儿童结核病患者营养风险评估及营养支持的应用研究  

Nutritional risk assessment and application of nutritional support in children with tuberculosis

作　　者：张锋 张小佛 周海依 王芳[1] 孙艳[2] 刘晓燕[1] Zhang Feng;Zhang Xiaofo;Zhou Haiyi;Wang Fang;Sun Yan;Liu Xiaoyan(Department of Student&pediatrics Tuberculosis,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha,Hunan 430004,China;Department of Nutrition,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha,Hunan 430004,China)

机构地区：[1]南华大学附属长沙中心医院学生儿童结核科,湖南长沙430004 [2]南华大学附属长沙中心医院营养科,湖南长沙430004

出　　处：《临床肺科杂志》2024年第5期734-738,共5页Journal of Clinical Pulmonary Medicine

基　　金：湖南省卫生计生委科研项目(No.20201223)。

摘　　要：目的 评价儿童结核病患儿营养风险状况及其影响因素,探讨营养支持在结核病治疗中的作用。方法 应用营养状况和生长风险筛查工具STRONGkids对136例儿童结核病住院患儿进行营养风险评估并分析营养状况的影响因素;观察营养支持治疗前后营养相关指标的变化分析其疗效。结果 38.2%(52/136)的儿童结核病住院患儿存在营养风险。与非营养风险组相比,营养风险组中患结核性脑膜炎、腹腔结核的占比更高(P<0.05),检测的血红蛋白、白蛋白、前白蛋白和淋巴细胞绝对值更低(P<0.05),药物性肝损伤和营养不良发生率更高和住院时间更长(P<0.05)。营养风险多因素Logistic回归分析显示,血红蛋白量低于90g/L(OR=8.039,95%CI:1.636~39.510,P=0.010),前白蛋白低于200g/L(OR=2.77,95%CI:1.205~6.368,P=0.016)均是儿童结核病患儿发生营养风险的危险因素。营养支持治疗2周后检测的白蛋白和前白蛋白、获增白蛋白和前白蛋白均明显升高(P<0.05)。结论 儿童结核病患者营养风险发生率较高,血红蛋白前白蛋白降低与营养风险的发生密切相关。营养风险筛查能指导营养支持治疗,改善临床结局。Objective To evaluate the nutritional risk of hospitalized children with tuberculosis(TB) and its influencing factors,and to explore the role of nutritional support in the treatment of TB.Methods 136 hospitalized children with tuberculosis were assessed by STRONGkids,a screening tool for nutritional status and growth risk,and the influencing factors were analyzed.To observe the changes in nutrition-related indexes before and after nutritional support treatment and analyze its curative effect.Results 38.2%(52/136) of hospitalized pediatric tuberculosis patients were found to have a nutritional risk.In comparison to the non-nutritional risk group,the nutritional risk group had a higher proportion of patients with tuberculous meningitis and abdominal tuberculosis(P<0.05),lower levels of detected hemoglobin,albumin,prealbumin,and absolute lymphocyte count(P<0.05),higher incidence of drug-induced liver injury and malnutrition,and longer hospital stay(P<0.05).Multivariate Logistic regression analysis of nutritional risk showed that hemoglobin less than 90 g/L(OR=8.039,95%CI:1.636~39.510,P=0.010) and prealbumin less than 200g/L(OR=2.77,95%CI:1.205~6.368,P=0.016) were risk factors for nutritional risk in children with childhood tuberculosis.After 2 weeks of nutritional support therapy,significant increases were observed in albumin,prealbumin,and the attainment of normal levels of albumin and prealbumin(P<0.05).Conclusion The occurrence of nutritional risk is higher in pediatric tuberculosis patients,and the decline in hemoglobin and prealbumin level are closely related to the occurrence of nutritional risk.Nutritional risk screening can guide nutritional support therapy and improve clinical outcomes.

关 键 词：营养风险 STRONGkids 结核 因素分析 儿童 

分 类 号：R459.3[医药卫生—治疗学] R529.9[医药卫生—临床医学]