脑卒中后吞咽障碍患者PG-SGA评分与不良预后风险的相关性

Association between PG-SGA scores and the risk of poor outcomes in stroke patients with dysphagia

目的脑卒中患者常伴有吞咽障碍,这种伴随症状会影响机体营养状态,本研究探讨脑卒中后吞咽障碍患者主观整体营养评估法(PG-SGA)评分与不良预后风险的相关性。方法选取浙江省人民医院淳安分院2021年10月—2022年10月收治的116例脑卒中后吞咽障碍患者作为研究对象。根据改良Rankin量表(mRS)评分分为预后良好组(mRS≤2分)和预后不良组(mRS评分3~5分)。应用多因素logistic回归分析及限制性立方样条探讨患者营养状态与不良预后风险间的相关性。结果随访观察90 d,88例(75.86%)患者mRS≤2分归为预后良好组,其余28例(24.14%)为预后不良组。预后不良组患者年龄较预后良好组大,入院时美国国立卫生研究院卒中量表(NIHSS)、PG-SGA评分较预后良好组高,血清白蛋白水平、肱三头肌皮褶厚度较预后良好组低(P<0.05)。多因素logistic回归分析显示,年龄大(OR=1.179,95%CI:1.059~1.314)、入院时NIHSS评分高(OR=1.775,95%CI:1.161~2.713)、PG-SGA评分高(OR=1.741,95%CI:1.069~2.834)为不良预后的危险因素,血清白蛋白高(OR=0.883,95%CI:0.804~0.970)为不良预后的保护因素(P<0.05)。限制性立方样条显示,脑卒中后吞咽障碍患者PG-SGA评分与不良预后间存在剂量-反应关系(χ^(2)=0.029,P<0.05)。结论脑卒中后吞咽障碍患者营养状态与不良预后风险有关,临床需引起重视,及时根据情况行营养支持。

Objective Dysphagia is commonly observed in stroke patients and can have an impact on their nutritional status.This study aims to investigate the correlation between the patient-generated subjective global assessment(PGSGA)score and the risk of poor prognosis in stroke patients with dysphagia.Methods A total of 116 patients with poststroke dysphagia from Chun'an Branch of Zhejiang Provincial People's Hospital between October 2021 and October 2022 were selected as the study objects.According to the modified Rankin scale(mRS),the patients were divided into a good prognosis group(mRS≤2 points)and a poor prognosis group(mRS 3-5 points).Multivariate logistic regression analysis and restricted cubic spline were used to investigate the association between nutritional status and the risk of poor prognosis.Results After a 90-day follow-up observation,88 cases(75.86%)with mRS≤2 scores were classified as the good prognosis group,while the remaining 28 cases(24.14%)were categorized as the poor prognosis group.The admission National Institutes of Health stroke scale(NIHSS)and PG-SGA scores were higher in the poor prognosis group compared to the good prognosis group,whereas the serum albumin level and triceps skin fold thickness were lower(P<0.05).Multivariate logistic regression analysis revealed that older age(OR=1.179,95%CI:1.059-1.314),high NIHSS score on admission(OR=1.775,95%CI:1.161-2.713),and high PG-SGA score(OR=1.741,95%CI:1.069-2.834)were risk factors for poor prognosis.Conversely,high serum albumin(OR=0.883,95%CI:0.804-0.970)was identified as a protective factor for poor prognosis(P<0.05).The restricted cubic spline analysis showed a dose-response relationship between PG-SGA score and poor prognosis in stroke patients with dysphagia(χ^(2)=0.029,P<0.05).Conclusion The nutritional status of stroke patients with dysphagia is related to the risk of poor prognosis,highlighting the importance of timely clinical attention and nutritional support based on individual needs.