老年肺部感染患者营养及免疫状况分析研究

发布时间：2018-05-05 03:07

本文选题：老年患者 + 肺部感染　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:在全球范围内,因感染性疾病死亡的人数占人类总死亡人数的30%左右,而老年患者因自身免疫功能下降、多脏器功能衰退、多种慢性基础疾病等更易发生感染,发病率明显高于年轻人。在感染性疾病中以呼吸道感染为著,且易造成各种不良事件发生,严重者可死亡。因此如何预防及更好地控制感染疾病的发生发展,改善患者预后及降低死亡率已成为目前临床工作的重点。临床工作中发现,目前因感染住院的老年患者多伴有营养不良及免疫功能低下,而营养不良、免疫功能低下可延长感染患者预后时间甚至加重原有感染,如此恶性循环,导致患者经久不愈,机体状态越来越差。因此针对感染性患者如能尽早评估筛查其存在营养不良及免疫功能低下,并给予积极干预对患者的预后、生活质量有极为重要的意义。因感染性疾病中以肺部感染发生比例最高,故本研究专门调查肺部感染患者的营养状态及免疫功能水平,目前已有关于感染患者营养水平的调查,但对于感染患者同时进行营养状态及免疫水平的评估研究尚有限,尤其老年患者的研究更少,本研究拟通过对老年肺部感染住院患者行营养及免疫功能方面评估分析,并调查临床中对老年肺部感染患者存在营养不良及免疫功能低下的干预情况,为优化老年肺部感染患者的营养及免疫支持治疗提供依据。方法:选取2016年8月-2017年2月在吉林大学第一医院老年干部科诊断肺部感染的老年患者140名,年龄≥60岁(平均年龄84.05±7.46岁),根据患者年龄分为三组,A组(60-74岁)、B组(75-89岁)和C组(≥90岁),入院后给予营养风险及免疫功能的筛查及评估,并对体重指数(Body mass index,BMI)、胆固醇、低密度脂蛋白(low densith lipoprotein,LDL)、尿酸、肌酐、白蛋白、前白蛋白、血红蛋白、视黄醇蛋白、淋巴细胞总数进行分析比较,同时分析肺部感染存在营养不良及免疫功能低下的老年患者临床干预的比例。数据分析结果应用统计软件SPSS22.0进行统计学分析,以P0.05为差异有统计学意义。结果:本研究纳入140例老年患者进行营养筛查,A组15例,B组99例,C组26例,总营养不良发生率为68.6%(96/140),总免疫低下发生率为80.7%(113/140),总营养不良合并免疫低下发生率为58.6%(82/140)。其中不同年龄组营养不良及免疫功能低下的比例不同,在A组营养不良的发生率、免疫功能低下发生比率及营养不良合并免疫功能低下发生率依次为40.0%、53.3%、26.7%;在B组依次为66.7%、79.8%、54.5%;在C组依次为92.3%、100%、92.3%。不同年龄组营养不良发生率差异显著(P0.05),B组营养不良发生率显著高于A组(P0.05),C组显著高于A组(P0.01)和B组(P0.05)。不同年龄组免疫低下发生率差异显著(P0.05)。B组免疫低下发生率显著高于A组(P0.05),C组显著高于A组(P0.01)和B组(P0.05)。另外,不同年龄组营养不良合并免疫低下发生率差异显著(P0.001)。B组营养不良合并免疫低下发生率显著高于A组(P0.05),C组显著高于A组(P0.001)和B组(P0.01)。另外,MNA-SF评分与白蛋白、前白蛋白、胆固醇、低密度脂蛋白、血红蛋白的线性相关性均显著(P0.05)。不同年龄组白蛋白、低密度脂蛋白、血红蛋白、体重指数(BMI)差异均显著(P0.05)。A组患者白蛋白显著高于B组患者(P=0.014,P0.05)和C组患者(P=0.039,P0.05);A组患者低密度脂蛋白显著高于B组患者(P0.001)和C组患者(P=0.002,P0.01);A组患者血红蛋白显著高于B组患者(P=0.009,P0.01)和C组患者(P0.001),B组显著高于C组患者(P=0.044,P0.05)。C组患者BMI数值水平显著低于A组患者(P=0.001,P0.01)和B组患者(P=0.012,P0.05),B组显著低于A组(P=0.038,P0.05),随年龄增长,BMI数值水平下降。其中感染性患者合并营养不良组中营养支持比例为38.5%;而免疫水平差的患者给予免疫支持治疗的比例也仅为24.8%;营养不良合并免疫功能低下同时给予营养及免疫支持治疗总比例仅为14.6%。结论:(1)肺部感染老年患者,营养不良及免疫功能低下发生率高,并且随着年龄增长,更易发生营养不良及免疫功能低下。(2)肺部感染存在营养不良及免疫功能低下的老年患者,临床工作中给予营养及免疫支持干预的比例低。(3)白蛋白、前白蛋白、胆固醇、低密度脂蛋白、血红蛋白的水平与机体营养状态相关,其中白蛋白、低密低脂蛋白及血红蛋白的水平与年龄相关。
[Abstract]:Objective: in the world, the number of deaths caused by infectious diseases accounts for about 30% of the total number of human deaths, and the elderly patients are more susceptible to infection due to their lower autoimmune function, multiple organ function decline, and many chronic basic diseases. The incidence of respiratory infection is significantly higher than that of young people. So how to prevent and control the occurrence and development of infected diseases, improve the prognosis of the patients and reduce the mortality has become the focus of clinical work. The poor function can prolong the prognosis of the infected patients and even aggravate the original infection, such a vicious cycle, which causes the patient to be prolonged, the body is getting worse and worse. Therefore, the quality of life is extremely good for the infected patients if they can assess the malnutrition and immune function as early as possible, and give positive intervention to the prognosis of the patients. It is of great significance. Because of the highest proportion of pulmonary infection in infectious diseases, this study specially investigates the nutritional status and immune function level of the patients with pulmonary infection. There is a survey on the nutritional level of the infected patients. However, the assessment of the nutritional status and immune level of the infected patients is still limited, especially in the elderly. The study of patients is less. This study is to evaluate the nutritional and immune function of hospitalized elderly patients with pulmonary infection, and to investigate the intervention of malnutrition and immunodeficiency in the elderly patients with pulmonary infection, and to provide the basis for optimizing the nutrition and immune support treatment of the elderly patients with pulmonary infection. 