肺结核患者食物摄入水平对抗结核治疗效果的影响

Effect of Diet Intake of Tuberculosis Patients on Outcomes of Anti-tuberculosis Therapy

目的:探讨肺结核患者的食物摄入水平对抗结核治疗效果的影响,为抗结核治疗患者的营养指导提供科学依据。方法:选取2009—2013年山东省某市县区确诊的肺结核患者作为研究对象,通过问卷调查收集其基本信息,测量患者的身高和体重,计算体质指数(BMI)。应用半定量食物频率表收集调查对象1 w 9类食物的消费情况,采用食物多样化评分(DDS)-9分类法评估膳食多样性,1~3分为膳食多样性不足、4~6分为适中、7~9分为充足。根据中国膳食宝塔将9类食物合并为5类,计算5类食物每日的平均摄入量。追踪随访研究对象的停药原因,使用多因素Logistic回归模型,分析食物摄入水平对抗结核治疗效果的影响。结果:本研究共纳入肺结核患者2711名,其中未治愈的患者共有147名,占总人数的5.4%。膳食调查结果显示,治愈和未治愈患者的DDS、动物性食物摄入量和蔬菜水果类食物摄入量均呈现显著差异(P均<0.05)。膳食多样性为不足、适中和充足者的未治愈率分别为11.4%、6.3%和4.3%。与食物多样性不足相比,食物多样性充足可显著降低结核治疗失败的风险,校正混杂因素影响后OR值为0.42(95%CI:0.21~0.81)。采用五分位法计算获得结核病患者平均每日摄入动物性食物量分别为0~250 g、250~300 g、300~400 g、400~550 g、≥550 g,其未治愈率分别为9.7%、3.4%、5.5%、4.6%、3.2%。随着动物性食物摄入增加,结核未治愈率下降(P<0.01)。与动物性食物摄入量≤250 g/d相比,动物性食物摄入量>250 g/d可降低抗结核治疗失败的风险。平均每天摄入蔬菜水果类食物量为0~200 g、200~300 g、300~350 g、350~400 g、≥400 g的患者,其未治愈率分别为9.1%、7.2%、4.9%、3.6%、4.4%。随着蔬菜水果类食物摄入增加,结核未治愈率下降(P=0.002)。与蔬菜水果类食物摄入量≤200 g/d相比,蔬菜水果类食物摄入量>350 g/d可降低抗结核治疗失败的风险。结论:抗结核治疗患者的食物摄入水平可影响抗结核治疗效果,食物多样性、动物性食物和蔬菜水果类食物摄入量的增加,可有效降低抗结核治疗未治愈的风险。

【Objective】To analyze the effects of dietary intake on anti-tuberculosis treatment outcomes,and provide a theoretical basis for the nutritional guidance of tuberculosis treatment patients.【Method】We enrolled tuberculosis patients from a hospital in Shandong province from 2009 to 2013.Basic information inchuding sex,age,treatment history,reasons for discontinuation of medication were collected through questionnaires.The height and weight were measured and the body mass index was calculated.The semi-quantitative food frequency table was used to investigate the weekly consumption of 9 types of food.The Dietary Diversity Score(DDS)was used to evaluate the dietary diversity,score 1—3 represent insufficient food diversity,4—6 are moderate,7—9 are adequate.According to theChinese Dietary Guidelines,9 types of foods were combined into 5 categories,and the average daily intake of 5 categories of food was calculated.Multivariate logistic regression models were used to analyze the effects of dietary intake on the efficacy of tuberculosis treatment.【Result】A total of 2711patients were enrolled,of which 147(5.4%)were not cured.Dietary survey results showed significant differences in DDS,animal food intake,and vegetable and fruit food intake between cured and uncured patients(P<0.05).The uncured rates of insufficient,moderate and adequate dietary diversity were 11.4%,6.3%,and 4.3%.Compared with insufficient food diversity,adequate food diversity could significantly reduce the risk of uncured TB treatment,and theORvalue was 0.42(95%CI:0.21-0.81)after adjusting for the multiple factors.The patients were divided into 5 groups according to the average daily intake of animal foods,which were 0—250 g,250—300 g,300—400 g,400—550 g,≥550 g,and their uncured rates were 9.7%,3.4%,5.5%,4.6%and 3.2%,respectively.As the intake of animal food increased,the uncured rate of tuberculosis decreased(P<0.01).Compared with animal food intake≤250 g/d,animal food intake>250 g/d could reduce the uncured risk.The average daily intake of vegetables and fruits was 0—200 g,200—300 g,300—350 g,350—400 g,≥400 g,and the uncured rates were 9.1%,7.2%,4.9%,3.6%and 4.4%,respectively.As the intake of vegetables and fruits increased,the uncured rate of tuberculosis decreased(P=0.002).Compared with vegetable and fruit food intake≤200g/d,vegetable and fruit food intake>350 g/d could reduce the risk of anti-tuberculosis treatment is not cured.【Conclusion】The diet has an impact on anti-tuberculosis treatment.Increased dietary diversity,animal food intake,and vegetable and fruit food intake are associated with the reduced risk of uncured in anti-tuberculosis treatment.