老年慢阻肺急性加重期营养状况及急性加重危险因素分析  

Evaluation of nutritional status and risk factors of acute exacerbation of chronic obstructive pulmonary disease in the elderly

作　　者：任姗姗[1] 李冠臻[1] 孙建琴[2] 陈鄢津 张片红[4] 楼惠玲 杨子艳 朱明炜[1] Ren Shanshan;Li Guanzhen;Sun Jianqin;Chen Yanjin;Zhang Pianhong;Lou Huiling;Yang Ziyan;Zhu Mingwei(Department of Nutrition,Beijing Hospital,National Center of Gerontology Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nutrition,Shanghai Huadong Hospital,Shanghai 200040,China;Department of Gastrointestinal Surgery,Tianjin Nankai Hospital,Tianjin 300140,China;Department of Nutrition,the Second Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310009,China;Department of Geriatrics,Guangzhou first People′s Hospital,Guangzhou 510180,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,北京100730 [2]上海华东医院营养科,上海200040 [3]天津南开医院胃肠外科,天津300140 [4]浙江大学医学院附属第二医院营养科,杭州310009 [5]广州市第一人民医院老年科,广州510180

出　　处：《中华健康管理学杂志》2022年第4期236-240,共5页Chinese Journal of Health Management

基　　金：北京市科技计划项目(D181100000218004)。

摘　　要：目的评估老年慢性阻塞性肺疾病(简称慢阻肺)急性加重期营养状况,并分析急性加重的危险因素。方法回顾分析2012年1月—2020年12月主要来自全国5家三级甲等医院(北京医院、上海华东医院、天津南开医院、浙江大学医学院附属第二医院、广州市第一人民医院)的老年慢阻肺住院患者的调查数据。根据全球慢阻肺防治倡议诊断标准(GOLD),将纳入的339例老年慢阻肺患者分为急性加重期组和稳定期组。比较两组患者入院后年龄、性别、病史、人体测量、实验室检查、营养支持情况及营养风险筛查2002(NRS2002)、全球领导人营养不良倡议(GLIM)营养不良诊断结果的差异,并采用多因素logistic回归分析老年慢阻肺急性加重的危险因素。结果339例65~100岁老年慢阻肺患者纳入本研究,其中急性加重期组177例(52.21%),稳定期组162例(47.79%)。GLIM标准下急性加重期组营养不良检出率高于稳定期组(51.98%比41.98%,P<0.05)。急性加重期组的体重、体质指数(BMI)、握力均显著低于稳定期组[(55.47±8.42)比(60.63±9.30)kg、(20.52±4.25)比(22.39±4.57)kg/m^(2)、(12.32±4.21)比(16.59±2.97)kg](均P<0.05)。Spearman相关分析表明,老年慢阻肺患者急性加重与营养不良呈正相关(r=0.443,P<0.001),与体重、BMI及小腿围呈负相关(r=-0.200、-0.214、-0.135,均P<0.05)。多元logistic回归分析显示,老年慢阻肺患者急性加重仅与营养不良相关(OR=7.799,95CI:4.466~13.622,P<0.001)。结论老年慢阻肺急性加重期营养不良发生率较高,营养不良与急性加重独立相关。Objective To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease(COPD)in the elderly.Methods Data of elderly hospitalized patients with COPD mainly from 5 grade A,class 3 hospitals(Beijing Hospital,Shanghai Huadong Hospital,Tianjin Nankai hospital,the Second Affiliated Hospital of Medical College of Zhejiang University,Guangzhou First People′s Hospital)from January 2012 to December 2020 were retrospectively analyzed.According to the global initiative for chronic obstructive lung disease criteria(GOLD),elderly COPD patients were divided into acute exacerbation group and stable group.The differences in age,gender,medical history,anthropometry,laboratory examination,nutritional support,results of nutritional risk screening 2002(NRS2002)and global leadership initiative on malnutrition(GLIM)were compared between the two groups after admission,and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results A total of 339 elderly patients with COPD aged 65-100 years were included in this study,including 177 cases(52.21%)in acute exacerbation stage.The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage(51.98%vs 41.98%,P<0.05).The weight,body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period[(55.47±8.42)vs(60.63±9.30)kg,(20.52±4.25)vs(22.39±4.57)kg/m^(2),(12.32±4.21)vs(16.59±2.97)kg](all P<0.05).Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition(r=0.443,P<0.001),and negatively correlated with body weight,body mass index and calf circumference(r=-0.200,-0.214,-0.135,all P<0.05).Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition(OR=7.799,95%CI:4.466-13.622,P<0.001).Conclusions The incidence of malnutrit

关 键 词：肺疾病 慢性阻塞性 营养不良 老年 急性加重 

分 类 号：R563.9[医药卫生—呼吸系统]