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中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (06) : 374 -380. doi: 10.3877/cma.j.issn.1674-6880.2017.06.003

所属专题: 文献

论著

糖尿病合并肺结核患者营养风险筛查、评估及干预的临床研究
沈男男1, 王伶1, 劳国琴1, 石夏莹1, 张谊芳1, 王佳良1,()   
  1. 1. 312000 浙江绍兴,绍兴市立医院药剂科
  • 收稿日期:2017-03-08 出版日期:2017-12-01
  • 通信作者: 王佳良
  • 基金资助:
    浙江省药学会医院药学专项科研资助项目(2016ZYY29); 绍兴市科技局公益性项目(2017B70010)

Nutritional risk screening, assessment and intervention in diabetes mellitus patients with pulmonary tuberculosis

Nannan Shen1, Ling Wang1, Guoqin Lao1, Xiaying Shi1, Yifang Zhang1, Jialiang Wang1,()   

  1. 1. Department of Clinical Pharmacy, Shaoxing Municipal Hospital, Shaoxing 312000, China
  • Received:2017-03-08 Published:2017-12-01
  • Corresponding author: Jialiang Wang
  • About author:
    Corresponding author: Wang Jialiang, Email:
引用本文:

沈男男, 王伶, 劳国琴, 石夏莹, 张谊芳, 王佳良. 糖尿病合并肺结核患者营养风险筛查、评估及干预的临床研究[J/OL]. 中华危重症医学杂志(电子版), 2017, 10(06): 374-380.

Nannan Shen, Ling Wang, Guoqin Lao, Xiaying Shi, Yifang Zhang, Jialiang Wang. Nutritional risk screening, assessment and intervention in diabetes mellitus patients with pulmonary tuberculosis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(06): 374-380.

目的

观察营养风险筛查、评估和干预对糖尿病合并肺结核患者治疗效果的影响。

方法

选择绍兴市立医院2015年1月至2016年12月收治的152例糖尿病合并肺结核患者,采用营养风险筛查2002(NRS2002)评分进行筛查,根据结果分为无风险组72例,风险组80例,风险组再分为对照组和观察组,各40例。对照组和观察组均予相同的常规抗痨和降糖治疗,观察组额外加营养支持,对两组营养生化指标、细胞免疫功能及痰菌转阴率、病灶吸收率等指标进行比较。

结果

风险组NRS2002评分[(6.63 ± 0.36)vs.(2.44 ± 0.08),t = 10.740,P = 0.043]明显高于无风险组,总蛋白[(52.2 ± 1.0)g/L vs.(67.4 ± 1.5)g/L,t = 8.823,P = 0.039]、白蛋白[(33.5 ± 1.0)g/L vs.(44.7 ± 1.0)g/L,t = 7.770,P = 0.032]水平均明显低于无风险组。治疗后观察组体质量指数[(8.6 ± 0.5)kg/m2 vs.(10.6 ± 4.0)kg/m2t = 2.183,P = 0.032]、总胆固醇[(4.03 ± 0.21)mmol/L vs.(4.72 ± 0.22)mmol/L,t = 2.283,P = 0.025]、甘油三酯[(3.67 ± 0.30)mmol/L vs.(4.43 ± 0.22)mmol/L,t = 2.007,P = 0.048]、低密度脂蛋白[(3.7 ± 0.4)mmol/L vs.(4.8 ± 0.3)mmol/L,t = 2.098,P = 0.039]、空腹血糖[(6.0 ± 0.5)mmol/L vs.(8.9 ± 0.5)mmol/L,t = 4.089,P = 0.015]、糖化血红蛋白[(4.0 ± 0.3)% vs.(5.5 ± 0.6)%,t = 2.275,P = 0.026]水平和NRS2002评分[(3.3 ± 0.4)vs.(4.7 ± 0.4),t = 2.469,P = 0.016]较对照组均明显降低,高密度脂蛋白[(5.7 ± 0.6)mmol/L vs.(4.0 ± 0.5)mmol/L,t = 2.149,P = 0.035]水平明显高于对照组。治疗后观察组CD3+[(63.6 ± 1.5)% vs.(59.7 ± 1.1)%,t = 2.098,P = 0.039]、CD4+[(35.6 ± 1.5)% vs.(30.9 ± 1.7)%,t = 2.115,P = 0.038]水平均明显高于对照组,CD8+[(25.9 ± 1.2)% vs.(29.1 ± 1.0)%,t = 2.071,P = 0.042]水平明显低于对照组。治疗后观察组与对照组平均痰菌转阴天数[(67.1 ± 1.4)d vs.(72.1 ± 1.6)d,t = 2.312,P = 0.019]、病灶吸收率[(74.0 ± 3.8)% vs.(55.0 ± 2.7)%,t = 4.096,P = 0.030]的比较,差异均有统计学意义。

