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《广州医药》编辑部
目的 探讨基于肺康复的阻抗训练联合营养支持对老年慢性阻塞性肺疾病(COPD)衰弱患者肌少症及运动耐量的影响。方法 将2024年1月—2025年5月收治的80例老年COPD衰弱合并肌少症患者,分为对照组、观察组,各40例。所有患者均采取常规药物治疗,对照组予以营养支持,观察组在对照组基础上增加基于肺康复的阻抗训练。比较两组治疗前、治疗3个月后肌少症改善情况,运动耐量,肺功能指标,衰弱状态及生活质量。结果 治疗3个月后,观察组骨骼肌指数、握力、股四头肌肌厚度均较治疗前提高,且与对照组相比,观察组更高(P<0.05);治疗3个月后,两组6 min步行距离、日常活动代谢当量均较治疗前提高,Borg量表评分降低,且与对照组相比,观察组改善幅度更大(P<0.05);治疗3个月后,两组第一秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、最大通气量(MVV)均较治疗前改善,且与对照组相比,观察组更优(P<0.05);治疗3个月后,两组Fried衰弱表型评分、COPD评估测试(CAT)总分、圣乔治呼吸问卷(SGRQ)总分均较治疗前降低,且与对照组相比,观察组更低(P<0.05)。结论 老年COPD衰弱合并肌少症患者采取基于肺康复的阻抗训练联合营养支持可改善其肌少症情况,提升运动耐量,并且提升患者肺功能水平,改善衰弱状态,提升生活质量。
Objective To explore the effects of impedance training based on pulmonary rehabilitation combined with nutritional support on sarcopenia and exercise tolerance in elderly patients with chronic obstructive pulmonary disease(COPD)and frailty.Methods Eighty elderly patients with COPD and frailty complicated by sarcopenia,admitted from January 2024 to May 2025,were selected as the study subjects and divided into a control group and an observation group,with 40 patients in each group.All patients received conventional drug therapy.The control group received nutritional support,while the observation group received additional impedance training based on pulmonary rehabilitation on top of the matched group’s treatment.The improvement of sarcopenia,exercise tolerance,pulmonary function index,weakness status and quality of life before and 3 months after treatment were compared between the two groups.Results After 3 months of treatment,the skeletal muscle index,grip strength and quadriceps thickness of the observation group increased compared with that before treatment,and compared with the control group,the observation group was higher(P<0.05).After 3 months of treatment,the 6 min walking distance and daily activity metabolic equivalent of both groups increased compared with that before treatment,and the Borg Scale score decreased.Compared with the control group,the improvement of the observation group was better(P<0.05).After 3 months of treatment,Forced Expiratory Volume in one second(FEV1),FEV1/Forced Vital Capacity(FVC)and Maximal Voluntary Ventilation(MVV)of both groups improved compared with that before treatment,and the observation group was better than that of the control group(P<0.05).After 3 months of treatment,the Fried weakness phenotype score,COPD Assessment Test(CAT)total score and St. George’s Respiratory Questionnaire(SGRQ)total score of both groups were lower than that before treatment,and the observation group was lower than that of the control group(P<0.05).Conclusions Impedance training based on pulmonary rehabilitation combined with nutritional support can improve sarcopenia,enhance exercise tolerance,and improve pulmonary function levels,frailty status,and quality of life in elderly patients with COPD and frailty complicated by sarcopenia.
目的 探讨营养风险管理结合分期饮食指导对溃疡性结肠炎(UC)患者营养状况的影响。方法 选择郑州市大肠肛门病医院收治的90例UC患者,纳入时间为2024年1月—2025年1月,按照计算机分组法分为对照组(45例),给予分期饮食指导,观察组(45例),在对照组的基础上增加营养风险管理,观察两组患者症状改善情况、营养状况、生活质量。结果 干预后,观察组Mayo评分(4.30±1.14)分、主观整体营养状况评价表(PG-SGA)评分(1.74±0.38)分低于对照组(5.48±1.33、2.28±0.43)分(P<0.05);观察组血红蛋白(HB)、前白蛋白(PA)、白蛋白(ALB)水平高于对照组(P<0.05),IBDQ各维度评分及总分更高(P<0.05)。结论 对UC患者应用营养风险管理结合分期饮食指导,能够减轻临床症状,改善营养状况,促进生活质量的提升。
Objective To explore the influence of nutritional risk management combined with staged dietary guidance on the nutritional status of ulcerative colitis(UC)patients.Methods A total of 90 UC patients admitted to our hospital were selected and included from January 2024 to January 2025.According to the computer grouping method,45 cases were divided into control group with staged dietary guidance,and 45 cases were divided into observation group with nutritional risk management.The symptoms improvement,nutritional status,and quality of life of the two groups were observed.Results After intervention,the observation group had lower Mayo score(4.30±1.14)and Patient?Generated Subjective Global Assessment(PG-SGA)score(1.74±0.38)than the control group(5.48±1.33 and 2.28±0.43,respectively)(P<0.05);the observation group had higher levels of hemoglobin(HB),prealbumin(PA),and albumin(ALB)than the control group(P<0.05),and also had higher scores in all dimensions and total score of the Inflammatory Bowel Disease Questionnaire(IBDQ)(P<0.05).Conclusions The application of nutrition risk management combined with staged dietary guidance in UC patients can reduce clinical symptoms,improve nutritional status,promote the improvement of life quality.
