老年女性心力衰竭患者营养状况与预后相关分析

doi:10.3969/j.issn.1004-583X.2021.12.004

摘要/Abstract

摘要：

目的研究简易营养评价精简量表(mini nutritional assessment short-form version, MNA-SF)在老年女性心力衰竭患者营养不良风险评估中的应用价值及其与老年女性心力衰竭患者不良预后的关系。方法选取2018年1月1日-2020年1月1日于我院住院治疗的老年女性心力衰竭患者279例,收集患者临床资料,分析其临床特征;并采用MNA-SF评分评估患者营养状况,探究MNA-SF评分与患者预后相关性。结果心功能Ⅳ级组营养不良发生率高于心功能Ⅱ、Ⅲ级组(93.3% vs 69.4%,76.3%,P=0.035);MNA-SF评分与B型钠尿肽前体(NT-proBNP)呈负相关(r=-0.382, P<0.01);营养不良组NT-proBNP水平显著高于营养正常组(P<0.01),心脏不良事件发生率显著高于营养正常组(28.6% vs 12.1%,P=0.007)。结论老年女性心力衰竭患者营养不良发生率高,MNA-SF评分可作为老年女性心力衰竭患者营养状况的有效评估指标,营养状况评估对预后具有重要意义。

关键词: 心力衰竭, 营养状况, 预后

Abstract:

Objective To explore the application value of mini nutritional assessment short-form version(MNA-SF) for assessing nutritional status of heart failure(HF) in elderly women and its relationship with poor prognosis. Methods The data of 279 elderly HR women, who treated in our hospital from January 1, 2018 to January 1, 2020 were enrolled to analyze the clinical characteristics. MNA-SF score was used to assess the nutritional status, and the correlation between MNA-SF score and prognosis was explored. Results Malnutrition rate of cardiac function level Ⅳ in those patients was significantly higher than that of cardiac function level Ⅱ, Ⅲ (93.3% vs 69.4%,76.3%,P=0.035). MNA-SF was negatively related to N-terminal pro-B-type natriuretic peptide (NT-proBNP)(r=-0.382, P<0.01), NT-proBNP level of malnutrition patients was significantly higher than that of normal patients (P<0.01)and with significantly higher the adverse incidence for HR(28.6% vs 12.1%, P=0.007). Conclusion For elderly HR women the incidence of malnutrition is common. MNA-SF score can be used to evaluate for their nutritional status, with great significance for prognosis.

Key words: heart failure, nutritional status, prognosis

中图分类号:

R541

李姮, 李永辉, 王琳, 何峰. 老年女性心力衰竭患者营养状况与预后相关分析[J]. 临床荟萃, 2021, 36(12): 1079-1082.

Li Heng, Li Yonghui, Wang Lin, He Feng. Correlation analysis of nutritional status and prognosis for heart failure in elderly women[J]. Clinical Focus, 2021, 36(12): 1079-1082.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.12.004

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I12/1079

图/表 4

表1 3组基线资料比较

项目	心功能Ⅱ级组(n=72)	心功能Ⅲ级组(n=177)	心功能Ⅳ级组(n=30)	统计值	P值
年龄(岁)	79.0±6.9	81.9±6.4	82.1±4.2^*△	F=5.634	0.004
糖尿病[例(%)]	24(33.3)	82(46.3)	10(33.3)	χ²=4.498	0.105
高血压[例(%)]	52(72.2)	163(92.1)	22(73.3)	χ²=19.344	0.000
心率(次/min)	82.0±18.0	79.0±21.8	100.8±14.4^*△	F=7.358	0.001
BMI(kg/m²)	25.0±3.6	24.5±4.3	21.8±1.2^*△	F=7.548	0.026
cTnT(μg/L)	0.0±0.0	0.1±0.2	0.3±0.3^*△	F=16.635	0.000
NT-proBNP(ng/L)	735.0(342.9, 2094.0)	1027.0(432.9, 5062.0)	7419.2(2757.0, 12818.1)^*△	F=8.041	0.001
CRP(mg/L)	19.0±18.0	24.9±30.4	70.9±28.4	F=19.441	0.000
BUN(μmol/L)	8.5±4.0	8.6±4.2	9.0±4.2	F=0.099	0.906
UA(μmol/L)	383.3±137.6	377.6±133.7	383.0±91.3	F=0.024	0.976
Cr(μmol/L)	98.6±60.5	89.0±37.9	118.9±20.8	F=6.275	0.002
GLU(mmol/L)	8.9±4.0	7.5±2.9	7.8±4.0	F=4.867	0.008
TP(g/L)	64.3±8.1	64.1±6.3	64.1±6.2	F=0.021	0.979
GLB(g/L)	28.8±6.4	27.5±4.7	22.9±3.1	F=14.087	0.000
ALB(g/L)	36.3±3.8	36.7±3.8	29.9±2.7	F=40.767	0.000
ALT(U/L)	22.8±54.8	25.0±54.6	73.7±21.2	F=11.330	0.004
AST(U/L)	41.6±93.2	32.3±35.6	57.3±25.1	F=2.823	0.061
TC(mmol/L)	4.3±1.2	4.3±2.0	3.9±1.0	F=0.847	0.430
TG(mmol/L)	1.3±0.6	1.5±0.9	0.9±0.2	F=7.529	0.001
LDL(mmol/L)	2.9±0.9	2.9±1.4	2.5±0.8	$F$ =1.227	0.295
HDL(mmol/L)	1.1±0.3	1.1±0.3	1.3±0.3	$F$ =2.704	0.069
HBG(g/L)	116.5±9.6	119.5±14.0	96.5±6.8	$F$ =14.884	0.000
TSH(μU/mL)	5.7±16.5	4.0±5.7	2.2±1.4	$F$ =0.715	0.491
FIB(g/L)	4.2±1.5	3.7±1.3	4.1±1.3	$F$ =1.514	0.224
D-dimer(μg/mL)	1.2±1.1	1.3±2.4	3.5±4.0	$F$ =5.346	0.006
LV(mm)	43.7±4.0	45.7±5.4	49.6±5.5	$F$ =11.867	0.000
EF(%)	58.6±6.2	54.5±8.3	44.1±9.1^*△	$F$ =33.970	0.000
营养不良[例(%)]	50(69.4)	135(76.3)	28(93.3)	χ²=6.693	0.035
MNA-SF评分(分)	10.3±2.2	9.4±2.6	7.1±3.0^*△	$F$ =16.258	0.000

