住院老年阿尔茨海默病患者营养不良和营养风险对临床结局的影响

目的评估住院老年阿尔茨海默病（AD）患者的营养状况、营养风险及对临床结局的影响。方法纳入在北京老年医院住院,年龄≥65岁,符合美国国立神经病学、语言交流障碍和卒中-阿尔茨海默病和相关疾病学会工作小组标准（NINCDS-ADRDA）,临床诊断为AD的患者103例。受试者入院48 h内接受血液常规、生化检查、营养风险筛查（NRS2002）、简明精神状态检查（MMSE）、日常生活能力评定（BI指数）、Charlson合并症指数（CCI）评估。以出院（住院时间〈30 d者）或住院30 d为观察终点,记录观察期间患者是否死亡、是否发生感染性并发症或非感染性并发症,及住院期间营养支持情况。结果存在营养风险者50例（48.5%）,营养不良者44例（42.7%）。观察期间出现感染并发症者34例（33.0%）,非感染并发症者9例（8.7%）,死亡1例。存在营养风险者的CCI评分显著高于不存在营养风险者（P〈0.05）,BI指数低于不存在营养风险者（P〈0.05）,发生并发症的比例和营养不良者所占比例显著高于不存在营养风险者（P〈0.05）。Logistic回归分析显示营养风险和CCI评分均为影响临床结局的变量（P〈0.05）。结论老年AD住院患者存在营养风险和营养不良的比例很高;营养风险与慢性躯体疾病对并发症的发生和不良预后共同起作用。

Correlation between nutritional assessment of elderly inpatients with dementia and their clinical outcomes

Objective To assess the nutritional state and the risk factors of malnutrition of elderly inpatients withdementia and to explore its relationship with clinical outcomes. Methods A total of 103 inpatients with Alzheimer’s dis-ease aged 65 and over were enrolled.Routine examinations of the blood were detected and the NRS2002, the MMSE, the BIindex, and the Charlson Comordility Index（CCI） were evaluated in all subjects. Comorbidities, death, and nutritional sup-ports were recorded until discharges of the subjects or until the endpoint of 30 days. Results There were 50（48. 5%）subjects with nutritional risks, 44（42. 7%） with malnutrition. 34（33. 0%） subjects suffered infective comorbidities, 9（8. 7%） suffered non-infective comorbidities, 1 died during the study period. Average CCI of subjects with risk of malnutri-tion was statistically higher and BI index was statistically lower than that without malnutrition（P〈0. 05）. The rate of suffer-ing comorbidities and the rate of malnutrition in subjects with risk of malnutrition was statistically higher than those without（P〈0. 05）. A model of logistic regression analysis showed that both malnutrition and CCI score were significant variableswhich influenced the clinical outcomes. Conclusions The rate of nutritional risks and malnutrition is high in elderly in-patients with dementia. Both the nutritional risks and the chronic physical comorbidities deteriorate the clinical outcomessignificantly.