Duchenne型肌营养不良患儿营养状况及其影响因素的相关性

摘要

Objective To investigate the relationship between nutritional status and influencing factors of children with Duch-enne muscular dystrophy ( DMD) , providing the basis for nutritional and integrated caring of this disease.Methods The study included 154 children with DMD who received treatments at the Department of Neurology of the General Hospital of the Chinese People’ s Armed Police Force along with outpatient clinics from 2013 through 2014.Z-scores ( WAZ, HAZ, WHZ and BAZ) were calculated, ttest and Spearman rank correlation analysis were conducted between Z-scores and influencing factors.Results In Z-scores, means of both WHZ and BAZ were positive, while those of both WAZ and HAZ were negative.Growth retardation was present at the early stage of walking ( <9 year-old);there was a high incidence of low body weight and growth retardation ( P<0.05) till the late stage of walking (>9 year-old).For children with DMD, incidence rates of low body weight, growth retardation, emaciation and obesity were 4.6%, 20.1%, 3.9%and 13.0%, respectively.Especially, children at the early stage of walking had a high incidence of obesity (16.9%), while the incidence of growth retardation was up to 30.8%in those at the late stage of walking.Z-scores correlated with some influencing factors, WAZ and HAZ and family monthly income was positively related among them ( P<0.05) .Conclusions The nutritional status in chil-dren with DMD is unoptimistic with Z-scores at a low level;positive measures should be taken to allow clinicians and children’ s parents to improve the knowledge of the nutritional therapy for DMD, providing a good basis for sequential treatment of this disease.%目的：探讨Duchenne型肌营养不良（ duchenne muscular dystrophy，DMD）患儿的营养状况与影响因素之间的关系，为该病的营养及综合治疗提供依据。方法回顾性分析武警总医院神经内科联合门诊就诊的DMD患儿154例为研究对象，分别计算年龄别体重（ WAZ）、年龄别身高（ HAZ）、身高别体重（ WHZ）、年龄别体重（ BAZ）指数四项Z评分，将Z评分与影响因素间进行t检验和Spearman等级相关分析。结果 Z评分中WHZ与BAZ均值均为正值，WAZ与HAZ均值为负值，在行走早期（＜9岁）即可表现出发育迟缓，至行走晚期（≥9岁）时，低体重和发育迟缓发生率均较高（P＜0．05）。 DMD患儿低体重、生长迟缓、消瘦、肥胖的发生率分别为4．6％、20．1％、3．9％、13．0％，其中行走早期的患儿肥胖的发生率较高（16．9％），而行走晚期的患儿生长迟缓发生率高达30．8％。 Z评分与部分影响因素之间存在相关关系，其中WAZ和HAZ与家庭月收入呈正相关（ P＜0．05）。结论 DMD患儿的低体重及营养不良发生率较高，Z评分处在较低水平，应采取积极措施提高临床医师及患儿家属对DMD营养治疗的认识。