老年营养风险指数在老年慢性阻塞性肺疾病病情判断中的价值

The study on the value of geriatric nutritional risk index to assess the severity of elderly patients with chronic obstructive pulmonary disease

目的:探讨常用的营养评价指标在老年慢性阻塞性肺疾病(COPD)病人病情判断中的价值。方法:回顾性分析2018年1月至2020年8月在黄山首康医院老年科住院的94例老年COPD病人的临床资料,按转归分为好转组(n=83)和转ICU组(n=11)。评估营养状况和肺功能,收集第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1/预计值%)等信息,分析病人入院时的身体质量指数(BMI)、白蛋白、前白蛋白、视黄醇结合蛋白、淋巴细胞计数和老年营养风险指数(GNRI)等营养评价指标与肺功能的相关性,以及上述指标预测病人转入ICU的判断价值。结果:94例病人中男性60例,女性34例,中位年龄78(72, 83)岁。FEV1/预计值%与BMI、白蛋白、前白蛋白、视黄醇结合蛋白、淋巴细胞计数和GNRI等营养评价指标的相关系数分别是0.535(P <0.001)、0.726 (P <0.001)、0.351(P=0.001)、0.498 (P <0.001)、0.572 (P <0.001)和0.940(P <0.001)。上述指标预测病人转入ICU的受试者操作特征曲线的曲线下面积分别是0.744(95%CI:0.544~0.944, P <0.001)、0.834(95%CI:0.669~1.000, P <0.001)、0.658(95%CI:0.468~0.823,P<0.001)、0.602(95%CI:0.408~0.811,P<0.001)、0.649(95%CI:0.428~0.856, P <0.001)、0.875(95%CI:0.751~0.999, P <0.001)。结论:营养评价指标与老年COPD病人肺功能有一定的相关性,可协助判断COPD病人预后,其中GNRI的预测效果最佳。

Objective:To explore the value of common nutritional indexes to assess the severity of elderly patients with chronic obstructive pulmonary disease(COPD).Methods:The data of 94 elderly COPD patients who were hospitalized in the Department of Internal Medicine of Huangshan Shoukang Hospital from January 2018 to August 2020 were retrospectively analyzed.According to the final outcome of the patients,the patients were divided into improvement group(n=83)and ICU group(n=11).The nutritional status and lung functions of patients were assessed.Data including forced expiratory volume in one second/prediction(FEV1/Pre)was collected.The correlation of levels of body mass index(BMI),albumin,prealbumin,retinol binding protein,lymphocyte count,and geriatric nutritional risk index with FEV1/Pre was analyzed.And the value of these indexes in predicting whether patients needed to be transferred to ICU or not was analyzed.Results:Among the 94 patients,60 were male and 34 were female.The age ranged from 50 to 92 years old,and the quartile was 78(72,83)years old.The correlation coefficients between FEV1/Pre and levels of BMI,albumin,prealbumin,retinol binding protein,lymphocyte count,and geriatric nutritional risk index were 0.535(P<0.001),0.726(P<0.001),0.351(P=0.001),0.498(P<0.001),0.572(P<0.001),and 0.940(P<0.001),respectively.The areas under the ROC curve predicted by levels of BMI,albumin,prealbumin,retinol binding protein,lymphocyte count,and geriatric nutritional risk index were 0.744(95%CI:0.544~0.944,P<0.001),0.834(95%CI:0.669~1.000,P<0.001),0.658(95%CI:0.468~0.823,P<0.001),0.602(95%CI:0.408~0.811,P<0.001),0.649(95%CI:0.428~0.856,P<0.001),and 0.875(95%CI:0.751~0.999,P<0.001),respectively.Conclusions:Levels of BMI,prealbumin,retinol binding protein,lymphocyte count,and geriatric nutritional risk index had certain correlation with the severity of COPD,which could be used to assess the severity of COPD.The elderly nutritional risk index showed the best prediction value.