脑卒中伴吞咽障碍患者行胃造瘘术后营养状况的影响因素及列线图分析

背景营养不良是影响脑卒中伴吞咽障碍患者预后质量及增加死亡率的因素之一.内镜下经皮胃造瘘管术(percutaneous endoscopic gastrostomy,PEG)为此类患者提供了持续改善营养状况的重要途径.但是PEG术后患者营养状况及风险因子尚不完全明确,值得关注.目的了解脑卒中伴吞咽障碍患者行PEG术后的营养状态,并探讨相关影响因素,为加强脑卒中伴吞咽障碍患者的营养干预提供参考.方法纳入2018-06/2022-06间于首都医科大学附属北京康复医院接受PEG手术并完成12 wk随访的108位脑卒中伴吞咽障碍患者为研究对象.利用营养风险筛查2002(nutrition risk screening 2002,NRS2002)评分结果将研究对象分为高营养风险组和低营养风险组.基于随机森林的机器学习算法和Logistic回归分析脑卒中伴吞咽障碍患者PEG术后12 wk营养风险的影响因素并构建列线图预测模型,通过受试者工作特征曲线(receiver operating curve,ROC)、校准曲线和决策曲线评价列线图模型的准确性与效能.结果108名患者中,低营养风险组有70例(占64.8%)、高营养风险组有38例(占35.2%).Logistic回归结果表明,年龄≥60岁、家庭经济条件差、存在感染与高营养风险存在显著正相关(均β>0,P<0.05);接受了进一步医治、高血清白蛋白水平、体质量指数与高营养风险存在显著负相关(均β<0,P>0.05).列线图预测营养风险的曲线下面积为0.819,校准曲线贴合良好.结论由年龄(≥60 vs<60岁)、家庭经济条件(良好vs差)、有无接受进一步医疗治疗(有vs无)、感染情况(有vs无)等变量构建的列线图能够预测脑卒中伴吞咽障碍患者行PEG术后的营养风险,对加强行PEG脑卒中伴吞咽障碍患者的营养管理有一定指导意义.

Bone marrow inhibition induced by azathioprine in a patient without mutation in the thiopurine S-methyltransferase pathogenic site:A case report

BACKGROUND Azathioprine(AZA)and its close analog 6-mercaptopurine are thiopurines widely used in the treatment of patients with cancer,organ transplantation,and autoimmune or inflammatory diseases,including systemic lupus erythematosus.Bone marrow inhibition is a common side effect of AZA,and severe bone marrow inhibition is related to decreased thiopurine S-methyltransferase(TPMT)activity.CASE SUMMARY We herein report a patient with proliferative lupus nephritis who was using AZA for maintenance therapy,had no common TPMT pathogenic site mutations,and exhibited severe bone marrow inhibition on the 15th day after oral administration.CONCLUSION This report alerts physicians to the fact that even though the TPMT gene has no common pathogenic site mutation,severe myelosuppression may also occur.