慢性心力衰竭住院患者营养风险评估的临床应用研究

doi:10.16150/j.1671-2870.2021.02.011

摘要/Abstract

摘要：

目的:应用营养风险筛查2002（nutritional risk screening 2002,NRS 2002）量表（以下简称NRS 2002）评估慢性心力衰竭（心衰）患者住院时的营养风险发生率,并评估其与心功能间的关系。方法:采用前瞻性研究方法,用NRS 2002评分对确诊为慢性心衰的住院患者进行营养风险筛查,同时测定与营养相关的指标[包括体质量指数（body mass index,BMI）、血红蛋白、前白蛋白、白蛋白、三酰甘油、总胆固醇、肾功能]以及与心衰相关的生物标志物[脑利尿钠肽前体（pro-brain-type natriuretic propeptide,pro-BNP）],分析NRS 2002评分与上述指标间的相关性。随访患者6个月内发生心衰恶化再入院的情况。结果:165例患者被纳入研究,根据NRS 2002评分≥3分认为存在营养风险,住院慢性心衰患者的营养风险发生率为50.3%。有营养风险的患者中,60岁及以上患者的百分比高达73.5%（P<0.05）。相较于NRS 2002评分<3分组,≥3分组中纽约心脏协会（New York Heart Association,NYHA）心功能Ⅲ级以上患者的百分比明显升高（P<0.05）,而BMI、白蛋白、前白蛋白、血红蛋白、胆固醇、估算肾小球滤过率（estimated glomerular filtration rate,eGFR）水平均显著下降（P均<0.05）。采用Spearman秩相关检验分析发现,NRS 2002评分与BMI及血清白蛋白、前白蛋白、血红蛋白、三酰甘油、胆固醇水平呈负相关（P<0.05）,与年龄、NYHA心功能分级呈正相关（P<0.05）。在不同NYHA心功能分级患者中,NRS 2002评分、pro-BNP、白蛋白水平总体分布差异具有统计学意义（P<0.05）。NRS 2002评分≥3分组与<3分组之间的患者再入院率差异没有统计学意义（P=0.496）。结论:慢性心衰住院患者营养风险的发生率高（50.3%）,NRS 2002适用于慢性心衰住院患者的营养风险评估,营养风险筛查可作为慢性心衰住院患者整体评估的一部分。

关键词: 慢性心力衰竭, 营养风险筛查2002量表, 营养风险

Abstract:

Objectives: To assess the incidence of nutritional risk in hospitalized patients with chronic heart failure（CHF） using nutritional risk screening 2002 scale(NRS 2002) and analyze the relationship between CHF and NRS 2002. Methods: A prospective study was conducted in patients with CHF admitted at the Department of Cardiology. NRS 2002 was performed to assess nutritional risk of the patients. Nutrition related body mass index(BMI), hemoglobin, prealbumin, albumin, triglyceride, total cholesterol, renal function and CHF-related biomarker pro-brain-type natriuretic peptide (pro-BNP) were measured, and correlation of above mentioned indices with NRS 2002 was analyzed. All the patients were followed-up for six months, and readmission due to heart failure(HF) was counted. Results: A total of 165 patients were included in the study. When patients with NRS 2002 score ≥3 were regarded as having nutritional risk,the incidence of nutritional risk in the hospitalized patients with CHF was 50.3%. In patients with nutritional risk,patients aged 60 years and older accounted for 73.5%, higher than that in patients without(P<0.05). Compared with NRS 2002 score<3 group, percentage of patients with Ⅲor Ⅳcardiac function by New York Heart Association (NYHA) in NRS 2002 score≥3 group was significantly higher (P<0.05), while levels of BMI, albumin, prealbumin, hemoglobin, cholesterol and eGFR were lower (P<0.05). Spearman rank correlation test showed that NRS 2002 score was negatively correlated with BMI, pro-BNP, albumin, proalbumin, hemoglobin, triglyceride, cholesterol (P<0.05), while was positively correlated with age and NYHA grade (P<0.05). The NRS 2002 score, pro-BNP and albumin levels differed significantly between patients with different NYHA grades (P<0.05). However, there was no statistically significant difference in readmission rate between NRS 2002 score≥3 group and <3 group (P=0.496). Conclusions: The incidence of nutritional risk in hospitalized patients with CHF is as high as 50.3%.NRS 2002 is suitable for nutritional risk screening in patients with CHF during hospitalization,and can be used as part of the overall assessment of the patients.

