. doi: 10.1016/j.clnu.2018.08.037. doi: 10.1016/j.clnu.2018.08.037 URL
[33]	Calder PC, Adolph M, Deutz NE, et al. Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group. Clin Nutr, 2018, 37(1):1-18. doi: 10.1016/j.clnu.2017.08.032. doi: 10.1016/j.clnu.2017.08.032 URL
[34]	Esparza J, Boivin MA, Hartshorne MF, et al. Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intensive Care Med, 2001, 27(4): 660-664. doi: 10.1007/s001340100880. doi: 10.1007/s001340100880 URL
[35]	Day L, Stotts NA, Frankfurt A, et al. Gastric versus duodenal feeding in patients with neurological disease: a pilot study. J Neurosci Nurs, 2001, 33(3): 148-149, 155-159. doi: 10.1097/01376517-200106000-00007. doi: 10.1097/01376517-200106000-00007 pmid: 11413660
[36]	Hasse JM, Blue LS, Liepa GU, et al. Early enteral nutrition support in patients undergoing liver transplantation. JPEN J Parenter Enteral Nutr, 1995, 19(6): 437-443. doi: 10.1177/0148607195019006437. doi: 10.1177/0148607195019006437 pmid: 8748357
[37]	Kearns PJ, Chin D, Mueller L, et al. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: a randomized clinical trial. Crit Care Med, 2000, 28(6): 1742-1746. doi: 10.1097/00003246-200006000-00007. doi: 10.1097/00003246-200006000-00007 pmid: 10890612
[38]	Kortbeek JB, Haigh PI, Doig C. Duodenal versus gastric feeding in ventilated blunt trauma patients: a randomized controlled trial. J Trauma, 1999, 46(6): 992-996, 996-998. doi: 10.1097/00005373-199906000-00002. doi: 10.1097/00005373-199906000-00002 URL
[39]	Mowatt-Larssen CA, Brown RO, Wojtysiak SL, et al. Comparison of tolerance and nutritional outcome between a peptide and a standard enteral formula in critically ill, hypoalbuminemic patients. JPEN J Parenter Enteral Nutr, 1992, 16(1): 20-24. doi: 10.1177/014860719201600120. doi: 10.1177/014860719201600120 pmid: 1738214
[40]	Heimburger DC, Geels VJ, Bilbrey J, et al. Effects of small-peptide and whole-protein enteral feedings on serum proteins and diarrhea in critically ill patients: a randomized trial. JPEN J Parenter Enteral Nutr, 1997, 21(3):162-167. doi: 10.1177/0148607197021003162. doi: 10.1177/0148607197021003162 pmid: 9168369
[41]	Neumann DA, DeLegge MH. Gastric versus small-bowel tube feeding in the intensive care unit: a prospective comparison of efficacy. Crit Care Med, 2002, 30(7): 1436-1438. doi: 10.1097/00003246-200207000-00006. doi: 10.1097/00003246-200207000-00006 pmid: 12130958
[42]	Meredith JW, Ditesheim JA, Zaloga GP. Visceral protein levels in trauma patients are greater with peptide diet than with intact protein diet. J Trauma, 1990, 30(7): 825-828, 828-829. doi: 10.1097/00005373-199007000-00011. doi: 10.1097/00005373-199007000-00011 URL
