老年慢性心衰患者营养不良状况及其危险因素-现代医学

老年慢性心衰患者营养不良状况及其危险因素

单位：南京医科大学附属南京医院(南京市第一医院) 营养膳食中心, 江苏南京 210006

分类号：R541.6

出版年·卷·期（页码）：2025·53·第八期（1224-1230）

摘要：

目的：探讨老年慢性心衰(CHF)患者营养不良状况及其危险因素。方法：选取2022年1月至2024年10月于本院就诊及复查的310例老年CHF患者为研究对象，采用心力衰竭特异性微型营养评价量表(MNA-HF)评估老年CHF患者营养状况，依据有无营养不良分为营养不良组与无营养不良组。采集患者有无合并衰弱、白蛋白(Alb)、C反应蛋白(CRP)等资料，Logistic回归分析老年CHF患者发生营养不良的影响因素，据此构建列线图预测模型，并采用受试者操作特征(ROC)曲线、精确率-召回率(PR)曲线、校正曲线、H-L检验评估该模型的预测性能。结果：剔除不合格问卷后，最终纳入302例老年CHF患者。统计显示，302例老年CHF患者营养不良占比23.51%(71/302)。Logistic回归分析显示，NYHA心功能分级(OR=2.083)、合并衰弱(OR=4.069)、水肿情况(OR=4.620)、Alb(OR=0.768)、CRP(OR=1.754)是老年CHF患者发生营养不良的独立影响因素(P＜0.05)。构建老年CHF患者营养不良的列线图预测模型，ROC曲线评估发现该模型预测营养不良的曲线下面积(AUC)为0.895(95%CI 0.851～0.939)，灵敏度为84.51%，特异度为81.82%，PR曲线显示，AUC为0.767。绘制校准曲线显示，平均绝对误差为0.013，H-L检验显示，该模型预测值与实际观测值差异无统计学意义(χ²=10.339，P=0.242)。结论：老年CHF患者营养不良发生率高，其发生与NYHA心功能分级、合并衰弱、水肿情况、Alb、CRP多种因素有关，且据此构建的列线图预测模型具有良好的区分度与预测效能。

Objective: To investigate the malnutrition status and its risk factors in elderly patients with chronic heart failure(CHF). Methods: 310 elderly CHF patients treated and followed up in our hospital from January 2022 to October 2024 were selected. The Mini-Nutrition Assessment Special for Heart Failure(MNA-HF) was used to evaluate nutritional status and the patients were divided into malnutrition and non-malnutrition groups in accordance with whether they were malnutrional or not. Clinical data including presence of frailty, albumin(Alb) and C-reactive protein(CRP) were collected. Logistic regression analysis was performed to identify risk factors for malnutrition, and a nomogram prediction model was constructed based on the results of the analysis. The model's predictive performance was evaluated using receiver operating characteristic(ROC) curve, Precision-Recall(PR) curve, calibration curve, and Hosmer-Lemeshow test. Results: After excluding invalid questionnaires, 302 elderly CHF patients were included in the final analysis. Statistics showed that the prevalence of malnutrition was 23.51%(71/302). Logistic regression analysis identified New York Heart Association(NYHA) functional classification(OR=2.083), presence of frailty(OR=4.069), edema status (OR=4.620), Alb(OR=0.768), and CRP(OR=1.754) as independent risk factors for malnutrition in elderly CHF patients(P<0.05). The nomogram prediction model showed an area under the curve(AUC) of 0.895(95%CI 0.851-0.939) with sensitivity of 84.51% and specificity of 81.82%. The PR curve showed an AUC of 0.767. The calibration curve showed a mean absolute error of 0.013, and the Hosmer-Lemeshow test indicated no statistically significant difference between the predicted and the observed values(χ²=10.339, P=0.242). Conclusion: Elderly CHF patients have a high prevalence of malnutrition, which is associated with multiple factors including NYHA cardiac function classification, comorbid frailty, edema status, Alb, and CRP levels. The nomogram prediction model constructed based on these factors demonstrates good discrimination and predictive performance.

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