老年住院肺结核患者营养状况及影响因素分析

doi:10.19983/j.issn.2096-8493.2024167

摘要/Abstract

摘要：

目的: 分析老年肺结核患者的营养状况及其影响因素,为老年肺结核住院患者营养干预提供参考依据。方法: 采用回顾性研究,收集2020年11月15日至 2024年1月31日云南省传染病医院结核科确诊为肺结核的≥65岁老年患者作为研究对象,共计134例。比较两组一般资料、影像学结果及营养状况指标[体质量指数(BMI)、血清白蛋白(ALB)、前白蛋白(PAB)、总蛋白(TP)、C-反应蛋白(CRP)、白细胞(WBC)、血红蛋白(Hb)、淋巴细胞计数(LYM)]水平,采用logistic回归分析患者发生营养风险的独立危险因素。结果: 老年肺结核营养风险的发生率为62.7%(84/134)。多因素logistic回归分析结果显示,有胸腔积液[OR(95%CI)=5.090(2.165~11.969)]和空洞 [OR(95%CI)=3.136(1.127~8.729)]是老年肺结核发生营养风险的危险因素,ALB为30~40g/L [OR(95%CI)=0.106(0.026~0.438)]是患者发生营养风险的保护因素。结论: 老年肺结核患者营养风险发生率较高,有胸腔积液和空洞,以及ALB水平均是营养风险发生的影响因素,临床治疗中应重视老年肺结核的营养风险筛查及营养干预。

关键词: 老年人, 结核, 因素分析,统计学

Abstract:

Objective: To analyze the nutritional status of elderly patients with pulmonary tuberculosis (TB) and its influencing factors, and to provide reference for nutritional intervention for elderly hospitalized patients with TB. Methods: A retrospective study was conducted. A total of 134 elderly patients aged ≥65 years diagnosed with TB in the Department of TB of Yunnan Provincial Hospital of Infectious Diseases from November 15, 2020 to January 31, 2024. The general data, imaging results and nutritional status index (body mass index (BMI), serum albumin (ALB), prealbumin (PAB), total protein (TP), C-reactive protein (CRP), white blood cells (WBC), hemoglobin (Hb), lymphocyte count (LYM)) levels were compared between the two groups, and the independent risk factors of nutritional risk were analyzed by logistic regression method. Results: The prevalence of nutritional risk in elderly patients with TB was 62.7% (84/134). The results of multivariate logistic regression analysis showed that pleural effusion (OR (95%CI)=5.090 (2.165-11.969)) and cavities (OR (95%CI)=3.136 (1.127-8.729)) were risk factors for nutritional risk in patients, while albumin 30-40 g/L (OR (95%CI)=0.106 (0.026-0.438)) was a protective factor for nutritional risk. Conclusion: The incidence of nutritional risk in elderly patients with TB is high, and pleural effusion, cavity and ALB level are the influencing factors of nutritional risk. In clinical treatment, attention should be paid to nutritional risk screening and nutritional intervention in elderly patients with pulmonary tuberculosis.

Key words: Aged, Tuberculosis, Factor analysis, statistical

中图分类号:

R521
R151

周琪, 李明懿, 王金秀, 张红燕, 杨雪娟, 毛霖. 老年住院肺结核患者营养状况及影响因素分析[J]. 结核与肺部疾病杂志, 2025, 6(2): 198-203. doi: 10.19983/j.issn.2096-8493.2024167

Zhou Qi, Li Mingyi, Wang Jinxiu, Zhang Hongyan, Yang Xuejuan, Mao Lin. Analysis of nutritional status and influencing factors of elderly hospitalized patients with pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(2): 198-203. doi: 10.19983/j.issn.2096-8493.2024167