Key words: Chronic heart failure, Nutritional risk screening 2002 scale, Nutritional risk

中图分类号:

R541.4

盛虹, 章安迪. 慢性心力衰竭住院患者营养风险评估的临床应用研究[J]. 诊断学理论与实践, 2021, 20(02): 178-183.

SHENG Hong, ZHANG Andi. Study on application of nutritional risk screening in hospitalized patients with chronic heart failure[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(02): 178-183.

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参考文献 19

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参数	所有患者（n=165）	NRS 2002评分<3分组（n=82）	NRS 2002评分≥3分组（n=83）	P值
性别
男	103（62.4%）	54（65.9%）	49（59.0%）	0.313
女	62（37.6%）	28（34.1%）	34（41.0%）
平均年龄（岁）	62.1±14.5	57.6±12.7	66.5±15.0	<0.001
年龄<60岁	69（41.8%）	47（57.3%）	22（26.5%）
年龄≥60岁	96（58.2%）	35（42.7%）	61（73.5%）
NYHA心功能分级				<0.001
Ⅱ	67（40.6%）	42（51.2%）	25（30.1%）	<0.001
Ⅲ	75（45.4%）	31（37.8%）	44（53.0%）	<0.001
Ⅳ	23（14.0%）	9（10.0%）	14（16.9%）	<0.001
BMI（kg/m²）	24.8±5.5	26.5±5.1	23.4±5.4	<0.001
LVEF（%）	40.5±12.2	41.1±12.4	40.5±12.2	0.524
实验室检查
pro-BNP（ng/L）	2 465.4±2 681.4	2 356.3±3 142.5	2 759.6±2 311.2	0.161
白蛋白（g/L）	38.3±4.6	39.3±4.0	37.3±4.8	0.004
前白蛋白（mg/L）	226.5±220.9	262.9±297.0	193.4±65.5	0.035
C反应蛋白（mg/L）	9.7±27.3	6.3±2.1	12.7±33.6	0.163
血红蛋白（g/L）	132.8±21.4	138.4±19.2	126.1±22.3	<0.001
三酰甘油（mmol/L）	1.4±0.7	1.5±0.7	1.3±0.7	0.056
胆固醇（mmol/L）	3.9±1.1	4.2±1.1	3.6±1.0	0.000
血肌酐（μmol/L）	91.5±32.9	86.6±25.1	96.3±38.3	0.062
eGFR[mL/（min·1.73 m²]	76.1±24.1	81.7±20.5	70.5±23.7	0.003
再入院	24（14.5%）	11（13.4%）	13（15.7%）	0.496

项目	r值	P值
性别	0.057	0.473
年龄	0.359	<0.001
NYHA心功能分级	0.402	<0.001
BMI	-0.415	<0.001
白蛋白	-0.182	0.008
前白蛋白	-0.027	0.001
血红蛋白	-0.302	<0.001
三酰甘油	-0.253	0.003
胆固醇	-0.286	<0.001
LVEF	-0.089	0.262
eGFR	-0.276	<0.001

NYHA心功能分级	例数(n)	NRS 2002评分	BMI(kg/m²)	pro-BNP(pg/mL)	LVEF(%)	前白蛋白(mg/L)	白蛋白(g/L)	血红蛋白(g/L)
Ⅱ级	67	2.2±0.7	25.4±4.6	1 561.1±1 808.8	42.3±12.7	266.6±39.7	39.5±3.6	135.7±19.5
Ⅲ级	75	3.1±1.0^a)	24.4±6.3	3 145.8±3 183.3^a)	39.7±12.5	201.4±69.5	37.9±5.0^a)	131.7±21.6
Ⅳ级	23	3.2±1.1^a)	25.1±5.3	2 465.4±2 236.8^a)	38.6±8.9	180.2±56.3	35.8±4.9^a)	125.4±26.5
P值		<0.001	0.316	0.001	0.263	0.133	0.004	0.33