结论

规范的营养风险筛查、评估及干预能明显改善糖尿病合并肺结核患者的营养状态、免疫功能和治疗效果。

Objective

To investigate the effects of nutritional risk screening, assessment and intervention on the treatment of diabetes mellitus patients with pulmonary tuberculosis (DM-PTB).

Methods

Totally 152 DM-PTB patients of Shaoxing Municipal Hospital from January 2015 to December 2016 were screened by nutritional risk screening 2002 (NRS2002) and divided into the risk-free group (n = 72) and the risk group (n = 80) based on their screening results.The risk group was further divided into the observation group (n = 40) and the control group (n = 40). The two groups were given the same conventional anti-tuberculosis and hypoglycemic treatment, while the observation group was added with nutrition support, to analyze the biochemical indicators, cellular immune functions, the sputum negative conversion rate and the lesion absorption rate in order to determine effects of the nutrition therapy on DM-PTB patients.

Results

As compared to the risk-free group, the score of NRS2002 in the risk group [(6.63 ± 0.36) vs. (2.44 ± 0.08), t = 10.740, P = 0.043] was significantly higher, and the levels of total protein [(52.2 ± 1.0) g/L vs. (67.4 ± 1.5) g/L, t = 8.823, P = 0.039] and albumin [(33.5 ± 1.0) g/L vs. (44.7 ± 1.0) g/L, t = 7.770, P = 0.032] were lower. The levels of the body-mass index [(8.6 ± 0.5) kg/m2 vs. (10.6 ± 4.0) kg/m2, t = 2.183, P = 0.032], total cholesterol [(4.03 ± 0.21) mmol/L vs. (4.72 ± 0.22) mmol/L, t = 2.283, P = 0.025], triglycerides [(3.67 ± 0.30) mmol/L vs. (4.43 ± 0.22) mmol/L, t = 2.007, P = 0.048], low density lipoprotein [(3.7 ± 0.4) mmol/L vs. (4.8 ± 0.3) mmol/L, t = 2.098, P = 0.039], fasting blood glucose [(6.0 ± 0.5) mmol/L vs. (8.9 ± 0.5) mmol/L, t = 4.089, P = 0.015], glycosylated hemoglobin [(4.0 ± 0.3) % vs. (5.5 ± 0.6)%, t = 2.275, P =0.026] and the NRS2002 score [(3.3 ± 0.4) vs. (4.7 ± 0.4), t = 2.469, P = 0.016] in the observation group after treatment were lower than those in the control group, while the level of high density lipoprotein [(5.7 ± 0.6) mmol/L vs. (4.0 ± 0.5) mmol/L, t = 2.149, P = 0.035] was higher. The levels of CD3+ [(63.6 ± 1.5) % vs. (59.7 ± 1.1) %, t = 2.098, P = 0.039] and CD4+ [(35.6 ± 1.5) % vs. (30.9 ± 1.7) %, t = 2.115, P = 0.038] in the observation group were higher as compared to the control group, while the CD8+ level [(25.9 ± 1.2) % vs. (29.1 ± 1.0) %, t = 2.071, P = 0.042] was lower. There were significant differences in the average sputum negative conversion time [(67.1 ± 1.4) d vs. (72.1 ± 1.6) d, t = 2.312, P = 0.019] and the lesion absorption rate [(74.0 ± 3.8) % vs. (55.0 ± 2.7) %, t = 4.096, P = 0.030] between the observation and control groups after treatment.

Conclusion

Normative nutritional risk screening, assessment and intervention can obviously improve the nutritional status, immune functions and treatment effects of DM-PTB patients.

表1 两组DM-PTB患者NRS2002评分和营养指标的比较( ± s
表2 两组DM-PTB营养风险患者治疗前后生化指标的比较( ± s
表3 两组DM-PTB营养风险患者治疗前后细胞免疫功能的比较( ± s
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