增龄与肾功能不全对老年人营养状况的影响

目的评价不同肾功能水平老年患者的营养状态及其影响因素。方法回顾性分析2016年9月至2017年2月在南京医科大学第一附属医院老年肾科住院的患者189例。依据微型营养评估简表(MNA-SF)评分结果分为3组:营养正常组(12~14分)、营养不良危险组(8~11分)和营养不良组(0~7分)。比较各组临床资料。采用SPSS 20.0软件进行数据分析。根据数据类型分别采用t检验或X~2检验比较组间差异。营养不良发生的危险因素采用logistic回归分析。结果 189例患者中,营养不良组10例,占5.3%;营养不良风险组58例,占30.7%;营养正常组121例,占64.0%。与营养正常组相比,营养不良风险组和营养不良组患者的体质量指数(BMI)、白蛋白(ALB)、红细胞计数、血红蛋白(Hb)和淋巴细胞计数百分比均显著降低(P0.05),而营养不良组患者的中性细胞计数百分比显著增加(P0.05)。不同营养状况患者的年龄分布、肾功能及贫血状况差异均有统计学意义(P0.05)。多因素回归分析表明,高龄(OR=1.06,95%CI 1.00~1.12)、低估算肾小球滤过率(OR=0.97,95%CI 0.94~1.00)、低BMI(OR=0.76,95%CI0.65~0.87)、低ALB(OR=0.93,95%CI 0.86~0.99)和贫血(OR=2.46,95%CI 1.60~3.32)是患者发生营养不良及营养不良风险的危险因素。结论增龄与肾功能不全可能增加营养不良风险及营养不良的发生率,且营养不良也与患者的BMI、ALB水平及贫血严重程度相关。

Influence of aging and renal insufficiency on nutritional status in the elderly

Objective To investigate the nutritional condition and the influencing factors in the elderly patients with different kidney function levels. Methods A total of 189 patients hospitalized in our department during September 2016 to February 2017 were enrolled and retrospectively analyzed in this study. According to their scores of the mini nutritional assessment short-form (MNA-SF), the patients were divided into normal nutrition group (12-14 points), malnutrition risk group (8-11 points) and malnutrition group (0-7 points). Clinical data were compared and analyzed by SPSS statistics 20.0. The differences were compared with t test or Chi-square test respectively. The risk factors of malnutrition were analyzed by logistic regression analysis. Results Among the 189 patients, MNA-SF scores showed that 10 patients (5.3%) were suffering from malnutrition, 58 subjects (30.7%) in malnutrition status and 121 participants (64.0%) in normal nutrition condition. Compared with the normal nutrition group, the body mass index (BMI), albumin, erythrocyte count, hemoglobin (Hb) and lymphocyte count were significantly lower in the malnutrition risk group and the malnutrition group(P<0.05), and the percentage of neutral cell counts was significantly higher in the malnutrition group(P<0.05). The age distribution, renal function and anemia status of the patients at different nutritional status were statistically significant (P<0.05). Multivariate regression analysis showed that the risk factors of malnutrition included aged (OR=1.06,5%CI:1.00-1.12), low estimated glomerular filtration rate (eGFR, OR=0.97,5%CI:0.94-1.00), low BMI (OR=0.76,5%CI:0.65-0.87), low albumin (OR=0.93, 95%CI:0.86-0.99) and anemia (OR=2.46,5%CI:1.60-3.32). ConclusionAging and renal insufficiency may increase the incidence of malnutrition risk and malnutrition, and malnutrition is also associated with BMI, albumin level, and anemia severity.