老年脑卒中患者应用全球营养领导人发起的营养不良标准评价营养状态的研究  

The Global Leadership Initiative on Malnutrition criteria for the assessment of elderly inpatients with stroke and their correlation with clinical outcomes

作　　者：任姗姗[1] 杨子艳 李冠臻[1] 朱明炜[1] Ren Shanshan;Yang Ziyan;Li Guanzhen;Zhu Mingwei(Department of Nutrition,Beijing Hospital,National Center of Gerontology Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院营养科国家老年医学中心中国医学科学院老年医学研究院,100730

出　　处：《中华老年医学杂志》2022年第3期271-275,共5页Chinese Journal of Geriatrics

基　　金：北京医院院级课题(BJ-2019-161);北京市科技计划项目(D181100000218004)。

摘　　要：目的应用全球营养领导人发起的营养不良标准(GLIM)评定老年脑卒中住院患者营养不良的发生情况,并探讨与临床结局的相关性。方法回顾性研究,应用GLIM标准对2012年3月至2021年8月全国多中心658例65~92岁老年脑卒中住院患者进行营养不良评价,并探讨营养不良与临床结局的相关性。结果658例患者中,男性身高、体重、体质指数、上臂围、小腿围、肌酐高于女性(均P<0.05),总胆固醇低于女性(P<0.05)。采用GLIM诊断的营养不良发生率为9.12%(60例)。营养不良患者体重、体质指数、上臂围、小腿围、白蛋白、总胆固醇低于非营养不良患者(均P<0.05),年龄、住院时间、感染性并发症及死亡率高于非营养不良患者(均P<0.05)。采用微型营养评估量表-简版(MNA-SF)评价,14.74%(97例)患者存在营养不良。GLIM与MNA-SF评价一致性一般(灵敏度59.4%,特异度100.0%,阳性预测值100.0%,阴性预测值93.1%,Kappa=0.712)。经GLIM诊断的营养不良与住院时间延长(OR=1.022,95%CI:1.005~1.039,P<0.01)、感染并发症(OR=16.614,95%CI:8.130~33.952,P<0.01)及死亡风险增加(OR=2.810,95%CI:1.393~3.548,P<0.05)有关。结论老年脑卒中住院患者应用GLIM诊断营养不良的发生率低于MNA-SF,且营养不良与不良临床结局相关。Objective To use the Global Leadership Initiative on Malnutrition(GLIM)criteria to assess the incidence of malnutrition in hospitalized elderly stroke patients,and to investigate the correlation between the criteria and clinical outcomes.Methods A cross-sectional study was conducted from March 2012 to August 2021 to evaluate malnutrition in 658 elderly stroke inpatients aged 65-92 years,the GLIM criteria were used,and the correlation between the criteria and clinical outcomes was explored.Results Of the 658 patients,men showed higher values in height,weight,Bady mass index,upper arm circumference,calf circumference and creatinine(all P<0.05),but lower total cholesterol(P<0.05).The incidence of malnutrition diagnosed with the GLIM criteria was 9.12%(60 cases).Based on the GLIM criteria,those with malnutrition had lower weight,Bady mass index,upper arm circumference,calf circumference,albumin and total cholesterol(all P<0.05),while age,duration of hospitalization,infectious complications and mortality was higher than those without malnutrition(P<0.05).Using the mini nutritional assessment-short form(MNA-SF),14.74%(97 cases)of the patients had malnutrition.Results from the GLIM criteria and the MNA-SF were moderately consistent(sensitivity:59.4%,specificity:100.0%,positive predictive value:100.0%,negative predictive value:93.1%,Kappa=0.712).Malnutrition diagnosed with the GLIM criteria was associated with a longer duration of hospitalization(OR=1.022,95%CI:1.005-1.039,P<0.01),increased infectious complications(OR=16.614,95%CI:8.130-33.952,P<0.01),and increased risk of death(OR=2.810,95%CI:1.393-3.548,P<0.05).Conclusions The incidence of malnutrition in hospitalized elderly stroke patients based on the GLIM criteria is lower than that based on the MNA-SF,and malnutrition is associated with adverse clinical outcomes.

关 键 词：营养不良 卒中 住院病人 

分 类 号：R743.3[医药卫生—神经病学与精神病学]