目的 调查消化系统恶性肿瘤患者营养风险、营养知识-态度-行为(知信行)水平的现状,探究各因素是否对患者的营养风险、营养知信行水平具有影响,并分析两者之间的相关性。方法 选取中山大学附属第八医院(深圳福田)2024年2月—10月的244例消化系统恶性肿瘤患者为研究对象,采用一般资料调查表、营养风险筛查NRS2002量表以及消化系统肿瘤患者营养知信行问卷进行调查,数据收集后进行统计分析,从而研究消化系统恶性肿瘤患者营养筛查风险与营养知信行水平的现状、影响因素及两者间的相关性。结果 69.3%的消化系统恶性肿瘤患者存在营养风险,营养风险评分为(2.72±1.42)分。消化系统恶性肿瘤患者营养知识水平得分为(12.30±5.26)分、营养态度水平得分为(14.80±2.68)分、营养行为水平得分为(22.82±4.55)分、营养知信行水平总分为(49.96±9.50)分。家庭经济收入是患者营养风险水平的核心影响因素(P<0.05),学历水平是患者营养知信行水平的核心影响因素(P<0.05)。消化系统恶性肿瘤患者营养风险水平与营养知信行的总体水平呈负相关(r=-0.143,P<0.05)。结论 消化系统恶性肿瘤患者的营养知信行水平总体处于中等水平,但普遍存在营养风险较高的情况。在患者治疗期间实施个性化营养健康宣教至关重要,这将有助于提升患者的营养知识水平,从而整体性改善其营养知信行素养并降低其营养风险,但在进行营养宣教和制定个性化营养方案时应充分考虑患者的家庭经济收入及学历水平。
Objective To explore the nutritional risk and nutritional knowledge-attitude-behavior status of patients with digestive system malignant tumors,to analyze the influencing factors of nutritional risk,nutritional knowledge-attitude-behavior,and explore the correlation between them.Methods From February 2024 to October 2024,244 patients with digestive system malignant tumors at the Eighth Affiliated Hospital of Sun Yat-sen University were selected as the research subjects.A general information questionnaire,Nutritional Risk Screening 2002,and digestive system tumor patient nutrition knowledge-attitude-behavior questionnaire were used to study the influencing factors and correlations between the nutritional screening risk and nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors.Results There were 69.3% of the patients with digestive system malignant tumors had nutritional risk score ≥3,and the overall score was(2.72±1.42).The scores of nutritional knowledge,attitude,behavior and total score of digestive system malignant tumors patients were(12.30±5.26),(14.80±2.68),(22.82±4.55)and(49.96±9.50),respectively.Family economic income was the core influencing factors of nutritional risk in patients with digestive system malignant tumors,while educational level was the core influencing factor of nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors.The nutritional risk level of patients with malignant tumors of the digestive system was significantly negatively correlated with the overall level of nutritional knowledge-attitude-behavior.Conclusions The nutritional knowledge-attitude-behavior level of patients with malignant tumors of the digestive system is generally at a medium level,but there is a widespread situation of relatively high nutritional risk.It is extremely important and necessary to conduct personalized nutrition knowledge education for patients during their treatment period,which will help enhance patients’ nutritional knowledge level,thereby comprehensively improving their nutritional knowledge-attitude-behavior literacy and reducing their nutritional risks.However,when conducting nutrition education and formulating personalized nutrition plans,the patient’s family economic income,medical payment methods and educational level should be fully considered.
