老年代谢综合征患者微型营养评估及相关因素的研究

发布时间：2018-04-22 15:45

本文选题：老年 + 代谢综合征　；参考：《承德医学院》2017年硕士论文

【摘要】：目的:探讨应用微型营养评估(miniature nutritional assessment,MNA)对老年代谢综合征(metabolic syndrome,MS)患者的营养状况进行评价,并研究营养不良的相关因素,以便为进一步采取相应的营养教育和营养治疗等提供临床依据,早期改善营养状态,辅助临床治疗,提倡健康的生活方式和饮食方式等,改善老年人的营养状态和生活质量,减轻家庭和社会的负担。方法:随机选择2015年3月至2016年3月期间承德医学院附属医院的老年病科住院的年龄≥60岁的老年MS患者102例作为观察组,健康老年体检者120例作为对照组。对两组均进行MNA测评,对两组MNA评分进行比较。依据MNA评分,将观察组分为营养良好组(a)、潜在营养不良组(b)和营养不良组(c),将对照组记录为(d)。记录一般临床指标:年龄、性别、腰围、臀围、身高、体重,并计算腰/臀比(W/H)、体质指数(BMI),白蛋白(ALB)、前白蛋白(PA)、淋巴细胞总数(LC)、血红蛋白(HGB)、钠(Na)、钾(K)、钙(Ca)、镁(Mg)、磷(P)、氯(Cl)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(Apo-A1)、载脂蛋白B(Apo-B)、空腹血糖(Free Blood Glucose,FBG)、餐后2小时血糖(2-hour Postprandial Blood Glucose,2h PBG)(但需重复一次检验)、尿酸(UA)、肌酐(Cr)、尿素氮(BUN)、高敏C反应蛋白(sCRP)等。采用SPSS19.0统计学软件对数据进行分析,计量资料以?x±s表示,资料服从正态分布,采用单因素方差分析,两两比较采用LSD-t检验;计数资料描述用例数(百分比),统计差异采用χ2检验;相关分析统计采用Spearman相关;应用二分类Logistic回归分析筛选出老年MS患者营养不良的相关因素。P0.05为差异有统计学意义。结果:1观察组MNA营养不良检出率高于对照组,差异有统计学意义(χ2=9.404,P=0.002)。2各临床指标的组间比较观察组不同营养状态患者及对照组性别构成、BMI、W/H、高血压病比例、TC、LDL-C、LC、上臂围、UA、Na、K、Apo-A1、Apo-B等差异无统计学意义(P0.05),观察组不同营养状态患者及对照组年龄、HGB、ALB、PA、2型糖尿病(T2-DM)、TG、HDL-C、sCRP、小腿围、β2-MG、BUN、Cr等差异有统计学意义(P0.05)。两两比较显示营养不良组患者年龄高于其余三组,营养不良风险组年龄高于营养良好组,差异有统计学意义(P0.05)。营养不良组HGB、ALB、PA低于其余三组,营养不良组HGB低于对照组,差异有统计学意义(P0.05)。营养不良组、营养不良风险组HDL-C对照组。营养不良组sCRP高于营养不良风险组,营养不良风险组高于营养良好组,营养良好组高于对照组,差异有统计学意义(P0.05)。营养不良组HbA1c高于营养不良风险组,营养不良风险组高于营养良好组及对照组,差异有统计学意义(P0.05)。营养不良组糖尿病比例高于其余三组,营养不良风险组亦高于对照组,差异有统计学意义(P0.05)。营养良好组及对照组小腿围高于其余两组,营养不良组β2-MG、BUN高于其余三组,差异有统计学意义(P0.05)。3 Spearman相关性分析发现老年MS患者的MNA评分与年龄、T2-DM、sCRP、HbA1c、β2-MG、BUN等存在负相关关系(P0.05),r值分别为-0.446、-0.314、-0.374、-0.446、-0.300、-0.239;MNA评分与HGB、ALB、PA、HDL-C、小腿围、Apo-B等存在正相关关系(P0.05),r值分别为0.318、0.525、0.339、0.279、0.309、0.219;与性别、BMI、W/H、高血压病、TG、TC、LDL-C、LC、上臂围、Apo-A1不存在相关关系(P0.05)。4二分类Logistic回归分析显示高龄、低白蛋白血症、血清PA偏低、sCRP及HbA1c水平增高与老年MS患者营养不良发生显著相关(P0.05),OR值分别为5.622、15.092、5.919、9.591、3.776。结论:1老年代谢综合征患者营养不良发生率高于正常体检老年人。2高龄、高敏C反应蛋白增高及糖化血红蛋白水平增高与老年MS患者营养不良发生显著相关,可能是老年MS患者营养不良的危险因素。
[Abstract]:Objective: To evaluate the nutritional status of elderly metabolic syndrome (metabolic syndrome, MS) patients with miniature nutritional assessment (MNA), and to study the related factors of malnutrition in order to provide clinical basis for further nutrition education and nutrition treatment, and to improve nutritional status in early stage. To assist the clinical treatment, promote healthy lifestyle and diet, improve the nutritional status and quality of life of the elderly and reduce the burden of family and society. Methods: 102 cases of MS patients aged over 60 years of age in the Department of geriatrics in Affiliated Hospital of Chengde Medical College from March 2015 to March 2016 were selected as the observation group. 120 healthy elderly patients were treated as the control group. The two groups were evaluated by MNA, and the two groups of MNA scores were compared. According to the MNA score, the observation group was divided into good nutrition group (a), potential malnutrition group (b) and malnutrition group (c), and the control group was recorded (d). Age, sex, waist, hip, height, weight, and plan were recorded. W/H, body mass index (BMI), albumin (ALB), prealbumin (PA), total lymphocyte count (LC), hemoglobin (HGB), sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), phosphorus (P), chlorine (Cl), glycosylated hemoglobin, triglyceride, high-density lipoprotein cholesterol, low density lipoprotein cholesterol (LDL), apolipoprotein 1 (Apo-A1), apolipoprotein B (Apo-B), fasting blood glucose (Free Blood Glucose, FBG), postprandial 2 hours blood