老年营养风险指数对腹膜透析相关性腹膜炎患者治疗效果的评估价值  

The geriatric nutritional risk index on the treatment effect of peritoneal dialysis-associated peritonitis in elderly patients

作　　者：于龙丽[1] 隋小妮[1] 李垟[1] YU Long-li;SUI Xiao-ni;LI Yang(Department of Nephrology,Qingdao Hospital Affiliated to Rehabilitation University(Qingdao Municipal Hospital),Qingdao 266000,China)

机构地区：[1]康复大学附属青岛医院(青岛市市立医院)肾内科,青岛266000

出　　处：《中国血液净化》2024年第7期520-523,共4页Chinese Journal of Blood Purification

基　　金：山东省医药卫生科技发展计划(2020WS158)。

摘　　要：目的探讨老年营养风险指数(geriatric nutritional risk index,GNRI)对腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis,PDAP)患者治疗效果的评估价值。方法选取2020年1月—2023年1月于青岛市市立医院就诊的PDAP患者147例作为研究对象,根据患者治疗效果分为治愈组和治疗失败组,比较2组间GNRI分值及临床特征差异,分析GNRI分值与PDAP患者治疗效果的关系。结果治愈组患者102例,治疗失败组患者45例,其中患者死亡25例、拔管10例、转院治疗10例。与治愈组相比,治疗失败组患者GNRI分值、体质量指数、血红蛋白、白蛋白(ALB)降低(t=5.134、7.517、2.336、3.259,P<0.001、<0.001、0.021、0.001),透析龄高于治愈组(t=10.924,P<0.001)。Logistic多因素回归分析显示GNRI分值下降(OR=0.541,95%CI:0.335~0.872,P<0.001)、ALB下降(OR=0.638,95%CI:0.494~0.825,P<0.001)和透析龄延长(OR=1.674,95%CI:1.081~2.591,P<0.001)是PDAP患者治疗失败的独立危险预测因素。ROC曲线分析显示GNRI分值预测PDAP患者治疗失败的ROC曲线下面积为0.735,敏感度为89.55%,特异度为75.43%,约登指数为0.649,最佳预测值为90.53分。结论GNRI分值下降是PDAP患者治疗失败的独立危险预测因素,且对PDAP患者治疗失败具有较高的预测效能,及早纠正患者营养状态可改善患者治疗效果。Objective To investigate the relationship between geriatric nutritional risk index(GNRI)and treatment effect of peritoneal dialysis-associated peritonitis(PDAP)in elderly patients.Methods A total of 147 PDAP patients treated in Qingdao Municipal Hospital from January 2020 to January 2023 were selected as the research subjects.They were divided into a cured group(102 cases)and a failed group(45 cases)based on the treatment outcome of PDAP.GNRI scores and clinical characteristics of the two groups were compared.The relationship between GNRI score and treatment outcome of PDAP patients was analyzed.Results There were 102 patients in the cured group and 45 patients in the failed group(including death 25 cases,withdrawal of the tubes 10 cases,and transferred to other hospitals 10 cases)after the treatment.Compared with the cure group,GNRI score,body mass index(BMI),hemoglobin(Hb)and albumin(ALB)were significantly reduced(t=5.134,7.517,2.336 and 3.259 respectively;P<0.001,<0.001,0.021 and 0.001 respectively),while dialysis age was significantly increased(t=10.924,P=0.000)in the failed treatment group.Multivariate logistic regression analysis showed that lower GNRI score(OR=0.541,95%CI:0.335~0.872,P<0.001),lower serum ALB(OR=0.638,95%CI:0.494~0.825,P<0.001)and longer dialysis age(OR=1.674,95%CI:1.081~2.591,P<0.001)were the independent risk predictors for treatment failure of PDAP patients.ROC analysis showed that the area under ROC curve of GNRI score to predict treatment failure of PDAP patients was 0.735,with the sensitivity of 89.55%,the specificity of 75.43%,the Yoden index of 0.649,and the best predictive value of 90.53.Conclusion Decreased GNRI score is an independent risk factor for treatment failure of PDAP patients,and is highly efficient for the prediction of treatment failure in PDAP patients.Therefore,early correction of abnormal nutritional status can improve the treatment outcome of PDAP.

关 键 词：腹膜透析相关性腹膜炎 老年营养风险指数 治疗效果 危险因素 

分 类 号：R459.5[医药卫生—治疗学]