140 elderly patients who were diagnosed with pulmonary infection in No.1 Hospital of Jilin University, August 2016 -2017 years, aged more than 60 years old (average age 84.05 + 7.46 years), were divided into three groups, A group (60-74 years old), group B (75-89 years old) and C group (> 90 years old). After admission, the nutritional risk and immune function were screened and evaluated. The body mass index (Body mass index, BMI), cholesterol, low density lipoprotein (low densith lipoprotein, LDL), uric acid, creatinine, albumin, prealbumin, hemoglobin, retinol protein, and total lymphocyte count were analyzed and compared, and the proportion of clinical intervention in elderly patients with malnutrition and immunodeficiency was analyzed. According to the results of the analysis, statistical analysis was carried out with statistical software SPSS22.0, and the difference was statistically significant. Results: the study included 140 elderly patients with nutritional screening, 15 cases in group A, 99 in group B, 26 in group C, 68.6% (96/140) in total dystrophy, 80.7% (113/140), total dystrophy combined with immunization. The rate of low incidence was 58.6% (82/140). Among the different age groups, the rate of malnutrition and immunodeficiency were different. The incidence of malnutrition, the rate of hypofunction and the incidence of malnutrition combined with immunodeficiency were 40%, 53.3%, 26.7%, in group B, 66.7%, 79.8%, 54.5% in the group of B, and 92.3% in the group C, 100% in the order of 92.3%, 100% in turn. The incidence of malnutrition in 92.3%. group was significantly higher than that in group A (P0.05), in group B, in group C, in group C, in group A (P0.01) and in group B (P0.05). The incidence of immunocompromises in the group of different ages was significantly higher than that in the group of A (P0.05). In addition, there was significant difference in the incidence of malnutrition and immunocompromises in different age groups (P0.001) the incidence of malnutrition and immunocompromises in group.B was significantly higher than that in group A (P0.05), and in C group was significantly higher than that in group A (P0.001) and B group (P0.01). In addition, the linear correlation between MNA-SF score and albumin, prealbumin, cholesterol, low density lipoprotein and hemoglobin was significantly higher than that in group A. The difference of albumin, low density lipoprotein, hemoglobin and body mass index (BMI) in different age groups (P0.05) was significantly higher than that of group B (P=0.014, P0.05) and C group (P=0.039, P0.05) in group.A (P0.05), and low density lipoprotein in A group was significantly higher than that in B group and group patients. Erythroprotein was significantly higher than that in group B (P=0.009, P0.01) and group C (P0.001), and group B was significantly higher than that of group C (P=0.044, P0.05).C group, the BMI numerical level was significantly lower than that of the A group. The proportion of nutritional support in the dystrophy group was 38.5%, while the proportion of immune support treatment was only 24.8% in the patients with poor immunization level, and the total proportion of nutritional and immune support treatment was only 14.6%. conclusion: (1) the incidence of malnutrition and immunodeficiency was high in the elderly patients with lung infection. And with age, malnutrition and immunodeficiency are more likely to occur. (2) there is a low proportion of nutritional and immune support in the clinical work of elderly patients with malnutrition and immunodeficiency. (3) albumin, prealbumin, cholesterol, low density lipoprotein, hemoglobin level and body nutrition The levels of albumin, low density lipoprotein and hemoglobin were age-related.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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