作者：文静1，孙靓2，王大为3

单位：

1.100071北京市，北京丰台医院老年科　2.100176北京市，北京同仁医院神经内科　3.100176 北京市，北京同仁医院全科医学科

Units：

1.Department of Geriatrics, Beijing Fengtai Hospital, Beijing 100071, China2.Department of Neurology, Beijing Tongren Hospital, Beijing 100176, China3.Department of General Medicine, Beijing Tongren Hospital, Beijing 100176, China

关键词：

营养不良；炎症；营养支持；C反应蛋白；预后；影响因素分析

Keywords：

Malnutrition; Inflammation; Nutritional support; C-reactive protein; Prognosis; Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.203

Funds：

摘要：

目的　探讨入院时炎症水平对老年营养不良患者营养支持治疗预后的影响。方法　回顾性选取2021年1—9月在北京丰台医院老年科住院的老年营养不良患者198例。根据入院后营养支持治疗方案将患者分为干预组（接受个体化营养支持治疗）和对照组（接受标准医院食品）。收集患者入院时临床资料，包括年龄、性别、营养风险筛查（NRS）2002评分、主要诊断、合并症、Barthel指数、炎症水平。以C反应蛋白（CRP）＜10 mg/L为低炎症水平，10~80 mg/L为中等炎症水平，＞80 mg/L为高炎症水平。老年营养不良患者出院后90 d全因死亡的影响因素分析采用Cox比例风险回归分析；以炎症水平进行分层，比较不同营养支持治疗老年营养不良患者预后，采用Kaplan-Meier法绘制生存曲线，生存曲线的比较采用Log-rank检验。结果　198例患者中低炎症水平56例（28.3%），中等炎症水平78例（39.4%），高炎症水平64例（32.3%）；接受个体化营养支持治疗102例，接受标准医院食品96例。出院后90 d死亡28例（14.1%）。Cox比例风险回归分析结果显示，年龄〔HR =1.084，95%CI （1.021，1.150）〕、营养支持治疗方案〔HR =0.243，95%CI （0.100，0.591）〕是老年营养不良患者出院后90 d全因死亡的影响因素（P ＜0.05）。干预组生存率高于与对照组（χ2=4.673，P =0.031）；其中低炎症水平、中等炎症水平患者中干预组生存率高于对照组（χ2=4.510，P =0.034；χ2=4.307，P =0.038）；高炎症水平患者中干预组与对照组生存率比较，差异无统计学意义（χ2=0.453，P =0.501）。结论　年龄、营养支持治疗方案是老年营养不良患者出院后90 d全因死亡的影响因素，入院时低炎症水平和中等炎症水平患者接受个体化营养支持治疗后生存率明显升高，营养支持治疗方案需要根据患者入院时炎症水平进行个性化调整。

Abstract：

Objective　To investigate the effect of inflammatory level at admission on the prognosis of nutritionalsupport therapy in elderly patients with malnutrition. Methods　A total of 198 elderly patients with malnutrition hospitalized inDepartment of Geriatrics in Beijing Fengtai Hospital from January to September 2021 were retrospectively selected as the studysubjects. They were divided into the intervention group (recieved individualized nutritional support treatment) and the controlgroup (recieved standard hospital food) according to the nutritional support treatment regimen after admission. Clinical data atadmission were collected, including age, gender, Nutritional Risk Screening (NRS) 2002 score, main diagnosis, comorbidities,Barthel Index and inflammation level. C-reactive protein (CRP) level < 10 mg/L was as low inflammation level, 10-80 mg/L wasas moderate inflammation level, and > 80 mg/L was as high inflammation level. Cox proportional risk regression analysis wasused to analyze the influencing factors of all-cause mortality in elderly patients with malnutrition at 90 days after discharge. Theinflammation level was stratified to compare the prognosis of elderly patients with malnutrition treated with different nutritionalsupport. Kaplan-Meier method was used to draw the survival curve, and Log-rank test was used to compare the survival curve.Results　Among 198 patients, 56 (28.3%) had low inflammation level, 78 (39.4%) had moderate inflammation level, and 64(32.3%) had high inflammation level. One hundred and two cases were treated with individualized nutrition support, 96 cases weretreated with standard hospital food. Twenty-eight cases (14.1%) died at 90 days after discharge. Cox proportional risk regressionanalysis showed that age [HR =1.084, 95%CI (1.021, 1.150) ] , nutritional support treatment regimen [HR =0.243, 95%CI (0.100,0.591) ] were influencing factors of all-cause mortality in elderly patients with malnutrition at 90 days after discharge (P < 0.05) .The survival rate of the intervention group was higher than that of the control group (χ2=4.673, P =0.031) . The survival rate ofthe intervention group was higher than that of the control group in patients with low inflammation level (χ2=4.510, P =0.034) .The survival rate of the intervention group was higher than that of the control group in patients with moderate inflammation level(χ2=4.307, P =0.038) . There was no significant difference in the survival rate between the intervention group and the controlgroup in patients with high inflammation level (χ2=0.453, P =0.501) . Conclusion　Age, nutritional support treatment regimenare the influencing factors of all-cause mortality in elderly patients with malnutrition at 90 days after discharge. The survival rateof patients with low and moderate inflammation levels at admission significantly ascends after individualized nutritional supporttreatment. Nutritional support treatment should be personalized according to the inflammatory level of patients at admission.

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