肺外结核患者的营养状况调查及影响因素分析

Investigation of nutritional status and analysis of influencing factors in patients with extrapulmonary tuberculosis

目的:调查肺外结核患者的营养状况并分析其相关的影响因素。方法:选取2020年1月1日至2021年12月31日期间6家结核病专科医院的住院肺外结核患者作为研究对象,共3223例,其中,男性1852例(57.46%),女性1371例(42.54%);年龄中位数(四分位数)为41(28,58)岁。收集研究对象一般人口学特征和临床特征资料(包括性别、年龄、身高、体质量、临床诊断、肺外结核部位、合并症、免疫状态、既往肺结核治疗史等),以及营养风险筛查-2002(NRS-2002)评分情况。研究对象病历资料信息均完整,明确诊断为肺外结核,并在其尚未得到有效抗结核治疗或控制的情况下进行营养风险筛查。分析研究对象营养风险发生情况,并采用多因素logistic回归模型分析肺外结核患者营养风险发生的影响因素。结果:3223例研究对象中,仅累及1个肺外部位者占86.91%(2801/3223),累及2个部位及以上者占13.09%(422/3223)。研究对象NRS-2002得分波动于1~5分,得分中位数(四分位数)为3(1,4)分,共1814例(56.28%)患者存在营养风险(NRS-2002评分≥3分)。422例累及2个及以上肺外部位研究对象中存在营养风险者占63.74%(269/422);2801例累及单个肺外部位研究对象中存在营养风险者占55.16%(1545/2801)。多因素logistic回归分析显示,低体质量指数(体质量指数<18.5)[OR(95%CI)=20.641(19.745~26.307)]、合并免疫抑制[OR(95%CI)=1.182(1.023~1.421)],以及复治[OR(95%CI)=1.804(1.549~2.177)]是肺外结核患者发生营养风险的危险因素。结论:肺外结核患者营养风险发生比例较高,临床治疗中应多关注其营养状况,尤其警惕低体质量指数、合并免疫抑制及复治患者。

Objective:To investigate the nutritional status of patients with extrapulmonary tuberculosis and analyze the related factors.Methods:A total of 3223 inpatients with extrapulmonary tuberculosis from 5 tuberculosis specialized hospitals from January 1,2020 to December 31,2021 were selected as research subjects,including 1852 males(57.46%)and 1371 females(42.54%);the median(quartile)age was 41(28,58)years old.The general demography characteristics and clinical characteristics of the subjects were collected(including gender,age,height,body mass,clinical diagnosis,location of extrapulmonary tuberculosis,complications,immune status,previous tuberculosis treatment history,etc.),as well as the nutrition risk screening-2002(NRS-2002)score.All the subjects had complete medical records and information,and were definitely diagnosed with extrapulmonary tuberculosis.Nutritional risk screening was conducted when they had not yet received effective anti-tuberculosis treatment or control.The occurrence of nutritional risk in the subjects was analyzed and the influencing factors of nutritional risk in patients with extrapulmonary tuberculosis were analyzed using a multivariate logistic regression model.Results:Among the 3223 study subjects,86.91%(2801/3223)involved only one extrapulmonary site,and 13.09%(422/3223)involved two or more sites.The NRS-2002 score of subjects fluctuated from 1 to 5,and the median(quartile)score was 3(1,4).A total of 1814 cases(56.28%)had nutritional risk(NRS-2002 score≥3).Of the 422 study subjects with involvement in two or more extrapulmonary sites,63.74%(269/422)were at nutritional risk;of the 2801 studies involving a single extrapulmonary site,55.16%(1545/2801)had nutritional risks.Multivariate logistic regression analysis showed that low body mass index(body mass index<18.5)(OR(95%CI)=20.641(19.745-26.307)),concomitant immunosuppression(OR(95%CI)=1.182(1.023-1.421)),and retreatment(OR(95%CI)=1.804(1.549-2.177))were risk factors for nutritional risk in patients with extrapulmonary nodules.Conclusion:The incidence of nutritional risk in patients with extrapulmonary tuberculosis is relatively high,and more attention should be paid to their nutritional status in clinical treatment,especially for patients with low body mass index,combined immunosuppression,and retreatment.