结核病患者营养素缺乏临床特征研究进展

doi:10.3969/j.issn.1000-6621.2020.07.018

摘要/Abstract

摘要：

营养不良是活动性结核病患者的常见结局之一,也是结核病患者早期死亡的危险因素。若不加以干预,结核病与营养不良间会形成一种恶性循环,导致结核病患者临床症状更为严重,治疗不良事件发生率更高,患者死亡风险更高。随着中国居民平均生活水平的提高及临床营养学的发展,对于结核病患者的营养管理,也逐渐开始重视起来。为更有针对性地设计营养补充方案,首先需要明确结核病患者各类营养素缺乏的具体情况。作者通过对国内外结核病营养研究现状进行分析,综合阐述了结核病患者宏量营养素、维生素和矿物质等各类营养素缺乏的临床特征,梳理了结核病患者的营养支持治疗思路,提出了各营养素的补充目标。

关键词: 结核, 营养不良, 疾病特征, 综述

Abstract:

Malnutrition is one of the common outcomes of the patients with active tuberculosis (TB), and it is also a risk factor for early death of the TB patients. Without interventions, a vicious circle between TB and malnutrition will be formed, resulting in more serious clinical manifestations, higher incidence of adverse drug events (ADEs), and higher risk of death in TB patients. Along with the improvement of the Chinese average living level and the development of clinical nutriology, more and more attentions have been paid to the nutrition management of TB patients. In order to design more targeted nutrition supplement programs, it is necessary to determine the specific situation of various nutrients deficiency in TB patients. Based on the analysis of national and international researches about the nutrients of TB patients, the author comprehensively expounded the clinical characteristics of the TB patients when they were short of macronutrients, vitamins and minerals etc., combed the ideas of nutrition support treatment to the TB patients, and provided the targeted supplement indicators of various nutrients.

Key words: Tuberculosis, Malnutrition, Disease attributes, Review

姜丽, 张晓强, 刘伶俐, 王晗, 刘峰, 李智越, 沈生荣. 结核病患者营养素缺乏临床特征研究进展[J]. 中国防痨杂志, 2020, 42(7): 741-746. doi: 10.3969/j.issn.1000-6621.2020.07.018

JIANG Li, ZHANG Xiao-qiang, LIU Ling-li, WANG Han, LIU Feng, LI Zhi-yue, SHEN Sheng-rong. Research progress of clinical characteristics of malnourished patients with tuberculosis[J]. Chinese Journal of Antituberculosis, 2020, 42(7): 741-746. doi: 10.3969/j.issn.1000-6621.2020.07.018

图/表 1

表1

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文献第一作者 (年份)	国别	补充营养类型	受试者	样本量 (例)	饮食结构	结果
Paton(2004)^[12]	新加坡	蛋白质、能量	成年结核病患者,体质量指数(BMI)<20	36	补充治疗组:建议饮食标准,额外添加含2510~3766kJ的安素(含25~37.5g蛋白质),为期6周对照组:建议饮食标准,为期6周	补充治疗组与对照组在第12周均出现体质量增加,分别为2.6kg和0.8kg;体质量和握力增加
Martins(2009)^[13]	东帝汶	蛋白质、能量	成年结核病患者,80%的患者BMI<18.5	270	补充治疗组:建议饮食标准,额外添加含1799kJ的肉类(含18g蛋白质),2个月院内+6个月居家对照组:建议饮食标准,2个月院内+6个月居家	补充治疗组与对照组在第8周体质量分别增加5.2kg和3.5kg
Sudarsanam(2011)^[14]	印度	蛋白质、维生素、微量元素、能量	成年结核病患者,BMI≤19,其中22例患者并发HIV感染,CD4⁺ T淋巴细胞≤200 个/μl	103	建议饮食标准,额外添加谷物和豆类混合物,能量约为3891kJ,蛋白质含量约31.5g,为期6个月对照组:建议饮食标准,为期6个月	组间结果差异无统计学意义,但补充治疗组的结核病及结核病并发HIV感染者都有改善的趋势
Jahnavi(2010)^[15]	印度	蛋白质、维生素、微量元素、能量	成年结核病患者,BMI≤20	100	建议饮食标准,额外添加糖丸(一种补充能量的食物;含2510kJ能量和6g蛋白质),100g的坚果(用于补充维生素和矿物质),为期3个月对照组:建议饮食标准,为期3个月	补充治疗组与对照组在第3个月均出现较为明显的体质量增加,分别为3.7kg 和1.1kg