NRS-2002在心血管疾病住院患者营养风险筛查中的应用及相关因素分析-现代医学

NRS-2002在心血管疾病住院患者营养风险筛查中的应用及相关因素分析

单位：1. 东南大学附属中大医院心血管内科, 江苏南京 210009;
2. 东南大学公共卫生学院, 江苏南京 210009

关键词：营养风险筛查表2002 心血管疾病住院患者营养风险筛查

分类号：R473.5

出版年·卷·期（页码）：2023·51·第六期（758-764）

摘要：

目的：探讨营养风险筛查表2002(NRS-2002)在心血管疾病住院患者营养风险筛查中的应用及相关因素分析。方法：选取2021年11月在东南大学附属中大医院心血管内科住院患者721例为研究对象，应用NRS-2002评分表在入院24 h内进行营养风险筛查。分为有营养风险组(NRS-2002评分≥3分)和无营养风险组(NRS-2002评分<3分)，记录疾病名称、合并症、危重症、纽约心脏病学会(NYHA)的心功能分级及营养相关指标包括体质量指数(BMI)、血清总蛋白(TP)、白蛋白(ALB)、前蛋白(PA)、总胆固醇(TC)、甘油三脂(TG)、脂蛋白a(LPa)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、白细胞计数(WBC)、血红蛋白(Hb)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、游离T3(FT3)、游离T4(FT4)、促甲状腺激素(TSH)，分析两组患者各指标的相关性。结果：721例心血管疾病住院患者中存在营养风险的134例，营养风险发生率18.51%；有营养风险组较无营养风险组年龄更大，且NYHA心功能Ⅱ~Ⅳ级、危重症、心律失常尤其是心房纤颤、有合并症包括2型糖尿病(T2DM)、慢性肾功能不全及慢性阻塞性肺疾病(COPD)患者明显增多，差异有统计学意义(P<0.05)。有营养风险组TP、ALB、Hb、FT3较无营养风险组明显下降，差异有统计学意义(P<0.05)。FBG、LPa、BUN、Cr与无营养风险组相比明显升高，差异有统计学意义(P<0.05)。相关性分析表明，有营养风险组与NYHA心功能Ⅱ~Ⅳ级、危重症者、心血管疾病合并症(T2DM、慢性肾功能不全及COPD)以及实验室指标(WBC、BUN、Cr、UA)呈正相关(P<0.05)，与BMI以及PA、TC、Hb、FT3呈负相关(P<0.05)。有营养风险组影响因素的Logistic回归分析结果显示，年龄、BMI、危重症、合并症(2型DM、慢性肾功能不全)、NYHA心功能Ⅱ-Ⅳ级、WBC、Hb是发生营养风险的影响因素(P<0.05)。结论:心血管疾病住院患者年龄越大、心功能分级越严重，有营养风险发生率越高。与BMI、心血管疾病合并T2DM、慢性肾功能不全及WBC、Hb密切相关，尤其是危重症患者。应引起医护人员对心血管疾病患者高度关注，尽早发现营养风险，为营养干预提供理论依据。

Objective: To investigate the application of the Nutritional Risk Screening 2002(NRS-2002) in nutritional screening of inpatients with cardiovascular disease and the analysis of related factors. Methods: 721 inpatients hospitalized in the cardiovascular medicine department of our hospital in November 2021 were selected as the study objects, and NRS 2002 was applied to screen patients for nutritional risk within 24 hours of admission. The study objects were divided into the nutritional risk group(NRS-2002 score ≥ 3 points) and the no nutritional risk group(NRS-2002 score <3 points), and collected disease name, comorbidities, critical illness, the New York Heart Association(NYHA) cardiac function class and nutrition-related indicators including the Body Mass Index(BMI), serum total protein(TP), albumin(ALB), preprotein(PA), total cholesterol(TC), triglyceride(TG), lipoprotein a(LPa), fasting blood glucose(FBG), glycosylated hemoglobin(HbA1c), white blood cell count(WBC), hemoglobin(Hb), urea nitrogen(BUN), creatinine(Cr), uric acid(UA), free T3(FT3), free T4(FT4), thyroid stimulating hormone(TSH) to analyze the correlation between the two groups of patients with each index. Results: Among the 721 inpatients with cardiovascular disease, 134 inpatients were at nutritional risk, and the incidence of nutritional risk was 18.51%; The group with nutritional risk was older than the group without nutritional risk, and there were significantly more patients with cardiac function class Ⅱ-Ⅳ, critically ill patients, arrhythmias especially atrial fibrillation, and patients with comorbidities including the Type 2 diabetes mellitus(T2DM), chronic renal insufficiency, and chronic obstructive pulmonary disease(COPD), and the difference was statistically significant(P<0.05).The TP, ALB, Hb and FT3 of patients with nutritional risk group were significantly lower than those without nutritional risk, and the difference was statistically significant(P<0.05). Compared with patients without nutritional risk, FBG, LPa, BUN and Cr were significantly increased, and the difference was statistically significant(P<0.05). Correlation analysis showed that the nutritional risk group was positively correlated(P<0.05) with cardiac function class Ⅱ-Ⅳ or higher, those with critical illness, cardiovascular disease comorbidities(T2DM, chronic renal insufficiency and COPD) and laboratory indicators(WBC, BUN, Cr, UA), and negatively correlated(P<0.05) with BMI and PA, TC, Hb and FT3. The logistic regression analysis of influencing factors of nutritional risk group showed that age, BMI, Critically ill patients, combined with T2DM, combined with chronic renal insufficiency, NYHA cardiac function class I-IV,WBC and Hb was the influencing factor of nutritional risk(P<0.05). Conclusion: The older inpatients with cardiovascular disease, the more severe the cardiac function classification, and the higher the incidence of nutritional risk. It is closely related to BMI, cardiovascular disease complicated with T2DM, chronic renal insufficiency and Hb, especially in critically ill patients. Medical staff should pay high attention to patients with cardiovascular disease to identify nutritional risks as early as possible, and provide theoretical basis for nutritional intervention.[Key words] nutritional risk screening 2002; cardiovascular disease; inpatients; nutritional risk screening

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