老年急性白血病营养状况调查及营养不良危险因素分析

Nutritional status and risk factors of elderly patients with acute leukemia

目的:分析老年急性白血病患者营养状况及发生营养不良相关危险因素。方法:回顾性分析164例老年急性白血病患者的临床资料,采用患者主观整体评估(PG-SGA)法进行营养状况评估,分为营养支持组(PG-SGA评分≥9分)和无需营养支持组(PG-SGA评分<9分),2组患者的实验室指标及人体测量的各项指标;通过白血病生活质量评估(FACT-Leu)量表计算生活质量总分,将PG-SGA评分和生活质量各维度评分进行相关性分析;采用单因素分析及Logistic多因素回归分析营养不良的相关危险因素。结果:与无需营养支持组患者比较,需营养支持组患者血红蛋白(HB)、白蛋白(ALB)、前白蛋白(PA)、体重指数(BMI)、上臂中点周径(MAC)、肱三头肌皮皱厚度(TSF)各项指标显著降低(t=10.301、6.340、5.845、8.748、6.642、3.040,均P<0.05);PG-SGA评分与生理状况评分、功能状况评分、白血病特异模块评分及总体生活质量评分呈负相关(r=-0.197、-0.208、-0.154、-0.280,均P<0.05)。单因素分析结果表明高危、初治、急性髓细胞白血病、有胃肠道反应是老年急性白血病患者发生营养不良的危险因素(r=6.044、8.893、4.067、7.110,均P<0.05);Logistic回归分析显示高危、初治、急性髓细胞白血病是营养不良的独立危险因素(OR=2.656、0.268、2.844,均P<0.05)。结论:老年急性白血病需营养支持患者比例较高,营养状况和生活质量相关,应针对危险因素积极给予营养评估和干预。

Objective:To investigate the nutritional status of elderly patients with acute leukemia during hospitalization and analyze the risk factors of malnutrition.Methods:A total of 164 elderly patients with acute leukemia were retrospectively analyzed.Patient Generated Subjective Global Assessment(PG-SGA)was used for nutritional assessment.The patients were divided into groups according to the PG-SGA score.The laboratory and anthropometric indexes of patients in the group requiring nutrition support(PG-SGA score≥9)and the group without nutrition support(PG-SGA score<9)were compared.The quality of life(QOL)score of the patients was calculated by the Functional Assessment of Cancer Therapy-Leukemia(FACT-Leu),and the PG-SGA score and QOL score were compared by a correlation analysis.The risk factors of malnutrition were analyzed by univariate and logistic regression.Results:The levels of Hb,ALB,PA,BMI,MAC and TSF were significantly lower in the nutritional support(PG-SGA score≥9)group than those in the non-nutritional support group(all P<0.05).PG-SGA score was negatively correlated with physiological status score,functional status score,leukemia specific module score and overall QOL score(all P<0.05).The single factor analysis showed that the risk factors of malnutrition in elderly patients with acute leukemia were high risk,primary treatment,acute myeloid leukemia and gastrointestinal reaction(P<0.05).Logistic regression analysis showed that the independent risk factors of malnutrition were high risk,primary treatment and acute myeloid leukemia(OR=2.656,0.268,2.844 respectively;P<0.05).Conclusion:The proportion of elderly patients with acute leukemia requiring nutritional support was higher than that without nutritional support.Nutritional status is related to QOL.Nutritional evaluation and intervention should be given to the risk factors.