老年慢性心血管疾病患者营养状态与临床结局的相关性研究

Correlation study between the nutritional status and clinical outcome in elderly patients with chronic cardiovascular disease

目的调查老年慢性心血管疾病住院患者的营养状态,评估其与临床结局的相关性。方法前瞻、平行、多中心横断面调查,2012年4月1日至2012年5月31日期间,在北京医院、解放军总医院、首都医科大学附属北京友谊医院、天津市中西医结合医院南开医院、空军军医大学西京医院、哈尔滨医科大学附属第二医院住院、年龄≥65岁的老年慢性心血管疾病住院患者,收集患者人体测量指标和相关的实验室指标,并应用微型营养评定精法(MNA-SF),了解其营养状态,记录住院期间病死率、感染性并发症、住院时间等临床结局指标,并分析不同营养状态与临床结局的相关性。对数据行χ~2检验、方差分析、t检验。结果本研究纳入符合入选标准的老年慢性心血管疾病患者2 093例,年龄(75.2±6.9)岁,体重指数(24.2±3.7)kg/m2,握力(18.2±11.8)kg,上臂围(26.6±3.5)cm;白蛋白(35.81±10.51)g/L;总蛋白(65.19±7.79)g/L;前清蛋白(182.8±104.1)mg/L;甘油三酯(1.46±1.12)mmol/L;血浆总胆固醇(4.16±1.49)mmol/L;血红蛋白(126.7±18.1)g/L;1 993例患者完成了MNA-SF,顺应性95.22%;其中5.77%(115/1 993)存在营养不良,28.50%(568/1 993)有营养不良风险;慢性心功能不全、心肌病、心瓣膜等疾病的营养不良风险及营养不良发生率较高。总感染性并发症发生率为4.92%,其中营养正常患者为3.36%,营养不良风险患者为6.51%,营养不良患者为14.78%,差异有统计学意义(χ~2=33.79,P<0.05);总住院时间为(10.94±7.60)d,营养正常患者住院时间为(10.10±6.97)d,营养不良风险患者为(12.25±8.16)d,营养不良患者为(14.94±9.73)d,差异有统计学意义(F=31.480,P<0.05)。结论老年慢性心血管疾病住院患者有一定的营养不良风险和营养不良发生率,且营养不良风险及营养不良与不良临床结局正相关,应重视其住院期间的营养状态的评估和干预。

Objective To investigate the nutritional status of elderly patients with chronic cardiovascular disease during hospitalization and evaluate their correlation with clinical outcomes.Methods A prospective,parallel multicenter cross-sectional study was carried out in Beijing Hospital,The General Hospital of the People＇s Liberation Army,Beijing Friendship Hospital,Capital Medical University,Tianjin Hospital of ITCWM,Nankai Hospital,Xijing Hospital,Air Force Medical University,the 2 nd Affiliated Hospital of Harbin Medical University from April 1 st 2012 to May 31 st 2012. Subjects in the study were inpatients aged 65 years and above with chronic cardiovascular disease. Anthropometric parameters and related laboratory indicators were collected. Short form mini nutritional assessment（ MNA-SF） was used to assess the nutritional status. The in-hospital mortality and infection complications,hospitalization time and other clinical outcome indicators were recorded. Associations between nutritional status and clinical outcomes were further sought. Data were processed with chi-square test,analysis of variance,t test. Results The study enrolled 2 093 elderly patients with chronic cardiovascular disease met the inclusion criteria. Among the 2 093 patients,their age were（ 75. 2 ± 6. 9） years,their body mass index were（ 24. 2 ± 3. 7） kg/m^2,their grip strength were（ 18. 2 ± 11. 8） kg,their calf circumference were（ 26. 6 ± 3. 5） cm,their albumin were（ 35. 81 ± 10. 51） g/L,their total protein were（ 65. 19 ± 7. 79） g/L,their prealbumin were（ 182. 8 ±104. 1） mg/L,their total glyceride were（ 1. 46 ± 1. 12） mmol/L,their triglyceride were（ 4. 16 ±1. 49） mmol/L,their hemoglobin were（ 126. 7 ± 18. 1） g/L. One thousand nine hundred and ninety three of them completed the MNA-SF,compliance 95. 22%,5. 77%（ 115/1 993） were malnourished,28. 50%（ 568/1 993） were at risk of malnutrition. Among them,the incidence of malnutrition risk and malnutrition was higher in patients with chronic heart failure,cardiomyopathy,heart valve disease. And the total incidence of infection was 4. 92%. The incidence of normal nutrition group was 3. 36%,the malnutrition risk group was 6. 51%,the malnutrition group was 14. 78%,there were statistically significant differences（ χ~2= 33. 79,P〈0. 05）. The total hospitalization time was（ 10. 94 ± 7. 60） d,the normal nutrition group was（ 10. 10 ± 6. 97） d, the malnutrition risk group was（ 12. 25 ± 8. 16） d, the malnutrition group（ 14. 94 ± 9. 73） d,there were statistically significant differences（ F = 31. 480,P〈0. 05）.Conclusions Elderly patients with chronic cardiovascular disease have certain malnutrition risk and at risk of malnutrition. The correlation analysis between the MNA-SF evaluation results and the clinical outcome indicators showed that malnutrition risk and malnutrition were positively related to adverse clinical outcomes.Poor nutritional status is associated with worse clinical outcomes. The evaluation and intervention of their nutritional status during hospitalization shoud be payed attention to.