图/表 3

表1

老年肺结核患者营养风险发生的影响因素的单因素分析

因素	营养风险组(84例)	无营养风险组(50例)	χ²值	P值
性别			0.300	0.584
男性	56(66.7)	31(62.0)
女性	28(33.3)	19(38.0)
年龄组(岁)			6.389	0.094
65~69	28(33.3)	25(50.0)
70~74	14(16.7)	11(22.0)
75~79	25(29.8)	9(18.0)
≥80	17(20.2)	5(10.0)
治疗类型			0.017	0.896
初治	75(89.3)	45(90.0)
复治	9(10.7)	5(10.0)
居住地			0.489	0.484
农村	65(77.4)	36(72.0)
城镇	19(22.6)	14(28.0)
合并症			1.556	0.212
是	48(57.1)	34(68.0)
否	36(42.9)	16(32.0)
病灶累及肺野数(个)			1.682	0.195
<4	6(7.1)	7(14.0)
≥4	78(92.9)	43(86.0)
空洞			4.373	0.037
有	23(27.4)	6(12.0)
无	61(72.6)	44(88.0)
纵隔淋巴结肿大			5.622	0.018
是	65(77.4)	29(58.0)
否	19(22.6)	21(42.0)
胸膜增厚			1.900	0.168
是	57(67.9)	28(56.0)
否	27(32.1)	22(44.0)
胸腔积液			14.540	<0.001
有	43(51.2)	9(18.0)
无	41(48.8)	41(82.0)
病原学检测			1.966	0.161
阳性	54(64.3)	26(52.0)
阴性	30(35.7)	4(48.0)
合并肺外结核			1.824	0.177
是	35(41.7)	15(30.0)
否	49(58.3)	35(70.0)
体质量指数			52.813	<0.001
<18.50	57(67.9)	3(6.0)
18.50~23.99	25(29.8)	34(68.0)
≥24	2(2.3)	13(26.0)
TP(g/L)			6.532	0.011
<65	46(54.8)	16(32.0)
≥65	38(45.2)	34(68.0)
ALB(g/L)			13.610	0.001
<30	17(20.2)	3(6.0)
30~40	55(65.5)	27(54.0)
>40	12(14.3)	20(40.0)
PAB(mg/L)			25.615	<0.001
<100	29(39.2)	4(9.5)
100~200	42(56.8)	23(54.8)
>200	3(4.0)	15(35.7)
Hb(g/L)			12.234	0.002
≤90	13(15.7)	1(2.0)
91~119	34(41.0)	13(26.0)
≥120	36(43.3)	36(72.0)
LYM(×10⁹L)			11.382	0.001
<1.1	27(32.1)	31(62.0)
≥1.1	57(67.9)	19(38.0)
CRP(g/L)			10.890	0.001
≤10	23(27.4)	28(56.0)
>10	61(72.6)	22(44.0)
WBC(×10⁹L)			1.520	0.468
<4.0	13(15.5)	5(10.0)
4.0~10.0	61(72.6)	41(82.0)
>10.0	10(11.9)	4(8.0)

表1

表2

表3

老年肺结核患者发生营养风险影响因素的多因素logistic回归分析

影响因素	β值		s $x ˉ$ 值		Wald χ²值		P值		OR(95%CI)值
空洞	1.143		0.522		4.790		0.029		3.136(1.127~8.729)
胸腔积液	1.627		0.436		13.913		<0.001		5.090(2.165~11.969)
纵隔淋巴结肿大	0.848		0.484		3.063		0.080		2.335(0.903~6.033)
ALB(以>40g/L为参照)
30~40(g/L)		-2.245		0.725		9.595		0.002		0.106(0.026~0.438)
<30(g/L)		-1.023		0.669		2.340		0.126		0.359(0.097~1.334)
PAB(>200g/L为参照)
100~200(g/L)		0.029		0.976		0.001		0.976		1.030(0.152~6.970)
<100(g/L)		0.122		0.565		0.047		0.829		1.130(0.374-3.417)
TP≥65g/L		-0.358		0.508		0.498		0.480		0.699(0.258~1.891)
LYM≥1.1×10⁹/L		0.670		0.448		2.236		0.135		1.953(0.812~4.698)
CRP>10g/L		-0.266		0.502		0.280		0.597		0.766(0.286~2.502)
Hb(以≤90g/L为参照)
91~119(g/L)		2.042		1.279		2.549		0.110		7.703(0.628~93.431)
≥120(g/L)		0.259		0.492		0.276		0.599		1.295(0.494~3.397)

