肝胆胰外科老年患者营养状态与衰弱、肌肉衰减症的相关性分析  

Analysis of correlation between nutritional status and frailty and sarcopenia in geriatric patients planning to receive major hepatopancreatobiliary surgery

作　　者：李鹏雪 王丽娟[2] 胡宜福 程博[1] 丁丽丽[2] 李磊[1] 韦军民[1] 宋京海[1] 许静涌[1] Li Pengxue;Wang Lijuan;Hu Yifu;Cheng Bo;Ding Lili;Li Lei;Wei Junmin;Song Jinghai;Xu Jingyong(Department of General Surgery,National Center of Gerontology,Beijing Hospital,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Clinical Nutrition,National Center of Gerontology,Beijing Hospital,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]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,100730 [2]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,100730

出　　处：《中华临床营养杂志》2023年第2期87-94,共8页Chinese Journal of Clinical Nutrition

基　　金：北京医院“科技新星”项目(BJ-2020-082);中央高水平医院科研经费项目(BJ-2022-075);中国食品科学技术学会食品科技基金—雅培食品营养与安全专项科研基金(2021-M01)。

摘　　要：目的:分析拟行肝胆胰外科大手术的老年患者的营养状态与衰弱、肌肉衰减症的相关性。方法:选择2020年12月至2022年9月在北京医院肝胆胰外科连续入组的拟行肝胆胰外科大手术的老年住院患者144例。应用营养风险筛查2002量表进行营养风险筛查,采用全球营养领导层诊断营养不良标准进行营养不良诊断,采用Fried氏衰弱表型5项量表评估衰弱,应用亚洲肌肉衰减症工作组2019标准进行肌肉衰减症评估。分析营养状态、衰弱、肌肉衰减症患病率和重叠率,以及营养状态对衰弱和肌肉衰减症的影响。结果:患者平均年龄(70.10±7.44)岁,营养风险发生率73.6%(106/144),营养不良发生率68.1%(98/144),其中重度营养不良34.7%(50/144);衰弱发生率20.8%(30/144),肌肉衰减症发生率35.4%(51/144)。营养风险、重度营养不良、肌肉衰减症及衰弱的患病率随年龄增长呈上升趋势,但随体重指数增加呈下降趋势。肌肉衰减症与营养不良的重叠患病率为35.4%(51/144),衰弱与营养不良的重叠患病率为19.4%(28/144),肌肉衰减症与衰弱的重叠患病率为14.6%(21/144),肌肉衰减症、营养不良、衰弱三者的重叠患病率为14.6%(21/144)。营养风险与衰弱呈高度正相关关系(r=0.603,P<0.001)。营养风险组衰弱前期和衰弱的发生风险高于无营养风险组(xˉ=31.830,P<0.001),营养不良组衰弱前期和衰弱的发生风险高于营养正常组(xˉ=36.727,P<0.001)。Logistic回归分析显示,重度营养不良患者衰弱的发生风险是营养正常组的12.303倍(95%CI:2.592~58.409,P=0.002)。有营养风险组肌肉衰减症的发生风险高于无营养风险组(xˉ=13.982,P<0.001),营养不良组肌肉衰减症的发生风险高于营养正常组(xˉ=37.066,P<0.001)。结论:拟行肝胆胰外科大手术的老年患者营养不良、衰弱、肌肉衰减症的患病率及重叠患病率较高,营养不良的患者更易出现衰弱。Objective To analyze the correlation between nutritional status and frailty and sarcopenia in geriatric inpatients(GIPs)planning to receive major hepatopancreatobiliary(HPB)surgery.Methods From December,2020 to September,2022,GIPs who were planning to receive major HPB surgery were recruited.Nutritional assessment was performed using nutritional risk screening 2002(NRS-2002)and Global Leadership Initiative on Malnutrition(GLIM)criteria.Frailty and sarcopenia assessment were performed using Fried frailty phenotype(FFP)and Asian Working Group for Sarcopenia(AWGS)2019 consensus on sarcopenia diagnosis and treatment.The prevalence and concurrence of malnutrition,frailty and sarcopenia were investigated,and the correlation between nutritional status and frailty and sarcopenia was analyzed.Results A total of 144 participants at the mean age of(70.10±7.44)years were included.The prevalence of nutritional risk,malnutrition,and severe malnutrition were 73.6%(n=106),68.1%(n=98),and 34.7%(n=50)respectively.The prevalence of frailty was 20.8%(n=30)and that of sarcopenia was 35.4%(n=51).The prevalence of severe malnutrition increased significantly in older participants and the prevalence of nutritional risk,malnutrition and severe malnutrition decreased significantly with higher BMI.The prevalence was 35.4%(51/144)for concurrent sarcopenia and malnutrition,19.4%(28/144)for frailty and malnutrition,14.6%(21/144)for sarcopenia and weakness,and 14.6%(21/144)for sarcopenia,malnutrition,and weakness.There was a positive correlation between nutritional risk and frailty(r=0.603,P<0.001).The risk of pre-frailty and frailty in the nutritional risk group was higher than that in the non-nutritional risk group(χ2=31.830,P<0.001).The risk of pre-frailty and frailty in the malnutrition group was higher than that in the normal nutrition group(χ2=36.727,P<0.001).Logistic regression analysis showed that the risk of frailty in patients with severe malnutrition was 12.303 times higher than that in patients with normal nutrition status(95%CI:

关 键 词：肝胆胰外科 老年 营养不良 肌肉衰减症 衰弱 

分 类 号：R656[医药卫生—外科学] R685[医药卫生—临床医学]