表1 3组基线资料比较

项目	心功能Ⅱ级组(n=72)	心功能Ⅲ级组(n=177)	心功能Ⅳ级组(n=30)	统计值	P值
年龄(岁)	79.0±6.9	81.9±6.4	82.1±4.2^*△	F=5.634	0.004
糖尿病[例(%)]	24(33.3)	82(46.3)	10(33.3)	χ²=4.498	0.105
高血压[例(%)]	52(72.2)	163(92.1)	22(73.3)	χ²=19.344	0.000
心率(次/min)	82.0±18.0	79.0±21.8	100.8±14.4^*△	F=7.358	0.001
BMI(kg/m²)	25.0±3.6	24.5±4.3	21.8±1.2^*△	F=7.548	0.026
cTnT(μg/L)	0.0±0.0	0.1±0.2	0.3±0.3^*△	F=16.635	0.000
NT-proBNP(ng/L)	735.0(342.9, 2094.0)	1027.0(432.9, 5062.0)	7419.2(2757.0, 12818.1)^*△	F=8.041	0.001
CRP(mg/L)	19.0±18.0	24.9±30.4	70.9±28.4	F=19.441	0.000
BUN(μmol/L)	8.5±4.0	8.6±4.2	9.0±4.2	F=0.099	0.906
UA(μmol/L)	383.3±137.6	377.6±133.7	383.0±91.3	F=0.024	0.976
Cr(μmol/L)	98.6±60.5	89.0±37.9	118.9±20.8	F=6.275	0.002
GLU(mmol/L)	8.9±4.0	7.5±2.9	7.8±4.0	F=4.867	0.008
TP(g/L)	64.3±8.1	64.1±6.3	64.1±6.2	F=0.021	0.979
GLB(g/L)	28.8±6.4	27.5±4.7	22.9±3.1	F=14.087	0.000
ALB(g/L)	36.3±3.8	36.7±3.8	29.9±2.7	F=40.767	0.000
ALT(U/L)	22.8±54.8	25.0±54.6	73.7±21.2	F=11.330	0.004
AST(U/L)	41.6±93.2	32.3±35.6	57.3±25.1	F=2.823	0.061
TC(mmol/L)	4.3±1.2	4.3±2.0	3.9±1.0	F=0.847	0.430
TG(mmol/L)	1.3±0.6	1.5±0.9	0.9±0.2	F=7.529	0.001
LDL(mmol/L)	2.9±0.9	2.9±1.4	2.5±0.8	$F$ =1.227	0.295
HDL(mmol/L)	1.1±0.3	1.1±0.3	1.3±0.3	$F$ =2.704	0.069
HBG(g/L)	116.5±9.6	119.5±14.0	96.5±6.8	$F$ =14.884	0.000
TSH(μU/mL)	5.7±16.5	4.0±5.7	2.2±1.4	$F$ =0.715	0.491
FIB(g/L)	4.2±1.5	3.7±1.3	4.1±1.3	$F$ =1.514	0.224
D-dimer(μg/mL)	1.2±1.1	1.3±2.4	3.5±4.0	$F$ =5.346	0.006
LV(mm)	43.7±4.0	45.7±5.4	49.6±5.5	$F$ =11.867	0.000
EF(%)	58.6±6.2	54.5±8.3	44.1±9.1^*△	$F$ =33.970	0.000
营养不良[例(%)]	50(69.4)	135(76.3)	28(93.3)	χ²=6.693	0.035
MNA-SF评分(分)	10.3±2.2	9.4±2.6	7.1±3.0^*△	$F$ =16.258	0.000

