克罗恩病患者营养风险的影响因素

Survey and analysis of nutritional risk screening and influencing factors of hospitalized patients with Crohn's disease in the department of gastroenterology

目的分析克罗恩病患者营养风险的影响因素。方法收集2022年6月1日至2023年3月31日消化内科收治的克罗恩病患者154例。采集患者首次确诊年龄、性别、既往史、身体质量指数等一般资料,克罗恩病分型、病变部位、临床表现、用药情况等疾病相关资料,Harvey-Bradshaw指数、红细胞沉降率、红细胞分布宽度、人血白蛋白、血红蛋白等实验室检查指标,以及营养风险筛查2002量表(NRS 2002)评分和营养治疗情况。根据NRS 2002评分,将纳入患者分为营养风险组和无营养风险组。比较2组临床特征,对营养风险的影响因素开展Logistic回归分析。结果154例克罗恩病患者中,49.4%(76/154)有营养风险,33.7%(52/154)存在轻度或中度贫血。2组患者的年龄、分型、病变部位、疾病行为分布差异无统计学意义(P>0.05)。营养风险组的身体质量指数、血红蛋白、白蛋白水平均低于无营养风险组;处于活动期的患者比例、红细胞沉降率、红细胞分布宽度、累及上消化道或肛周病变或肠外症状的患者比例高于无营养风险组(P<0.05)。有营养风险且得到营养治疗的患者仅12例(15.78%)。多因素分析显示,红细胞沉降率>10 mm·h^(-1)和中度活动期是克罗恩病患者营养风险的独立影响因素。结论克罗恩病患者存在营养风险的比例较高,但接受营养治疗比例较低,临床应重点关注中度活动期和红细胞沉降率>10 mm·h^(-1)的克罗恩病患者,加强营养风险筛查和干预,改善克罗恩病患者的生存质量。

AIM To analyze the risk factors associated with nutritional risk in patients with Crohn's disease.METHODS From 1 June 2022 to 31 March 2023,154 cases of Crohn's disease patients admitted to the department of gastroenterology were collected.General data including age at first diagnosis,gender,medical history and body mass index(BMI)were collected.Disease-related data such as classification of Crohn's disease,lesion location,clinical manifestations and medication use were collected.Laboratory indicators such as the Harvey-Bradshaw index(HBI),erythrocyte sedimentation rate(ESR),red blood cell distribution width(RDW),serum albumin(Alb)and hemoglobin(Hb)were collected,as well as Nutritional Risk Screening 2002(NRS 2002)scores and nutritional treatment conditions.Patients were divided into nutritional risk group and non-nutritional risk group according to the NRS 2002 score.The clinical characteristics of 2 groups were compared,and logistic regression analysis was performed on the influencing factors of nutritional risk.RESULTS Among the 154 patients enrolled in the study,49.4%(76/154)were at nutritional risk,and 33.7%(52/154)had mild or moderate anemia.The BMI,Hb and Alb levels in the nutritional risk group were lower than those in the non-nutritional risk group(P>0.05).The proportion of patients in the active stage,ESR,RDW,and the proportion of patients with upper gastrointestinal or perianal lesions or parenteral symptoms were higher than those in the non-nutritional risk group(P<0.05).Only 12 cases(15.78%)received nutritional treatment during hospitalization among patients with nutritional risk.Multivariate analysis showed that higher ESR(>10 mm·h^(-1))and moderate disease activity were independent influencing factors for nutritional risk.CONCLUSION A large proportion of Crohn's disease patients admitted to the department of gastroenterology are at nutritional risk while rarely treated with nutrition therapy.We shall reinforce nutrition screening,intervention and guidance in patients with moderately active Crohn's disease and higher ESR(>10 mm·h^(-1)),thereby improving the quality of life for patients with Crohn's disease.