脓毒症患儿高营养风险的影响因素及其对免疫功能、微量元素和疾病转归的影响

Influencing Factors of High Nutritional Risk in Children with Sepsis and Their Effects on Immune Function,Trace Elements and Disease Outcome

目的:研究脓毒症患儿高营养风险的影响因素及其对免疫功能、微量元素和疾病转归的影响。方法:选取2019年1月-2021年12月我院收治的168例脓毒症患儿,采用营养状况和生长风险筛查工具(STRONGkids)筛查其营养风险,根据评分结果将营养风险患儿分为中低营养风险组与高营养风险组。比较两组临床资料,采用Logistic回归模型分析高营养风险的影响因素;比较中低营养风险组与高营养风险组免疫功能指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)),微量元素[铜(Cu)、铁(Fe)、锌(Zn)]含量及疾病转归情况。结果:经STRONGkids营养风险筛查结果显示,151例脓毒症患儿存在营养风险,营养风险发生率为89.88%,其中存在中低营养风险110例(中低营养风险组)和高营养风险41例(高营养风险组)。高营养风险组急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、乳酸、降钙素原水平及严重脓毒症占比高于中低营养风险组,白蛋白水平低于中低营养风险组(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分升高、严重脓毒症是脓毒症患儿发生高营养风险的危险因素(P<0.05),白蛋白升高是脓毒症患儿发生高营养风险的保护因素(P<0.05)。高营养风险组CD4^(+)、CD4^(+)/CD8^(+)低于中低营养风险组,CD8^(+)高于中低营养风险组(P<0.05)。两组Cu含量差异无统计学意义(P>0.05),高营养风险组Fe、Zn含量低于中低营养风险组(P<0.05)。中低营养风险组好转74例、未愈32例、死亡4例,高营养风险组好转19例、未愈15例、死亡7例,高营养风险组疾病转归良好率低于中低营养风险组(P<0.05)。结论:脓毒症患儿高营养风险发生率较高,严重脓毒症、APACHEⅡ评分、白蛋白水平为高营养风险的影响因素,且高营养风险导致患儿免疫功能下降,体内Fe、Zn含量降低,疾病转归情况较差,建议早期实施营养干预,改善患儿的预后。

Objective:To study the influencing factors of high nutritional risk in children with sepsis and their effects on immune function,trace elements and disease outcome.Methods:168 children with sepsis who were admitted to our hospital from January 2019 to December 2021 were selected,the nutritional status and growth risk screening tool(STRONGkids)was used to screen their nutritional risk,according to the scoring results,the children with nutritional risk were divided into medium-low nutritional risk group and high nutritional risk group.The clinical data of the two groups were compared,and the influencing factors of high nutritional risk were analyzed by Logistic regression model.The indexes of immune function(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),the contents of trace elements[copper(Cu),iron(Fe),zinc(Zn)]and the disease outcome situation were compared between the low and middle nutrition risk group and the high nutrition risk group.Results:The results of STRONGkids nutritional risk screening showed that 151 children with sepsis had nutritional risk,and the incidence of nutritional risk was 89.88%,including 110 cases of medium-low nutritional risk(medium-low nutritional risk group)and 41 cases of high nutritional risk(high nutritional risk group).The acute physiology and chronic health score system II(APACHE II)score,lactic acid,procalcitonin levels and the proportion of severe sepsis in the high nutritional risk group were higher than those in the medium-low nutritional risk group,and the albumin level was lower than that in the medium-low nutritional risk group(P<0.05).Multivariate Logistic regression analysis showed that increased APACHE I score and severe sepsis were risk factors for high nutritional risk in children with sepsis(P<0.05),and increased albumin was a protective factor for high nutritional risk in children with sepsis(P<0.05).CD4^(+)and CD4^(+)/CD8^(+)in the high nutritional risk group were lower than those in the medium-low nutritional risk group,and CD8^(+)was higher than that in the medium-low nutritional risk group(P<0.05).There was no significant difference in Cu content between the two groups(P>0.05).The Fe and Zn contents in the high nutritional risk group were lower than those in the medium-low nutritional risk group(P<0.05).There were 74 cases of improvement,32 cases of unrecovery,and 4 cases of death in the medium-low nutritional risk group,while 19 cases of improvement,15 cases of unrecovery and 7 cases of death in the high nutritional risk group,the good disease outcome rate in the high nutritional risk group was lower than that in the medium-low nutritional risk group(P<0.05).Conclusion:The incidence of high nutritional risk is high in children with sepsis.Severe sepsis,APACHE II score and albumin level are the influencing factors of high nutritional risk,and high nutritional risk leads to the decline of immune function,the reduction of Fe and Zn content in the body,and poor disease outcome.Early nutritional intervention is recommended to improve the prognosis of children.