脑性瘫痪儿童营养不良影响因素分析

Influencing factors for malnutrition in children with cerebral palsy

目的分析脑性瘫痪(CP)儿童发生营养不良的影响因素,为CP儿童营养不良防治提供参考。方法收集2021年1—7月就诊于安徽省儿童医院儿童康复科的CP儿童80例,根据有无营养不良分为营养不良组和对照组。比较两组患儿的性别、年龄、胎龄、出生体重、进食时间、全面主观营养量表(SGNA)评估、临床分型、粗大运动功能分级(GMFCS)、血清总蛋白(TP)、25羟维生素D[25-(OH)D]、血红蛋白(HGB)、铁蛋白(FE)差异。Spearman相关性分析比较TP、25-(OH)D、HGB、FE与营养状况的相关性,多因素Logistic回归分析CP儿童营养不良的影响因素。结果营养不良组进食时间≥30min(χ^(2)=21.798)、SGNA评估异常(χ^(2)=45.263)人数比例显著高于对照组、TP、HGB、FE平均值显著低于对照组(t=2.739、2.674、2.155,P<0.01);脑瘫儿童血清HGB与营养状态Z评分呈正相关(r_(s)=0.314,P<0.05);多因素Logistic回归分析显示,相较于GMFCSⅠ级,GMFCSⅡ级、Ⅲ级、Ⅳ级、Ⅴ级是CP儿童营养不良的危险因素(OR=1.750、3.667、1.374、2.375,P<0.05)。结论GMFCSⅡ级、Ⅲ级、Ⅳ级、Ⅴ级是CP儿童发生营养不良的危险因素,早期识别和干预有助于改善营养状况。

Objective To explore the influencing factors of malnutrition in children with cerebral palsy(CP),so at to provide references for its prevention and treatment.Methods A total of 80cases of CP children who visited the Department of Rehabilitation at Anhui Provincial Children′s Hospital from January to July 2021were collected and divided into malnutrition group and control group based on the presence or absence of malnutrition.The differences between the two groups regarding gender,age,gestational age,birth weight,feeding time,Subjective Global Nutritional Assessment(SGNA),clinical classification,Gross Motor Function Classification System(GMFCS)level,serum total protein(TP),25-hydroxyvitamin D[25-(OH)D],hemoglobin(HGB),and ferritin(FE)were compared.Spearman correlation analysis was used to analyze the correlations of TP,25-(OH)D,HGB and FE with nutritional status.Multivariate Logistic regression analysis was conducted to identify the influencing factors of malnutrition in children with CP.Results The proportion of patients with feeding time≥30minutes(χ^(2)=21.798)and abnormal SGNA assessment(χ^(2)=45.263)in the malnutrition group was significantly higher than that in the control group,while the average values of TP,HGB and FE were significantly lower than those in the control group(t=2.739,2.674,2.155,P<0.01).Serum HGB was positively correlated with nutritional status Z-score(r_(s)=0.314,P<0.05)in children with CP.Multivariate Logistic regression analysis showed that GMFCS levelsⅡ,Ⅲ,Ⅳ,andⅤwere risk factors for malnutrition in CP children compared to GMFCS levelⅠ(OR=1.750,3.667,1.374,2.375,P<0.05).Conclusions GMFCS levelsⅡ,Ⅲ,Ⅳ,andⅤare risk factors for the occurrence of malnutrition in children with CP.Early identification and intervention can help improve their nutritional status.