[43]	Mitchell AB, Ryan TE, Gillion AR, et al. Vitamin C and Thiamine for Sepsis and Septic Shock. Am J Med, 2020, 133(5): 635-638. doi: 10.1016/j.amjmed.2019.07.054. doi: S0002-9343(19)30699-0 pmid: 31469984
[44]	Tymon-Rosario J, Atrio JM, Yoon HA, et al. Streptococcus constellatus Peritonitis and Subsequent Septic Shock following Intrauterine Device Removal. Case Rep Obstet Gynecol, 2019, 2019: 6491617. doi: 10.1155/2019/6491617. doi: 10.1155/2019/6491617
[45]	Merchan C, Altshuler D, Aberle C, et al. Tolerability of Enteral Nutrition in Mechanically Ventilated Patients With Septic Shock Who Require Vasopressors. J Intensive Care Med, 2017, 32(9): 540-546. doi: 10.1177/0885066616656799. doi: 10.1177/0885066616656799 URL
[46]	刘岩红, 袁凤云, 蒋立会. 酪酸梭菌活菌胶囊对行早期肠内营养支持的感染性休克患者胃肠道症状改善作用观察. 中国微生态学杂志, 2021, 33(2): 209-213. doi: 10.13381/j.cnki.cjm.202102017. doi: 10.13381/j.cnki.cjm.202102017
[47]	韩骏锋, 刘永霞, 董淑丽, 等. 血行播散性肺结核合并急性呼吸窘迫综合征30例诊治分析. 山东医药, 2016, 56(28): 98-100. doi: 10.3969/j.issn.1002-266X.2016.28.036. doi: 10.3969/j.issn.1002-266X.2016.28.036
[48]	Rice TW, Mogan S, Hays MA, et al. Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med, 2011, 39(5): 967-974. doi: 10.1097/CCM.0b013e31820a905a. doi: 10.1097/CCM.0b013e31820a905a URL
[49]	Braunschweig CA, Sheean PM, Peterson SJ, et al. Intensive nutrition in acute lung injury: a clinical trial (INTACT). JPEN J Parenter Enteral Nutr, 2015, 39(1): 13-20. doi: 10.1177/0148607114528541. doi: 10.1177/0148607114528541 pmid: 24722769
[50]	Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr, 2006, 25(1): 37-44. doi: 10.1016/j.clnu.2005.10.010. doi: 10.1016/j.clnu.2005.10.010 URL
[51]	Villet S, Chiolero RL, Bollmann MD, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr, 2005, 24(4):502-509. doi: 10.1016/j.clnu.2005.03.006. doi: 10.1016/j.clnu.2005.03.006 URL
[52]	中国医师协会呼吸医师分会危重症专业委员会, 中华医学会呼吸病学分会危重症医学学组, 《中国呼吸危重症疾病营养支持治疗专家共识》专家委员会. 中国呼吸危重症患者营养支持治疗专家共识. 中华医学杂志, 2020, 100(8): 573-585. doi: 10.3760/cma.j.issn.0376-2491.2020.08.012. doi: 10.3760/cma.j.issn.0376-2491.2020.08.012
[53]	熊胜, 熊宇, 杨中善, 等. 肠内营养的临床研究进展. 临床消化病杂志, 2017, 29(6):398-401. doi: 10.3870/lcxh.j.issn.1005-541X.2017.06.20. doi: 10.3870/lcxh.j.issn.1005-541X.2017.06.20
[54]	陈英杰, 孟玲宇. 重症结核性脑膜炎昏迷患者营养支持治疗体会. 中国误诊学杂志, 2011, 11(4): 829-830.
[55]	中华医学会重症医学分会. 危重病人营养支持指导意见(2006). 中国实用外科杂志, 2006, 26(10): 721-732. doi: 10.3321/j.issn:1005-2208.2006.10.001. doi: 10.3321/j.issn:1005-2208.2006.10.001
[56]	孟丽娜, 张广宇, 张玉想. ICU重症结核性脑膜炎患者的营养评估与支持. 中华临床医师杂志(电子版), 2013, 7(6): 2657-2659. doi: 10.3877/cma.j.issn.1674-0785.2013.06.088. doi: 10.3877/cma.j.issn.1674-0785.2013.06.088
[57]	Reignier J, Boisramé-Helms J, Brisard L, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet, 2018, 391(10116): 133-143. doi: 10.1016/S0140-6736(17)32146-3. doi: S0140-6736(17)32146-3 pmid: 29128300
[58]	赵爱斌. 抗结核药物加肠内营养治疗重症结核性肠梗阻病人. 肠外与肠内营养, 2015, 22(4): 193-195.
