温州市成年住院结核病患者营养状况调查及影响因素分析

Investigation and analysis of nutritional status and its influencing factors of adult inpatients with tuberculosis in Wenzhou City

目的:分析温州市成年结核病住院患者营养状况及风险影响因素,为早期营养干预提供参考依据。方法:选择2023年1月1日至7月5日温州市中心医院感染科收治的住院时间超过24 h、年龄≥18岁且诊断为结核病的患者740例。排除因平车或轮椅而无法获得体质量者4例、严重精神疾病者2例、检验数据不完整者18例,最终纳入研究患者716例。收集患者入院时的人口学、临床及实验室资料,包括性别、年龄、结核病诊断类型、治疗类型、合并症、体质量指数(BMI)、病变肺野数、结核分枝杆菌检出情况、耐药情况、营养风险筛查-2002(the nutritional risk screening-2002,NRS-2002)结果、血清总蛋白、白蛋白、前白蛋白、血红蛋白、淋巴细胞计数、中性粒细胞/淋巴细胞比值(NLR)、预后营养指数(PNI)等,对上述资料进行统计比较,分析患者营养风险发生情况及影响因素。结果:716例患者中,231例患者NRS-2002评分≥3分,纳入营养风险组,485例患者NRS-2002评分<3分,纳入无营养风险组,患者营养风险发生率为32.26%(231/716)。多因素logistic回归分析显示,肺野病变数≥3个[OR(95%CI)=2.066(1.349~3.165)]、白蛋白<30 g/L[OR(95%CI)=4.468(1.767~11.297)]、前白蛋白100~200 g/L[OR(95%CI)=2.249(1.377~3.674)]、前白蛋白<100 g/L[OR(95%CI)=5.585(2.841~10.981)]、血红蛋白91~119 g/L[OR(95%CI)=2.205(1.458~3.335)]、血红蛋白≤90 g/L[OR(95%CI)=2.882(1.374~6.047)]是患者营养风险发生的危险因素。结论:温州市成年住院结核病患者营养风险发生率较高,临床在治疗过程中应重视该类患者的营养状况,重点关注肺野病变数>3个、白蛋白降低、前白蛋白降低、血红蛋白降低的患者。

Objective:To analyze the nutritional status and risk factors of adult tuberculosis inpatients in Wenzhou City,so as to provide reference for early nutritional intervention.Methods:A total of 740 patients with tuberculosis diagnosed in the Infection Department of Wenzhou Central Hospital from January 1 to July 5,2023 were selected.Excluding 4 patients who could not get measured for weight due to usage of trolley or wheelchair,2 patients with severe mental illness and 18 patients with incomplete laboratory data,716 patients were included in the study.Demographic,clinical and laboratory data on admission were collected,including sex,age,diagnostic type of tuberculosis,type of treatment,complication,BMI,number of affected lung fields,detection of Mycobacterium Tuberculosis,drug resistance,nutritional risk screening-2002(NRS-2002)results,serum total protein,albumin,prealbumin,hemoglobin,lymphocyte count,neutrophil-to-lymphocyte ratio(NLR),prognostic nutrition index(PNI),etc.The above data were statistically compared,and the occurrence and influencing factors of nutritional risk were analyzed.Results:Among the 716 patients,231 patients with NRS 2002 score≥3 were included in the nutritional risk group,and 485 patients with NRS 2002 score<3 were included in the non-nutritional risk group.The incidence of nutritional risk was 32.26%(231/716).Multivariate logistic regression analysis showed the affected lung fields>3(OR(95%CI)=2.066(1.349-3.165)),albumin<30 g/L(OR(95%CI)=4.468(1.767-11.297)),prealbumin≤200 g/L(100-200 g/L:OR(95%CI)=2.249(1.377-3.674),<100 g/L:OR(95%CI)=5.585(2.841-10.981)),hemoglobin≤120 g/L(91-119 g/L:OR(95%CI)=2.205(1.458-3.335),≤90 g/L:OR(95%CI)=2.882(1.374-6.047))were risk factors of nutritional risk in patients.Conclusion:The incidence of nutritional risk of adult inpatients with tuberculosis in Wenzhou City is high.In the course of treatment,more attention should be paid to the nutritional status of these patients,especially those with affected lung fields>3,low albumin/prealbumin/hemoglobin.