营养风险筛查及个体化膳食干预改善阿尔茨海默病患者认知能力的临床观察

Nutrition risk screening and individualized dietary intervention to improve cognitive ability of patients with alzheimer's disease

目的对阿尔茨海默病(AD)患者进行营养筛查,对有营养风险者给予个体化膳食干预,观察患者血液学指标及认知功能的改变,观察营养支持在AD患者治疗中的作用。方法采用营养风险筛查方法(NRS2002)对122例AD住院患者进行营养风险筛查,选取NRS2002评分≥3分的有营养不良或有营养风险者共64例,应用随机数字表将其分为两组,个体化营养支持组和普通饮食对照组,每组各32例。分析营养支持治疗对患者实验室营养指标:血清总蛋白(TP)、血清清蛋白(ALB)、前清蛋白(PA)、总胆固醇(TC)、三酰甘油(TG)、血红蛋白(Hb)水平的影响及治疗前后两组患者认知功能的改变。结果 122例AD患者中有64例患者存在营养不良或营养风险,总发生比例为52.5%。AD患者发生营养不良的危险性与年龄的增长、文化程度的降低有显著相关性(χ2=9.310,P=0.002;χ2=8.060,P=0.018)。随着生活能力、患者认知功能的降低,营养不良及危险的发生率显著升高(χ2=6.931,P=0.031;χ2=7.448,P=0.024)。个体化营养支持治疗组治疗3个月后,AD患者MMSE、ADL评分高于普通饮食对照组(P<0.05)。同时,患者血TP、ALB、PA、Hb、TC、TG水平亦有明显改善(P<0.05)。结论 AD患者发生营养不良及营养风险的比例较高,在常规内科治疗的同时加用个体化营养支持治疗可以显著改善患者的营养状况,改善患者的认知功能,提高患者的生活质量。

Objective To conduct nutritional screening of patients with Alzheimer’s disease（ AD）,individualized dietary interventions were provided to the patients with nutritional risk. In such interventions,the changes of hematological parameters and cognitive ability of the patients with AD were observed and effect of the nutritional support in the treatment of AD patients was searched. Methods We used NRS2002 to conduct nutrition risk screening for 122 cases of AD patients. 64 patients with malnutrition or nutritional risk were selected,whose NRS2002 scores were equal or greater than 3. These patients were divided into two groups by using random number table,which were the group of providing the patients with individualized nutrition support and the control group of providing the patients with general diet. Each group contained 32 patients. We analyzed the effect of the treatment with nutritional support on the levels of the laboratory nutritional indicators of patients including TP,ALB,PA,TC,TG,and Hb,and the changes of cognitive function of the patients in the two groups before and after treatment. Results 64 patients had malnutrition or nutritional risk in the 122 patients with AD,and the ratio was 52. 5%. The risk of malnutrition in AD patients was significantly associated with increased age and educational attainment（ χ2= 9. 310,P = 0. 002; χ2= 8. 060,P = 0. 018）. With the reduction of living ability and cognitive ability of patients,the incidence of malnutrition and nutritional risk increased significantly（ χ2=6. 931,P = 0. 031; χ2= 7. 448,P = 0. 024）. After the patients were treated for 3 months,the MMSE and ADL scores of the AD patients in the group of providing them with individualized nutrition support were higher than that in the control group of providing the patients with general diet（ P 〈 0. 05）. Also,the levels of TP,ALB,PA,Hb,TC,and TG in blood for the patients were also significantly improved. Conclusion The probability of malnutrition and nutrition risk appeared in the patients with AD is relatively high. The treatment with nutritional support for AD patients in the conventional medical therapy can significantly improve their nutritional status,cognitive ability and living quality.