合并糖尿病的老年社区获得性肺炎患者营养风险评估及短期预后

摘要

目的 使用老年营养风险评分(geriatric nutritional risk index,GNRI)评价因社区获得性肺炎(community acquired pneumonia,CAP)住院的老年糖尿病患者的营养风险,分析GNRI对其短期预后的预测价值.方法 回顾性分析2015年1月至2016年6月因CAP收住本院急诊科病房的老年(年龄≥65岁)糖尿病患者114例,设为糖尿病组,另选择同期住院的非糖尿病老年患者55例设为对照组,比较分析两组患者GNRI评分及肺炎严重程度指数(pneumonia severity index,PSI)评分.以GNRI=92分为界限,将糖尿病组患者分为GNRI<92分(n=43)和GNRI≥92分(n=71)两个亚组,比较亚组间PSI评分、呼吸机(有创、无创)使用率、住院死亡率及出院14天再住院率.同时分析GNRI等各因素与住院死亡率的相关性.结果 糖尿病组患者GNRI评分低于非糖尿病组[(89.27±6.30)分vs(93.26±8.29)分,P<0.05];糖尿病组内比较,GNRI<92分亚组PSI评分及住院死亡率均显著高于GNRI≥92分亚组[分别为(99.65±18.85)分vs(92.19±13.36)分,P=0.015;25.6% vs 8.45%,P=0.013];对糖尿病组住院死亡相关危险因素进行分析显示,GNRI评分、血浆白蛋白水平与住院死亡率呈负相关(r=-0.247,P=0.008;r=-0.303,P=0.001), PSI、冠心病史与住院死亡率呈正相关(r=0.168,P=0.024;r=-0.153,P=0.016).结论 合并糖尿病的老年CAP患者存在较大营养风险,营养风险高者短期预后较差,GNRI评分有助于预测其短期预后.%Objective To assess the nutrition risk of the elderly diabetes admitted in hospital as Community Acquired Pneumonia(CAP) by geriatric nutritional risk index(GNRI), analysis the value of GNRI in predicting the short-term prognosis. Method This retrospective study continuously enrolled 114 CAP patients with diabetes aged 65 at least, who were admitted by emergency department of our hospital from January 2015 to June 2016.This study also enrolled 55 CAP patents without diabetes as control group,who admitted the same time in the same department. GNRI and PSI were compared. The diabetes group was divided into two subgroup by the GNRI=92(GNRI<92, n=43;GNRI≥92,n=71).PSI,mechanic ventilation rate,in-hospital mortality and re-admitted in hospital in 14 days rate were compared. Figure out the relationship between in-hospital mortality and GNRI and other risk factors. Result GNRI of diabetes group was lower than control group(89.27±6.30, 93.26±8.29, P<0.05); PSI and in-hospital mortality in subgroup of GNRI<92 were higher than GNRI≥92 subgroup(99.65±18.85, 92.19±13.36, P=0.015); both GNRI and low serum album level showed minus relation to in-hospital mortality (r=-0.247, P=0.008; r=-0.303, P=0.001), while PSI and history showed positive relations(r=0.168, P=0.024; r=-0.153, P=0.016). Conclusion Higher nutrition risk was found in aged CAP patients with diabetes,that also meant worse short-term prognosis,it was useful to tools like GNRI to predict the short-term prognosis.