营养评估对炎症性肠病患者6个月再入院的影响分析

Analysis of effect of nutritional assessment on 6-month readmission of patients with inflammatory bowel disease

目的探讨营养评估对炎症性肠病患者6个月内再入院的影响,为临床工作提供参考。方法回顾性分析厦门大学附属中山医院消化中心2017年1月至2019年12月收治的炎症性肠病患者的一般资料、血清学营养指标、BMI、PNI指数、NRS2002评分,随访其6个月内再入院情况,分析营养指标及营养风险筛查对炎症性肠病患者的再入院的影响。结果本组患者6个月内再入院率为27.5%;再入院组与对照组患者的血清铁(P<0.001)、总铁结合力(P=0.006)、维生素B_(12)(P=0.003)、BMI(P=0.010)、NRS2002(P<0.001)评分有统计学差异;NRS2002评分是IBD患者6个月再入院的危险因素(OR=1.852,95%CI:1.207~2.841),血清铁为保护因素(OR=0.796,95%CI:0.686~0.925),两者联合的ROC曲线下面积为0.801(95%CI:0.717~0.885),预测价值高于两者任一单项预测。结论对住院IBD患者使用NRS2002并结合其血清铁水平进行营养评估,对存在营养风险且铁缺乏患者尽早进行营养干预,以降低患者6个月内再入院风险。

Objective To explore the effect of nutritional assessment on the 6-month readmission of patients with inflammatory bowel disease to provide reference for clinical practice.Methods A retrospective analysis of the general data,serological nutritional indicators,BMI,PNI index,and NRS2002 score of patients with inflammatory bowel disease admitted to the Gastroenterology Center of a tertiary hospital in Xiamen from January 2017 to December 2019 was conducted.Patients were followed up to collect 6-month readmission status.The analysis of the impact of nutritional indicators and nutritional risk screening on the readmission of patients with inflammatory bowel disease was performed.Results The 6-month readmission rate of patients in this group was 27.5%.The serum iron level(P<0.001),total iron binding capacity(P=0.006),vitamin B_(12)(P=0.003),BMI(P=0.010)and NRS2002 score(P<0.001)in the readmission group were statistically different than those in the control group.The NRS2002 score was a risk factor for 6-month readmission in IBD patients(OR=1.852,95%CI:1.207~2.841),and serum iron level was a protective factor(OR=0.796,95%CI:0.686~0.925).The combined area under the ROC curve was 0.801(95%CI:0.717~0.885),and the predictive value was higher than either of the individual predictions.Conclusion NRS2002 score should be combined with serum iron level for nutritional assessment in hospitalized IBD patients.Nutritional intervention should be given to patients with nutritional risk and iron deficiency as soon as possible,to reduce the risk of 6-month readmission.