表3

参考文献 20

[1]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012, 34(8): 485-508.
[2]	Feleke BE, Feleke TE, Biadglegne F. Nutritional status of tuberculosis patients, a comparative cross-sectional study. BMC Pulm Med, 2019, 19(1): 182. doi:10.1186/s12890-019-0953-0.
[3]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 结核与肺部疾病杂志, 2024, 5(4): 376-378. doi:10.19983/j.issn.2096-8493.2024022.
[4]	Marín Franco JL, Genoula M, Corral D, et al. Host-derived lipids from tuberculous pleurisy impair macrophage microbicidal-associated metabolic activity. Cell Rep, 2020, 33(13): 108547. doi:10.1016/j.celrep.2020.108547.
[5]	尹春阳, 方刚, 黄莉莉, 等. 有或无营养风险的老年肺结核住院患者相关临床指标的对比研究. 中国防痨杂志, 2020, 42(12): 1305-1309. doi:10.3969/j.issn.1000-6621.2020.12.010.
[6]	Besora-Moreno M, Llauradó E, Tarro L, et al. Social and economic factors and malnutrition or the risk of malnutrition in the elderly: a systematic review and meta-analysis of observational studies. Nutrients, 2020, 12(3): 737. doi:10.3390/nu12030737.
[7]	Li Y, Yang F, Zhou H, et al. Clinical application of NRS-2002 in nutritional risk screening of tuberculosis inpatients. Ann Palliat Med, 2021, 10(5): 5322-5328. doi:10.21037/apm-21-610.
[8]	谢雯霓, 邓国防, 施汶言, 等. 肺结核患者营养风险和营养指标相关性分析. 新医学, 2018, 49(10): 740-744. doi:10.3969/j.issn.0253-9802.2018.10.010.
[9]	Djochie RDA, Anto BP, Opare-Addo MNA. Determinants of adverse reactions to first-line antitubercular medicines: a prospective cohort study. J Pharm Policy Pract, 2023, 16(1):70. doi:10.1186/s40545-023-00577-6. pmid: 37291618
[10]	李毅, 侯韦莲, 汪兰兰. 住院老年病人膳食炎症指数、年龄与衰弱之间的关系研究. 肠外与肠内营养, 2023, 30(1): 8-13,19. doi:10.16151/j.1007-810x.2023.01.005.
[11]	刘伯飞, 户淑红, 杨继黎, 等. 营养支持对老年肺结核合并营养不良患者的效果研究. 宁夏医科大学学报, 2022, 44(9): 903-907. doi:10.16050/j.cnki.issn1674-6309.2022.09.007.
[12]	王霖, 杜映荣, 高建鹏, 等. 云南省老年结核病患者营养状况的调查. 昆明医科大学学报, 2022, 43(4): 32-37. doi:10.12259/j.issn.2095-610X.S20220432.
[13]	Porcel JM. Advances in the diagnosis of tuberculous pleuritis. Ann Transl Med, 2016, 4(15): 282. doi:10.21037/atm.2016.07.23.
[14]	李荣, 马进宝, 任斐, 等. 初治涂阳肺结核患者营养状况与胸部CT表现的关联性研究. 结核与肺部疾病杂志, 2020, 1(2): 17-23. doi:10.3969/j.issn.2096-8493.2020.01.005.
[15]	Hoyt KJ, Sarkar S, White L, et al. Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis. PLoS One, 2019, 14(3): e0214011. doi:10.1371/journal.pone.0214011.
[16]	Wang J, Dai Y, Liu J, et al. MTB-specific lymphocyte responses are impaired in tuberculosis patients with pulmonary cavities. Eur J Med Res, 2017, 22(1): 4. doi:10.1186/s40001-016-0242-9.
[17]	Liu QX, Tang DY, Xiang X, et al. Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: a comprehensive analysis. Front Cell Infect Microbiol, 2022,12:1013751. doi:10.3389/fcimb.2022.1013751.
[18]	谭隽怡, 向明确, 李天驹, 等. 营养因素与结核病患者预后相关研究进展. 中国感染与化疗杂志, 2024, 24(3): 366-370. doi:10.16718/j.1009-7708.2024.03.019.
[19]	陈薇, 丁芹, 顾颖, 等. 上海市900例老年住院结核病患者营养状况调查分析. 中国防痨杂志, 2020, 42(7): 725-730. doi:10.3969/j.issn.1000-6621.2020.07.015.
[20]	陈丹萍, 毛燕君, 李敏, 等. 老年肺结核患者营养状况调查及影响因素分析. 上海护理, 2022, 22(4): 38-43. doi:10.3969/j.issn.1009-8399.2022.04.009.

变量	赋值	变量	赋值
因变量		PAB(mg/L)	>200=0;100~200=1;<100=2
营养风险	无=0;有=1	ALB(g/L)	>40=0;30~40=l;<30=2
自变量		TP(g/L)	<65=0;≥65=1
空洞	否=0;是=1	LYM(×10⁹/L)	<1.1=0;≥1.1=1
纵隔淋巴结肿大	否=0;是=1	CRP(g/L)	≤10=0;>10=1
胸腔积液	无=0;有=1	Hb(g/L)	≤90=0;91~119=1;≥120=2