[59]	黄雪芝, 罗建冬, 吴登助, 等. 重症肠结核并发肠瘘患者的营养支持治疗. 中国防痨杂志, 2021, 43(2): 194-196. doi: 10.3969/j.issn.1000-6621.2021.02.017. doi: 10.3969/j.issn.1000-6621.2021.02.017
[60]	Gupta H, Agrawal A, Pathak AA. Superior Mesenteric Artery Syndrome Following Tubercular Intestinal Perforation. Cureus, 2019, 11(4): e4506. doi: 10.7759/cureus.4506. doi: 10.7759/cureus.4506
[61]	Machoki SM, Saidi H, Ahmed M. Conservative management of a high output enterocutaneous fistula in abdominal tuberculosis. BMJ Case Rep, 2011, 2011: bcr1120103494. doi: 10.1136/bcr.11.2010.3494. doi: 10.1136/bcr.11.2010.3494
[62]	吕和, 李雨泽, 闫雅更, 等. 2型糖尿病患者与其并发肺结核患者的膳食营养状况分析. 中国防痨杂志, 2017, 39(12): 1282-1285. doi: 10.3969/j.issn.1000-6621.2017.12.006. doi: 10.3969/j.issn.1000-6621.2017.12.006
[63]	Goncalves MD, Lu C, Tutnauer J, et al. High-fructose corn syrup enhances intestinal tumor growth in mice. Science, 2019, 363(6433): 1345-1349. doi: 10.1126/science.aat8515. doi: 10.1126/science.aat8515 pmid: 30898933
[64]	黄家辉, 叶旻泓, 周欣. 抗结核药物导致肝损害2015-2020年文献分析. 现代药物与临床, 2021, 36(4): 823-827. doi: 10.7501/j.issn.1674-5515.2021.04.039. doi: 10.7501/j.issn.1674-5515.2021.04.039
[65]	Bischoff SC, Bernal W, Dasarathy S, et al. ESPEN practical guideline: Clinical nutrition in liver disease. Clin Nutr, 2020, 39(12): 3533-3562. doi: 10.1016/j.clnu.2020.09.001. doi: 10.1016/j.clnu.2020.09.001 pmid: 33213977
[66]	北京医学会肠外肠内营养学专业委员会,《慢性肝病患者肠外肠内营养支持与膳食干预专家共识》专家委员会. 慢性肝病患者肠外肠内营养支持与膳食干预专家共识. 临床肝胆病杂志, 2017, 33(7): 1236-1245. doi: 10.3969/j.issn.1001-5256.2017.07.006. doi: 10.3969/j.issn.1001-5256.2017.07.006
[67]	Liu X, Kong M, Hua X, et al. Effects of an individualized nutrition intervention on the respiratory quotient of patients with liver failure. Asia Pac J Clin Nutr, 2019, 28(3): 428-434. doi: 10.6133/apjcn.201909_28(3).0001. doi: 10.6133/apjcn.201909_28(3).0001
[68]	吴牧晨, 孟庆华. 慢加急性肝衰竭患者的营养评估及临床管理. 临床肝胆病杂志, 2021, 37(4): 770-774. doi: 10.3969/j.issn.1001-5256.2021.04.006. doi: 10.3969/j.issn.1001-5256.2021.04.006
[69]	Cupisti A, Brunori G, Di Iorio BR, et al. Nutritional treatment of advanced CKD: twenty consensus statements. J Nephrol, 2018, 31(4): 457-473. doi: 10.1007/s40620-018-0497-z. doi: 10.1007/s40620-018-0497-z URL
[70]	陈丹萍, 李敏. 老年肺结核患者营养状况评价研究进展. 中国防痨杂志, 2018, 40(8): 894-897. doi: 10.3969/j.issn.1000-6621.2018.08.021. doi: 10.3969/j.issn.1000-6621.2018.08.021
[71]	Leder SB, Siner JM, Bizzarro MJ, et al. Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula. Dysphagia, 2016, 31(2): 154-159. doi: 10.1007/s00455-015-9669-3. doi: 10.1007/s00455-015-9669-3 URL

证据	具体描述	表示方法
质量等级
高	非常确信真实的效应值接近效应估计值	A
中	对效应估计值有中等程度的信心:真实值有可能接近估计值,但仍存在二者大不相同的可能性	B
低	对效应估计值的确信程度有限:真实值可能与估计值大不相同	C
极低	对效应估计值几乎没有信心:真实值很可能与估计值大不相同	D
推荐强度
强	支持使用某项干预措施的强推荐,干预措施明显利大于弊	1
弱	支持使用某项干预措施的弱推荐,干预措施可能利大于弊	2
弱	反对使用某项干预措施的弱推荐,干预措施可能弊大于利或利弊关系不明确	2
强	反对使用某项干预措施的强推荐,明确显示干预措施弊大于利	1