相位角在肺结核患者营养评估中的临床意义

Clinical significance of phase angle in the evaluation of nutritional status in patients with pulmonary tuberculosis

目的探讨相位角与肺结核患者营养状况的关系及其对临床结局的影响。方法对208例肺结核患者行完善营养风险筛查、人体测量、生化检查和人体成分分析检查。其中,154例相位角正常(正常相位角组), 54例低相位角(低相位角组)。分析相位角与营养指标的相关性,记录随访期间患者死亡情况。结果低相位角组患者年龄、耐药肺结核发生率、合并脑梗死、冠心病、肺癌以及存在营养风险的患者比例高于正常相位角组(P<0.05)。低相位角组血清白蛋白和前白蛋白水平低于正常相位角组(P<0.05)。两组骨骼肌、浮肿指数(ECW/TBW)、上臂肌围(AMC)、去脂体重指数(FFMI)和四肢骨骼肌含量(ASM)比较差异有统计学意义(P<0.05)。相位角与前白蛋白、骨骼肌、无机盐和ASM呈正相关(P<0.05),而与ECW/TBW和NRS2002评分呈负相关(P<0.05)。在随访期间,低相位角组死亡率高于正常相位角组(35.00%vs.7.14%)(P<0.05)。结论相位角有助于评估肺结核患者的营养状况和预测临床结局。

Objective To investigate the relationship between phase angle and nutritional status and its effect on clinical outcomes in the patients with pulmonary tuberculosis.Methods A total of 208 patients with pulmonary tuberculosis accepted nutritional risk screening, anthropometry, biochemical examination and human body composition analysis.According to the value of phase angle, the patients were divided into two groups of A(with normal phase angle, 154 cases) and B(with low phase angle, 54 cases).The correlation between phase angle and nutritional indicators was analyzed, and the death was recorded during the period of follow up.Results Compared with group A,the age, incidence of drug-resistant pulmonary tuberculosis and percentages of the patients complicated cerebral infarction, coronary heart disease, lung cancer and high nutritional risk were increased in group B(P<0.05).Serum levels of albumin and prealbumin in group B were lower than those in group A(P<0.05).There were statistical differences in the skeletal muscle, edema index(ECW/TBW),arm muscle circumference(AMC),fat-free mass index(FFMI) and appendicular skeletal muscle mass(ASM) between groups of A and B(P<0.05).The phase angle was positively correlated with prealbumin, skeletal muscle, inorganic salt and ASM(P<0.05),but was negatively correlated to ECW/TBW and NRS2002(P<0.05).The mortality during the period of follow up in group B was higher than that in group A(35.00% vs.7.14%)(P<0.05).Conclusion The phase angle is helpful in evaluating the nutritional status and predicting the clinical outcomes in the patients with pulmonary tuberculosis.