耐药肺结核患者的营养状况调查及影响因素分析:一项多中心、大样本研究  

Nutritional status of drug-resistant pulmonary tuberculosis patients and the influencing factors:a multi-center,large-sample study

作　　者：丁芹 张胜康 任斐 陈晓红 胡春梅 陈薇 范琳[6] Ding Qin;Zhang Shengkang;Ren Fei;Chen Xiaohong;Hu Chunmei;Chen Wei;Fan Lin(Department of Nutrition,Shanghai Pulmonary Hospital Affiliated to Tongji University,Shanghai 200433,China;Department of Nutrition,Hunan Chest Hospital,Changsha 410013,China;Department of Drug-resistance Tuberculosis,Xi’an Chest Hospital,Xi’an 710061,China;Department of Tuberculosis,Fuzhou Pulmonary Hospital,Fuzhou 350008,China;Department of Tuberculosis,the Second Hospital of Nanjing,Nanjing 210003,China;Department of Tuberculosis,Shanghai Pulmonary Hospital Affiliated to Tongji University/Shanghai Tuberculosis Clinical Research Center/Shanghai Key Laboratory of Tuberculosis(Lung),Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院营养科,上海200433 [2]湖南省胸科医院营养科,长沙410013 [3]西安市胸科医院耐药结核科,西安710061 [4]福州肺科医院结核科,福州350008 [5]南京市第二医院结核科,南京210003 [6]同济大学附属上海市肺科医院结核科/上海市结核病临床研究中心/上海市结核(肺)重点实验室,上海200433

出　　处：《中国防痨杂志》2023年第9期826-832,共7页Chinese Journal of Antituberculosis

基　　金：国家自然科学基金(82170006);上海市科委基金(21Y11901000,20ZR1446700);上海市肺科医院临床研究基金(FKLY20017,SKPY2021003)。

摘　　要：目的:调查耐药肺结核患者的营养状况并分析其影响因素。方法:采用回顾性研究方法,于2020年1月1日至2021年12月31日搜集中国17个省和2个直辖市共29家结核病专科医院的耐药肺结核患者作为研究对象,最终纳入1766例,年龄范围为18~90岁,平均年龄为(45.88±16.43)岁;平均体质量指数(body mass index, BMI)为20.03±3.25;其中,男性1255例(71.06%),女性511例(28.94%)。收集研究对象的人口学信息及临床特征资料;使用营养风险筛查简表(NRS-2002)评估研究对象是否存在营养风险,进一步的营养不良的评估及诊断参照全球营养不良领导倡议标准(global leadership initiative on malnutrition, GLIM)进行。采用多因素logistic回归分析耐药肺结核患者发生营养风险的影响因素。结果:1766例研究对象NRS-2002评分波动于1~5分,得分中位数(四分位数)为3(1~4)分;共1103例(62.46%)研究对象存在营养风险(NRS-2002≥3分)。NRS-2002评分≥3分组中,60~79岁者占70.56%(254/360),≥80岁者占83.33%(25/30),BMI<18.5者占100.0%(602/602),均明显高于NRS-2002评分<3分组[分别占29.44%(106/360)、16.67%(5/30)、0],差异均有统计学意义(χ2值分别为6.256和1345.000,P值分别为0.012和<0.01)。多因素logistic回归分析显示,高龄(≥60岁)[以18~39岁组为参照,60~79岁组:OR(95%CI)=2.130(1.194~3.803);≥80岁组:OR(95%CI)=12.400(3.114~49.369)]和低BMI[以BMI≥20.5者为参照,BMI<18.5者:OR(95%CI)=56.937(26.537~122.161)]是耐药肺结核患者发生营养风险的危险因素。研究对象营养不良发生率为52.55%(928/1766),1103例存在营养风险者中,营养不良发生率为84.13%(928/1103)。结论:耐药肺结核患者存在较高的营养风险,营养不良发生率较高,应对此类患者尽早行规范的营养风险筛查及营养不良的诊断,尤其关注高龄及低BMI患者。Objective:To investigate the nutritional status of drug-resistant pulmonary tuberculosis patients and analyze the influencing factors.Methods:A retrospective study was conducted in 1766 drug-resistant pulmonary tuberculosis patients from 29 tuberculosis specialized hospitals in 17 provinces and 2 municipalities of China from January 1,2020 to December 31,2021.The age range of the patients was 18 to 90 years with the average age of(45.88±16.43)years,and the average body mass index(BMI)was 20.03±3.25.Among them,1255 were male(71.06%)and 511 were female(28.94%).Demography information and clinical characteristics of the subjects were collected.The Nutritional Risk Screening-2002(NRS-2002)was used to assess whether the subjects were at nutritional risk.Further assessment and diagnosis of malnutrition were conducted in accordance with the Global Leadership Initiative on Malnutrition(GLIM)standards.Multivariate logistic regression analysis was used to investigate the influencing factors of nutritional risk in drug-resistant pulmonary tuberculosis patients.Results:The NRS-2002 score of 1766 subjects fluctuated from 1 to 5,and the median score(Quartile)was 3(1 to 4)points.A total of 1103 cases(62.46%)of the subjects had nutritional risks(NRS-2002 score≥3 points).In the NRS-2002 score≥3 group,70.56%(254/360)of the patients aged 60-79 years old,83.33%(25/30)aged≥80 years old,and BMI of all the patients(100.0%(602/602))<18.5,which were significantly higher than those in the NRS-2002 score<3 group(accounted for 29.44%(106/360),16.67%(5/30),and 0,respectively)(χ^(2) values were 6.256 and 1345.000,respectively;P values were 0.012 and<0.01).Multivariate logistic regression analysis showed that older age(with 18-39 years old group as reference,60-79 years old group:OR(95%CI)=2.130(1.194-3.803);≥80 years old group:OR(95%CI)=12.400(3.114-49.369))and lower BMI(with BMI≥20.5 as reference,BMI<18.5:OR(95%CI)=56.937(26.537-122.161))were risk factors for nutritional risk in drug-resistant pulmonary tuberculosis patients.The

关 键 词：结核 肺 抗药性 营养状况 营养不良 回顾性研究 

分 类 号：R52[医药卫生—内科学] R825.2[医药卫生—临床医学]