合并糖尿病的老年肺炎住院患者营养风险评估及短期预后  

Assessment of Nutrition Risk and Short-term Prognosis in Elderly Diabetes Pneumonia Patients

作　　者：翟文亮[1] 刘利欣 李俊芬[1] 王晶[1] Zhai Wenliang;Liu Lixin;Li Junfen(Emergency Department of Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院急诊科,北京100053

出　　处：《医学研究杂志》2018年第8期129-132,136,共5页Journal of Medical Research

摘　　要：目的使用老年营养风险评分(geriatric nutritional risk index,GNRI)评价因社区获得性肺炎(community acquired pneumonia,CAP)住院的老年糖尿病患者的营养风险,评估GNRI对短期预后的预测价值。方法回顾分析2015年1月~2016年6月因CAP收住首都医科大学宣武医院急诊科病房的年龄65岁及以上糖尿病患者114例,另选择同期住院的非糖尿病老年患者55例作为对照组,分析比较两组患者GNRI评分及PSI评分。以GNRI=92分为界限,将糖尿病组分为GNRI<92分(n=43)和GNRI≥92(n=71)分两个亚组,比较亚组间PSI评分,呼吸机(有创、无创)使用的发生率,住院病死率及出院患者2周内再住院率的差异。分析GNRI等各因素与住院病死率的相关性。结果糖尿病组患者GNRI评分低于非糖尿病组(89.27±6.30,93.26±8.29,P<0.05);糖尿病组内比较,GNRI<92亚组PSI评分及住院病死率均显著高于GNRI≥92亚组(99.65±18.85,92.19±13.36,P=0.015;25.6%,8.45%,P=0.013);对糖尿病组住院死亡相关危险因素分析显示,GNRI评分,血浆白蛋白水平与不良事件发生率呈负相关(r=-0.247,P=0.008;r=-0.303,P=0.001),同时PSI,冠心病史与住院死亡发生呈正相关(r=0.168,P=0.024;r=-0.153,P=0.016)。结论老年糖尿病CAP患者存在较大营养风险,营养风险高的短期预后较差,使用GNRI评分有助于预测短期预后。Objective To assess the nutrition risk of the elderly diabetes admitted in hospital as community acquired pneumonia（CAP） by geriatric nutritional risk Index（GNRI）,analysis the value of GNRI in predicting the short-term prognosis. Methods This retrospective study continuously enrolled 114 CAP paitients with diabetes aged 65 at least,who were admitted by emergency department of Xuanwu Hospital of Capital Medical University from January 2015 to June 2016, This study also enrolled 55 CAP paitents without diabetes as control group,who admitted the same time in the same department.GNRI and PSI were compared.Tthe diabetes group was divided into two subgroup by the GNRI=92（GNRI〈92,n=43; GNRI ≥ 92,n=71）.PSI,Mechanic Ventilation rate,in-hospital mortality and re-admitted in hospital in 14 days rate were compared.We figured out the relationship between in-hospital mortality and GNRI and other risk factors. Results GNRI of diabetes group was lower than control group （89.27±6.30,93.26±8.29,P〈0.05）.PSI and in-hospital mortality of GNRI〈92 subgroup were higher than GNRI ≥ 92 subgroup（99.65±18.85,92.19±13.36,P=0.015）.Both GNRI and low serum album level showed minus relation to in-hospital mortality（r=-0.247,P=0.008;r=-0.303, P=0.001）,while PSI and History showed positive relations（r=0.168,P=0.024;r=-0.153, P=0.016）. Conclusion Higher nutrition risk was found in aged CAP patients with diabetes,that also meant worse short-term prognosis.It was useful to tools like GNRI to predict the short-term prognosis.

关 键 词：老年营养风险评分 糖尿病 社区获得性肺炎 老年 

分 类 号：R587[医药卫生—内分泌]