克罗恩病患者的营养风险筛查  

Nutritional risk screening in patients with Crohn＆#39;s disease

作　　者：武芸[1] 何瑶[1] 陈芳[1] 冯婷[1] 李蔓英[1] 郭静[1] 余乔[1] 王慧玲[1] 唐睿晗[1] 李彤[1] 毛仁[1] 张盛洪[1] 陈白莉[1] 曾志荣[1] 陈旻湖[1] 

机构地区：[1]中山大学附属第一医院消化内科,广州510080

出　　处：《中华医学杂志》2016年第6期442-446,共5页National Medical Journal of China

摘　　要：目的 对克罗恩病（CD）患者进行营养风险筛查,调查CD患者存在营养风险的发生率及特点,探讨CD患者存在营养风险的危险因素.方法 纳入2003年1月至2014年1月于中山大学附属第一医院炎症性肠病诊治中心确诊的CD患者712例,采用蒙特利尔分型评估CD临床分型,以疾病活动度（CDAI）评分评估疾病活动度,同时应用欧洲营养风险筛查工具（NRS2002）进行营养风险评分,探讨CD患者存在营养风险的危险因素.对随访满1年的患者再次进行NRS 2002评分,以探讨治疗方式对CD患者消除营养风险的影响.结果 确诊时65.2％ （464/712）的CD患者存在营养风险.存在营养风险的发生率在不同疾病活动度（x2=117.169,P＜0.001）、确诊年龄（x2=11.256,P=0.004）、病变部位（x2=18.841,P=0.001）及疾病行为（x2=15.793,P＜0.001）的CD患者中差异均有统计学意义.但不同性别CD患者存在营养风险的发生率差异无统计学意义（x2=0.601,P=0.245）.多因素Logistic回归分析提示,腹部压痛（OR=1.895,95％ CI：1.080 ～3.324）,轻度活动（OR=1.846,95％ CI：1.179 ～2.890）、中度活动（OR =4.410,95％ CI：2.701～7.200）、重度活动（OR=14.069,95％ CI：1.718 ～ 115.192）,狭窄型（B2型）（OR=1.620,95％ CI：1.034 ～2.538）或穿透型（B3型）（OR=1.920,95％ CI：1.025～3.596）疾病行为,红细胞沉降率（ESR）水平较高（OR=1.024,95％ CI：1.015 ～1.034）是存在营养风险的独立危险因素;而确诊年龄在40岁以上（A3型）（OR=0.332,95％ CI：0.135 ～0.814）,白蛋白水平较高（OR=0.962,95％ CI：0.934 ～0.990）是存在营养风险的保护因素.随访1年时,32.0％ （111/347）的患者消除营养风险,接受手术治疗的患者消除营养风险的比率大于单纯使用药物治疗的患者[42.9％ （54/126）比25.8％ （57/221）,x2=10.742,P =0.001].结论 超过2/3的CD患者确诊时存在营养风险,不同的CD疾病活动度及蒙特利尔临床�Objective To screen the nutritional risk in patients with Crohn＆#39;s disease （CD）,to explore the prevalence and characteristics of nutritional risk in CD patients,and to identify the possible risk factors.Method A cross-sectional study was performed in 712 patients who was diagnosed as CD in the Center for Inflammatory Bowel Disease of First Affiliated Hospital of Sun Yat-sen University between January 2003 and January 2014.Montreal classification was used to classify CD,Crohn＆#39;s Disease Activity Index （CDAI） was used to evaluate disease activity,and Nutritional Risk Screening 2002 （NRS2002） was used to assess the nutritional risk in each patient.Reappraisal with NRS 2002 was conducted in patients followed up for 1 year to identify the possible effect of treatment on nutritional risk of the CD patients.Results The prevalence of nutritional risk was 65.2% （464/712） in the enrolled CD patients.The prevalence of nutritional risk was significantly different among patients with different disease activity （x2 =117.169,P 〈0.001）,also significantly different among patients of different age at diagnosis （x2 =11.256,P =0.004）,with different lesion location （x2 =18.841,P =0.001） and different disease behavior （x2 =15.793,P 〈0.001）,but not significantly different in patients of different sex （x2 =0.601,P =0.245）.Multivariate logistic regression showed that the independent predictive risk factors for nutritional risk included abdominal tenderness （OR =1.895,95% CI：1.080-3.324）;mild （OR =1.846,95% CI：1.179-2.890）,moderate （OR =4.410,95 % CI：2.701-7.200） and severe （OR =14.069,95 % CI：1.718-115.192）disease activity;B2 （stricturing） （OR =1.620,95% CI：1.034-2.538） and B3 （penetrating） （OR =1.920,95% CI：1.025-3.596） types of disease behavior;and high level with erythrocyte sedimentation rate （ESR） （OR =1.024,95% CI：1.015-1.034）.On the other hand,〉 40 years at diagnosis （A3 type） （OR =0.332,95% CI：0.135-0.814） and high

关 键 词：CROHN病 营养评价 营养风险筛查2002 营养风险 

分 类 号：R574.62[医药卫生—消化系统]