表2 3组住院及随访期间预后比较

项目	心功能 Ⅱ级组 ( $n$ =72)	心功能 Ⅲ级组 ( $n$ =177)	心功能 Ⅳ级组 ( $n$ =30)	统计值	$P$ 值
住院天数	7.1±2.5	7.6±2.8	10.1±2.9^*△	$F$ =13.280	0.000
住院全因死亡	0	0	6(20.0)	χ²=50.895	0.000
随访6月全因死亡	2(2.8)	2(1.1)	0	χ²=1.354	0.508
随访6月再入院	10(13.9)	45(25.4)	8(33.3)^*△	χ²=5.395	0.067

表2 3组住院及随访期间预后比较

项目	心功能 Ⅱ级组 ( $n$ =72)	心功能 Ⅲ级组 ( $n$ =177)	心功能 Ⅳ级组 ( $n$ =30)	统计值	$P$ 值
住院天数	7.1±2.5	7.6±2.8	10.1±2.9^*△	$F$ =13.280	0.000
住院全因死亡	0	0	6(20.0)	χ²=50.895	0.000
随访6月全因死亡	2(2.8)	2(1.1)	0	χ²=1.354	0.508
随访6月再入院	10(13.9)	45(25.4)	8(33.3)^*△	χ²=5.395	0.067

表3 MNA-SF评分与各指标相关性比较

指标	$r$ 值	$P$ 值
NT-proBNP	-0.382	<0.01
EF	0.223	<0.01
LV	-0.304	<0.01
BMI	0.236	<0.01
Cr	0.047	<0.01
HGB	0.277	<0.01
ALB	0.217	<0.01
住院天数	-0.186	<0.01

表3 MNA-SF评分与各指标相关性比较

指标	$r$ 值	$P$ 值
NT-proBNP	-0.382	<0.01
EF	0.223	<0.01
LV	-0.304	<0.01
BMI	0.236	<0.01
Cr	0.047	<0.01
HGB	0.277	<0.01
ALB	0.217	<0.01
住院天数	-0.186	<0.01

表4 MNA-SF亚组临床指标比较及其与预后关系

指标	营养不良组( $n$ =213)	营养正常组( $n$ =66)	统计值	$P$ 值
MNA-SF(分)	8.3±2.1	12.9±0.7	$t$ =60.700	0.000
BMI(kg/m²)	24.1±4.0	25.1±3.9	$t$ =0.294	0.088
NT-proBNP(ng/L)	1853.0(735.0, 6849.0)	442.3(218.5, 603.0)	$t$ =41.842	0.000
LV(mm)	46.1±5.6	44.8±4.6	$t$ =1.580	0.210
EF(%)	53.9±9.2	55.6±7.7	$t$ =6.717	0.164
HGB(g/L)	114.5±17.2	120.6±12.9	$t$ =9.979	0.015
住院天数(d)	8.0±2.8	6.6±2.6	$t$ =1.378	0.000
住院全因死亡[例(%)]	6(2.8)	0	χ²=1.900	0.168
6月全因死亡[例(%)]	4(1.9)	0	χ²=1.294	0.255
6个月内再入院[例(%)]	55(26.6)	8(12.1)	χ²=5.885	0.015
心脏不良事件[例(%)]	61(28.6)	8(12.1)	χ²=7.385	0.007
心功能Ⅳ级[例(%)]	28(13.1)	2(3.0)	χ²=3.693	0.030

表4 MNA-SF亚组临床指标比较及其与预后关系

指标	营养不良组( $n$ =213)	营养正常组( $n$ =66)	统计值	$P$ 值
MNA-SF(分)	8.3±2.1	12.9±0.7	$t$ =60.700	0.000
BMI(kg/m²)	24.1±4.0	25.1±3.9	$t$ =0.294	0.088
NT-proBNP(ng/L)	1853.0(735.0, 6849.0)	442.3(218.5, 603.0)	$t$ =41.842	0.000
LV(mm)	46.1±5.6	44.8±4.6	$t$ =1.580	0.210
EF(%)	53.9±9.2	55.6±7.7	$t$ =6.717	0.164
HGB(g/L)	114.5±17.2	120.6±12.9	$t$ =9.979	0.015
住院天数(d)	8.0±2.8	6.6±2.6	$t$ =1.378	0.000
住院全因死亡[例(%)]	6(2.8)	0	χ²=1.900	0.168
6月全因死亡[例(%)]	4(1.9)	0	χ²=1.294	0.255
6个月内再入院[例(%)]	55(26.6)	8(12.1)	χ²=5.885	0.015
心脏不良事件[例(%)]	61(28.6)	8(12.1)	χ²=7.385	0.007
心功能Ⅳ级[例(%)]	28(13.1)	2(3.0)	χ²=3.693	0.030

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