炎症性肠病住院患者营养风险与抑郁情绪、心理弹性及自我管理行为的关系

Relationship between nutritional risk and depression,resilience and self-management behavior in hospitalized patients with inflammatory bowel disease

目的:炎症性肠病住院患者营养风险与抑郁情绪、心理弹性及自我管理行为的关系。方法:对2019年1月-2021年12月于某院住院的110例炎症性肠病患者进行问卷调查,共回收有效问卷105份(95.45%),采用营养风险筛查评分简表(NRS 2002)评分评估营养状态,将≥3分者为纳入营养风险组,<3分者纳入营养正常组。分别采用抑郁自评量表(SDS)、康纳-戴维森心理韧性量表(CD-RISC)、炎症性肠病病人自我管理行为量表评估两组患者抑郁情绪、心理弹性及自我管理行为。采用Pearson相关性分析炎症性肠病住院患者营养风险与抑郁情绪、心理弹性及自我管理行为的相关性。通过绘制ROC曲线评估抑郁情绪、心理弹性及自我管理行为评分及三者联合对炎症性肠病住院患者营养风险的预测价值。结果:105例炎症性肠病住院患者中包含营养不良者43例、营养不良发生率40.95%。营养不良组中年龄≥40岁、吸烟、家庭人均月收入<3000元、住院天数≥14d、糖尿病、低蛋白血症患者所占比例高于营养正常组(χ^(2)=12.449,4.266,5.922,7.476,8.507,7.588;P<0.05)。营养不良组SDS评分高于营养正常组(t=3.220,P<0.01),CD-RISC量表中自强、乐观、坚韧维度评分低于营养正常组(t=3.563,4.252,3.121;P<0.01),自我管理行为量表重疾病监测、用药管理、情绪管理、饮食管理、生活管理、运动管理以及资源利用维度评分低于营养正常组(t=6.229,5.533,5.646,3.590,4.263,7.256,3.921;P<0.001)。炎症性肠病住院患者营养风险与SDS评分呈正相关(r=0.303,P<0.01),与CD-RISC评分(自强、乐观、坚韧维度)呈负相关(r=-0.331,-0.386,-0.294;P<0.01),与自我管理行为评分(疾病监测、用药管理、情绪管理、饮食管理、生活管理、运动管理以及资源利用维度)呈负相关(r=-0.528,-0.479,-0.486,-0.334,-0.387,-0.581,-0.361;P<0.01)。ROC分析结果显示,当SDS评分≥54.50分时,预测炎症性肠病住院患者营养不良灵敏度为60.5%,特异度为62.9%;当CD-RISC评分≤105.00分时,灵敏度为67.4%,特异度为79.0%;当自我管理行为评分≤105.00分时,灵敏度为65.1%,特异度为75.8%;三者联合预测灵敏度为74.4%,特异度为79.0%。结论:炎症性肠病住院患者具有较高营养不良风险,年龄大、吸烟、家庭人均收入低、住院时间长以及合并糖尿病、低蛋白血症是导致其营养不良的风险因素;炎症性肠病住院患者营养风险增加与抑郁水平高、心理弹性差、自我管理行为不良相关,可将三者作为预测营养不良的辅助手段,且联合预测效能更优。

Objective:To investigate the relationship between nutritional risk and depression,resilience and self-management behavior in hospitalized patients with inflammatory bowel disease.Methods:One hundred and ten patients with inflammatory bowel disease hospitalized in our hospital were investigated by questionnaire from January 2019 to December 2021.A total of 105 valid questionnaires were collected(the recovery rate was 95.45%).The nutritional status of patients was evaluated by using the nutritional risk screening score summary table(NRS 2002).Those with≥3 points were included in the nutritional risk group,and those with<3 points were included in the nutritional normal group.Self-rating Depression Scale(SDS),Connor-Davidson resilience scale(CD-RISC)and inflammatory bowel disease patients'self-management behavior scale were used to evaluate the depression,resilience and self-management behavior of two groups of patients.Pearson correlation was used to analyze the correlation between nutritional risk and depression,psychological resilience and self-management behavior in hospitalized patients with inflammatory bowel disease.Results:Among 105 hospitalized patients with inflammatory bowel disease,43 were malnourished,and the incidence of malnutrition was 40.95%.The proportion of patients with age≥40 years old,smoking,family per capita monthly income<3000 yuan,hospitalization days≥14 days,diabetes and hypoproteinemia in the malnutrition group was higher than that in the normal nutrition group(χ^(2)=12.449,4.266,5.922,7.476,8.507,7.588;P<0.05).The SDS score of patients in the malnutrition group was higher than that in the normal nutrition group(t=3.220,P<0.01),the self-improvement,optimism and tenacity dimension score in the CD-RISC scale was lower than that in the normal nutrition group(t=3.563,4.252,3.121;P<0.01),and the self-management behavior scale was lower than that in the normal nutrition group(t=6.229,5.533,5.646,3.590,4.263,7.256,3.921;P<0.01).The nutritional risk of inpatients with inflammatory bowel disease was positively correlated with SDS score(r=0.303,P<0.01),negatively correlated with CD-RISC score(r=-0.331,-0.386,-0.294;P<0.01),and negatively correlated with self-management behavior score(r=-0.528,-0.479,-0.486,-0.334,-0.387,-0.581,-0.361;P<0.01).ROC analysis showed that when SDS score was≥54.50,the sensitivity and specificity of predicting malnutrition in inpatients with inflammatory bowel disease were 60.5%and 62.9%respectively;When the CD-RISC score was≤105.00,the sensitivity was 67.4%,and the specificity was 79.0%;When the score of self-management behavior was≤105.00,the sensitivity was 65.1%,and the specificity was 75.8%;The sensitivity and specificity of the combined prediction were 74.4%and 79.0%respectively.Conclusion:Hospitalized patients with inflammatory bowel disease have a higher risk of malnutrition,the risk factors of malnutrition are age,smoking,low per capita income,long hospitalization time,diabetes and hypoalbuminemia.The increased nutritional risk of in-patients with inflammatory bowel disease is associated with high levels of depression,poor psychological resilience and poor self-management behavior,the above three scores can be used as auxiliary means to predict malnutrition,and the joint prediction is more effective.