不同营养不良诊断方法在老年神经系统疾病的比较研究  

Comparative study of different diagnostic methods for malnutrition in the elderly with nervous system diseases

作　　者：陈丽如[1] 丁丽丽[1] 王丽娟[1] 程博[1] 朱明炜[1,2] Chen Liru;Ding Lili;Wang Lijuan;Cheng Bo;Zhu Mingwei(Department of Clinical Nutrition,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of General Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院临床营养科、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]北京医院普通外科、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

出　　处：《中华老年医学杂志》2023年第6期639-644,共6页Chinese Journal of Geriatrics

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-B-094);中国食品科学技术学会食品科技基金(2020-14);北京市科学技术协会金桥工程种子项目(BJ-2022-258)

摘　　要：目的调查老年神经系统疾病患者营养不良的发生情况,探讨与临床结局的相关性。方法回顾性研究,应用全球领导人发起的营养不良诊断标准(GLIM)标准及主观全面营养评定(SGA)对“全国住院患者营养状况动态变化的多中心调查研究”数据库中的566例老年神经系统疾病患者进行整理分析。比较两种营养不良诊断工具,探讨营养不良与临床结局的相关性。结果符合GLIM标准诊断营养不良983例,营养不良发生率为14.66%(983/566),其中男性14.72%(48/326),女性14.58%(35/240)。中度营养不良患者占8.30%(47/566),重度营养不良患者占6.36%(36/566)。SGA评定中度营养不良(SGAB级)发生率为15.55%(88/566),重度营养不良(SGAC级)为1.94%(11/566),总营养不良(SGAB+C级)发生率为17.49%(99/566)。营养不良组总住院时间(15.46±6.49)d,无营养不良组为(13.55±5.09)d,(t=-3.02,P<0.01);营养不良组的体重明显低于无营养不良组[(52.0±8.5)kg比(65.2±9.6)kg,t=12.92,P<0.01],两组体质指数(BMI)[(19.1±2.7)kg/m^(2)比(23.9±2.6)kg/m^(2),t=15.48,P<0.01]、上臂围[(22.3±2.5)cm比(28.3±3.9)cm,t=7.01,P<0.01]、小腿围[(28.9±3.4)cm比(32.5±3.)3cm,t=6.81,P<0.01]均差异有统计学意义;实验室指标中营养不良组与无营养不良组的淋巴细胞[(5.0±8.5)×10^(9)/L比(9.4±11.8)×10^(9)/L,t=3.61,P<0.01]及白蛋白[(38.5±4.4)g/L比(40.7±5.1)g/L,t=3.18,P<0.01]均差异有统计学意义。GLIM与SGA诊断相关性较好(AUC=0.711),一致性尚可。结论老年神经系统疾病患者营养不良发生率较高;GLIM标准适合用于老年神经系统疾病患者的营养不良诊断,其诊断结果与SGA比较相关性较好,一致性尚可。营养不良与人体测量、实验室指标、临床结局等均存在一定关联。Objective To investigate the prevalence of malnutrition in elderly patients with neurological diseases and the of nutrition,and to explore their association with clinical outcomes.Methods A retrospective study was conducted to analyze 566 elderly patients with neurological diseases in the database of the"National Multicenter Survey on the Dynamic Changes of Nutritional Status of Hospitalized Patients"by using the Global leadership Initiative on Malnutrition(GLIM)criteria and subjective global assessment(SGA).The two diagnostic tools for malnutrition were compared to explore the correlation between malnutrition and clinical outcomes.Results Based on the GLIM criteria,83 cases were diagnosed with malnutrition and the incidence of malnutrition was 14.66%(83/566),with 14.72%(48/326)in men and 14.58%(35/240)in women.Patients with moderate malnutrition accounted for 8.30%(47/566)and patients with severe malnutrition accounted for 6.36%(36/566).According to the SGA,the incidence of moderate malnutrition(SGA Grade B)was 15.55%(88/566),the incidence of severe malnutrition(SGA Grade C)was 1.94%(11/566),and all cases of malnutrition(SGA Grade B+C)accounted for 17.49% of the participants(99/566).The total length of hospital stay was(15.46±6.49)days in the malnutrition group and(13.55±5.09)days in the non-malnutrition group,with a statistical difference between the two groups(t=-3.02,P<0.01).The body weight of the malnutrition group was significantly lower than non-malnutrition group[(52.0±8.5)kg vs.(65.2±9.6)kg,t=12.92,P<0.01].There were also statistically significant differences in BMI[(19.1±2.7)kg/m^(2)vs.23.9±2.6 kg/m^(2),t=15.48,P<0.01],upper arm circumference[(22.3±2.5)cm vs.(28.3±3.9)cm,t=7.01,P<0.01],and lower leg circumference[(28.9±3.4)cm vs.(32.5±3.3)cm,t=6.81,P<0.01]between the two groups.Laboratory tests showed that there were significant differences in lymphocytes[(5.0±8.5)×10^(9)/L vs.(9.4±11.8)×10^(9)/L,t=3.61,P<0.01]and albumin[(38.5±4.4)g/L vs.(40.7±5.1)g/L,t=3.18,P<0.01]between the malnutrit

关 键 词：神经系统疾病 营养不良 营养评估 

分 类 号：R741[医药卫生—神经病学与精神病学]