摘要
目的观察基于预后营养指数(prognostic nutritional index,PNI)的分级营养对耐药肺结核患者的干预效果,为耐药肺结核患者的营养评估和营养干预提供新的思路。方法采用随机数表抽样,将2023年1—7月安徽省胸科医院的耐药肺结核住院患者分为试验组和对照组,两组均予抗结核药物治疗,其中试验组患者应用PNI分为营养正常、轻度营养不良、中度营养不良、重度营养不良4个层级,分别施以营养教育、营养教育+饮食指导、营养教育+饮食指导+肠内营养、营养教育+饮食指导+肠内营养+肠外营养的分级干预;对照组予以营养教育为主的常规营养干预。比较两组患者营养干预后的营养状况、免疫功能和临床预后等。结果试验组和对照组分别有48例患者纳入本研究。干预3个月后,试验组营养状况指标血红蛋白、前白蛋白、白蛋白水平分别为(127.80±10.36)g/L、(196.69±28.86)mg/L、(44.78±4.51)g/L,均高于同期对照组的(123.12±9.93)g/L、(181.26±29.56)mg/L、(39.51±4.32)g/L,差异均有统计学意义(t=6.157、4.235、4.672,P均<0.05)。干预3个月后,试验组CD3^(+)、CD4^(+)T淋巴细胞百分比及CD4^(+)/CD8^(+)值分别为(62.42±7.32)%、(42.52±4.57)%、1.51±0.23,均高于对照组的(56.41±5.85)%、(39.13±3.57)%、1.27±0.26;CD8^(+)T淋巴细胞百分比为(31.42±3.42)%,低于对照组的(35.01±3.06)%,差异均有统计学意义(t=9.121、7.231、8.031、6.731,P均<0.05)。试验组干预3个月后痰菌转阴率、病灶吸收率、空洞闭合率分别为91.67%、89.58%、72.92%,均高于对照组的77.08%、72.91%和56.25%,差异均有统计学意义(χ^(2)=7.089、4.232、7.253,P均<0.05)。结论基于PNI的耐药肺结核患者分级营养干预可以提升患者血红蛋白、前蛋白和白蛋白水平,提高患者的痰菌转阴率、病灶吸收率和空洞闭合率,改善临床预后。
Objective To observe the application effect of graded nutritional intervention based on prognostic nutritional index(PNI)in drug-resistant pulmonary tuberculosis patients for novel evidence for nutritional evaluation and intervention of such group of patients.Methods By random number sampling,we recruited the drug-resistant pulmonary tuberculosis patients treated in the Inpatient Department of Anhui Provincial Chest Hospital from January to July of 2023,and randomly assigned them to experimental group and control group.Patients in both groups were treated with anti-tuberculosis drugs.Then the patients in the experimental group were further divided into normal nutrition,mild malnutrition,moderate malnutrition and severe malnutrition according to PNI,and respectively given graded intervention,including nutrition education,nutrition education+diet instruction,nutrition education+diet instruction+enteral nutrition,nutrition education+diet instruction+enteral nutrition+parenteral nutrition.Patients in the control group just received routine nutritional intervention,mainly focusing on nutritional education.Finally,the two groups were compared regarding the nutritional status,immune function and clinical prognosis after nutritional intervention.Results After 3 months of intervention,the nutritional status indicators of hemoglobin,prealbumin and albumin were higher in the experimental group than those in the control group[(127.80±10.36)g/L,(196.69±28.86)mg/L and(44.78±4.51)g/L,respectively,vs.(123.12±9.93)g/L,(181.26±29.56)mg/L and(39.51±4.32)g/L].The difference was significant(t=6.157,4.235,4.672,respectively,all P<0.05).Percentage of CD3^(+),CD4^(+)T cells and CD4^(+)/CD8^(+)in the experimental group were higher than those in the control group following three months of intervention[(62.42±7.32)%,(42.52±4.57)%and(1.51±0.23)vs.(56.41±5.85)%,(39.13±3.57)%and(1.27±0.26),respectively],yet the percentage of CD8^(+)T cells was lower in the experimental group than that in the control group[(31.42±3.42)%vs.(35.01±
作者
李爽
刘盛盛
王华
方雪晖
赵存喜
LI Shuang;LIU Shengsheng;WANG Hua;FANG Xuehui;ZHAO Cunxi(School of Public Health,Anhui Medical University,Hefei 230032,Anhui Province,China;Anhui Chest Hospital)
出处
《热带病与寄生虫学》
CAS
2024年第2期107-111,共5页
Journal of Tropical Diseases and Parasitology
基金
安徽省自然科学基金项目(2208085MH193)。
关键词
耐药肺结核
预后营养指数
分级干预
临床预后
Drug-resistant pulmonary tuberculosis
Prognostic nutritional index
Graded intervention
Clinical prognosis
