老年营养风险指数对高龄急性冠脉综合征患者病情严重程度及住院时间的影响  

Impact of Geriatric Nutritional Risk Index on the Severity of Disease and Length of Hospitalization in Very Advanced-Age Patients with Acute Coronary Syndrome

作　　者：桑甜甜 程楠[2] 李伊凡 吕纳强[3] 张炜[3] 刘晋星 顾莹珍 党爱民[3] SANG Tiantian;CHENG Nan;LI Yifan;LYU Naqiang;ZHANG Wei;LIU Jinxing;GU Yingzhen;DANG Aimin(Department of Geriatrics,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;SurgicalIntensive Care Unit,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100037,China;Department of Special Care Center,Fuwai Hospital,NationalCenter for Cardiovascular Diseases,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]首都医科大学附属北京积水潭医院老年医学科,北京市100035 [2]中国医学科学院北京协和医学院,国家心血管病中心,阜外医院外科恢复室,北京市100037 [3]中国医学科学院北京协和医学院,国家心血管病中心,阜外医院特需医疗中心,北京市100037

出　　处：《中国分子心脏病学杂志》2023年第6期5713-5719,共7页Molecular Cardiology of China

基　　金：中国医学科学院医学与健康科技创新工程(2017-I2M-2-002);北京积水潭医院青年基金项目(QN-202312)。

摘　　要：目的 通过老年营养风险指数(GNRI)对高龄急性冠脉综合征(ACS)患者进行营养状态评估,分析高龄ACS患者的营养状况对病情严重程度及住院时间的影响。方法 回顾性分析2011年1月至2015年12月中国医学科学院阜外医院因ACS入院拟行冠状动脉造影的高龄(≥80岁)患者196例。计算GNRI及全球急性冠状动脉事件注册(GRACE)评分,依据GNRI将196例患者分为存在营养不良风险组(GNRI≤98)和无营养不良风险组(GNRI> 98)。分析GNRI与高龄ACS患者GRACE评分及住院时间的相关性,评估GNRI对高龄ACS患者病情严重程度及住院时间的预测价值。结果 本组196例高龄ACS患者中,128例(65.3%)患者存在营养不良风险。与无营养不良风险组患者相比,存在营养不良风险组患者急性心肌梗死患病率(P=0.010)和冠状动脉多支病变比例(P=0.003)更高,GRACE评分更高(P=0.016),住院时间更长(P=0.007)。Spearman相关分析结果显示,GNRI与高龄ACS患者GRACE评分(P=0.001)、住院时间(P <0.001)呈显著负相关。多元线性回归分析结果提示,GNRI与高龄ACS患者GRACE评分、住院时间独立相关(P均=0.007)。受试者操作特征(ROC)曲线显示,GNRI下降能预测高龄ACS患者病情高危[曲线下面积(AUC)=0.621,P=0.004]和住院时间延长(AUC=0.663,P <0.001)。结论 高龄ACS患者营养不良患病率较高;低GNRI是高龄ACS患者病情高危及住院时间长的独立预测因素。Objective To investigate nutritional status of elderly patients with acute coronary syndrome(ACS) via geriatric nutritional risk index(GNRI) and to explore the impact of GNRI on the severity of disease and length of hospitalization.Methods A total of 196 patients aged ≥80 years hospitalized for ACS were included.GNRI level and global registry of acute coronary events(GRACE) scores were calculated at admission.The correlation of GNRI and GRACE scores,GNRI and length of hospitalization was analyzed,respectively;and the predictive value of GNRI for severity and length of hospitalization were evaluated.Results According to GNRI level,patients were divided into malnutrition risk group(GNRI≤98) and non-malnutrition risk group(GNRI>98).Compared with patients in non-malnutrition risk group,patients in malnutrition risk group had a higher prevalence of acute myocardial infarction(P =0.010),a higher proportion of coronary multivessel disease(P =0.003),a higher GRACE score(P =0.016),and a longer hospital stay(P =0.007).Spearman correlation analyses revealed that GNRI level was significantly negatively correlated with GRACE score(P =0.001) and length of hospitalization(P <0.001),respectively.Multivariate linear regression analyses showed that GNRI level was independently associated with GRACE score(P =0.007) and length of hospitalization(P =0.007),respectively.Receiver operating characteristic(ROC) curve analyses showed that decreased GNRI level may has a good predictive value for high-risk condition(GRACE>140)(area under the curve [AUC]=0.621,P =0.004) and prolonged hospital stay(AUC=0.663,P <0.001) risk.Conclusion Malnutrition is common in elderly patients with ACS.Low GNRI level was an independent predictor of high-risk condition(GRACE>140) and longer duration of hospitalization in elderly patients with ACS.

关 键 词：老年营养风险指数 全球急性冠状动脉事件注册评分 住院时间 高龄 急性冠脉综合征 

分 类 号：R541.4[医药卫生—心血管疾病]