glucose (2-hour Postprandial Blood Glucose, 2h), uric acid, creatinine, urea nitrogen, Gao Min anti stress protein, etc. The data were subject to normal distribution, using single factor analysis of variance, 22 comparison using LSD-t test, counting data to describe use case number (percentage), statistical difference using chi 2 test, correlation analysis and statistical use of Spearman correlation, and using two classified Logistic regression analysis to screen out the related factors of malnutrition in old MS patients.P0.05 Results: in 1 observation group, the detection rate of malnutrition in MNA was higher than that of the control group. The difference was statistically significant (x 2=9.404, P=0.002), and there was no significant difference in sex composition, BMI, W/H, the proportion of BMI, W/H, hypertension, TC, LDL-C, LC, Na, K, K, and other groups in the group of different nutritional state and control group of.2. .05), the age of different nutritional state and control group, HGB, ALB, PA, type 2 diabetes (T2-DM), TG, HDL-C, sCRP, leg circumference, beta 2-MG, BUN, Cr were statistically significant (P0.05). 22 comparison showed that the age of dystrophy group was higher than the other three groups, and the age of dystrophy risk group was higher than that of good nutrition group, the difference was statistically significant ( P0.05). The dystrophy group HGB, ALB, PA were lower than the other three groups, and the HGB in the dystrophy group was lower than the control group, the difference was statistically significant (P0.05). The malnutrition group, the malnutrition risk group HDL-C control group. The malnutrition group sCRP was higher than the dystrophy risk group, the malnutrition risk group was higher than the good nutrition group, the good nutrition group was higher than the control group, the difference was higher than the control group, the difference was there was the difference Statistical significance (P0.05). The dystrophy group HbA1c was higher than the dystrophy risk group, the dystrophy risk group was higher than the good nutrition group and the control group, the difference was statistically significant (P0.05). The proportion of diabetes in dystrophy group was higher than the other three groups, and the dystrophy risk group was also higher than that in the control group (P0.05). The lower leg circumference of the control group was higher than that of the other two groups, and the beta 2-MG and BUN in the dystrophy group were higher than the other three groups. The difference was statistically significant (P0.05).3 Spearman correlation analysis found that the MNA score of the elderly MS patients was related to the age, T2-DM, sCRP, HbA1c, beta 2-MG, BUN, etc. The score was correlated with HGB, ALB, PA, HDL-C, calf circumference, Apo-B and so on, and R values were 0.318,0.525,0.339,0.279,0.309,0.219, and BMI, W/H, hypertension, TG, TC, hypoalbuminemia, low serum albumin, low serum albumin, low serum albumin, low serum albumin. The increase of A1c was significantly associated with malnutrition in elderly patients with MS (P0.05), and the OR value was 5.622,15.092,5.919,9.591,3.776., respectively. The incidence of malnutrition in 1 elderly patients with metabolic syndrome was higher than that of normal aged people with.2, high sensitivity C reactive protein and increased glycosylated blood erythroprotein level and malnutrition in elderly MS patients. Significant correlation may be a risk factor for malnutrition in elderly patients with MS.

【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589

【参考文献】