目的 评估使用炎症、免疫及营养指标对于胃癌根治术后发生腹膜转移的预测作用,并建立适用于术前风险评估的预测模型。方法 回顾性收集2022—2024年苏州市立医院85例晚期胃癌患者的临床资料,按术后是否发生腹膜转移分为转移组44例与非转移组41例。通过分析比较两组间的营养参数[血清白蛋白、纤维蛋白原及预后营养指数(PNI)]、炎症指标[中性粒细胞计数、C反应蛋白、中性粒细胞与淋巴细胞比值(NLR)及全身免疫炎症指数(SII)]、肿瘤标志物以及免疫功能指标(淋巴细胞计数、IL-2、IL-6、TNF-α和IFN-γ)等。使用单因素及多因素Logistic回归分析确定独立预测因子,并构建预测模型,采用Bootstrap法内部验证,计算校正后的曲线下面积及收缩因子,以优化模型性能。结果 多因素分析结果显示,IL-6(OR=1.116,95%CI:1.020~1.224)与CA125(OR=1.016,95%CI:1.006~1.026)为术后腹膜转移的独立预测因素,构建的预测模型区分能力良好,初始AUC为0.801(95%CI:0.702~0.900),经Bootstrap校正后AUC为0.797,模型校准度理想,具有良好的临床稳健性。结论 基于术前IL-6和CA125水平的预测模型,可用于评估胃癌患者根治术后发生腹膜转移的风险。该模型可在术前阶段有效识别高风险病例,为临床制定个体化辅助治疗方案及随访策略提供关键参考,并具有改善患者预后的潜在价值。
Objective To evaluate the predictive value of inflammatory,immune,and nutritional indicators for peritoneal metastasis after radical gastrectomy in gastric cancer and to establish a predictive model applicable for preoperative risk assessment.Methods Clinical data from 85 patients with advanced gastric cancer treated at Suzhou Municipal Hospital between 2022 and 2024 were retrospectively collected.Patients were divided into two groups based on postoperative peritoneal metastasis occurrence:a metastasis group(n=44)and a non-metastasis group(n=41).Indicators analyzed and compared between groups included nutritional parameters(serum albumin,fibrinogen,PNI),inflammatory markers(neutrophil count,CRP,NLR,SII),tumor markers and immune indicators(lymphocyte count,IL-2,IL-6,TNF-α,IFN-γ).Univariate and multivariate logistic regression analyses identified independent predictors for constructing the prediction model.Internal validation was performed using 1 000 bootstrap resamples to calculate the adjusted area under the curve(AUC)and shrinkage factor for model optimization.Results Multivariate analysis identified IL-6(OR=1.116,95%CI:1.020-1.224)and CA125(OR=1.016,95%CI:1.006-1.026) as independent predictors of postoperative peritoneal metastasis.The constructed predictive model demonstrated good discriminatory ability,with an initial AUC of 0.801(95%CI:0.702–0.900)and a bootstrap-corrected AUC of 0.797.The model exhibited ideal calibration and good clinical robustness.Conclusions This study established a predictive model based on preoperative IL-6 and CA125 levels to assess the risk of peritoneal metastasis after radical surgery in gastric cancer patients.The model effectively identifies high-risk cases preoperatively,providing critical guidance for developing individualized adjuvant treatment and follow-up strategies,with potential to improve patient prognosis.
目的 探讨预后营养指数(PNI)对脓毒症合并心力衰竭患者发生谵妄的预测价值,并评估其在指导护理风险分层中的作用。方法 采用回顾性队列研究,纳入2022年2月—2024年9月广东省第二中医院收治的162例脓毒症合并心力衰竭患者。通过ROC曲线确定PNI预测谵妄的最佳截断值,并以此将患者分为高低PNI组。比较两组基线特征,采用Kaplan-Meier曲线分析谵妄累积发生率和28天院内死亡率,通过Cox比例风险模型评估PNI与谵妄及预后的独立关联,并利用ROC曲线评价其预测性能。最后利用亚组分析技术进一步评估PNI预测价值的普适性。结果 低PNI(≤35.72)是谵妄发生的独立危险因素。竞争风险模型显示,低PNI组10 d谵妄累积发生率达37.8%,高于高PNI组的10.0%。多因素分析表明,PNI每降低一个单位,谵妄风险增加约17.2%。限制性立方样条分析提示PNI与谵妄风险呈线性负相关。ROC曲线分析显示PNI预测谵妄的AUC为0.721,其预测效能优于白蛋白和SOFA评分。亚组分析进一步证实PNI的保护效应在不同临床特征患者中具有一致性。结论 PNI是脓毒症合并心力衰竭患者谵妄风险的独立预测指标,其预测效能优于传统单一指标。基于PNI的风险分层有助于早期识别谵妄高危患者,为实现精准护理干预提供重要依据。
Objective To explore the predictive value of the prognostic nutritional index(PNI)for delirium in patients with sepsis complicated by heart failure,and to evaluate its role in guiding nursing risk stratification.Methods A retrospective cohort study was conducted,including 162 patients with sepsis and heart failure admitted to Guangdong Provincial Second Hospital of Traditional Chinese Medicine between February 2022 and September 2024.The optimal PNI cut-off value for predicting delirium was determined using ROC curve analysis,and patients were divided into high and low PNI groups accordingly.Baseline characteristics of the two groups were compared.Kaplan-Meier curves were used to analyze the cumulative incidence of delirium and 28-day in-hospital mortality.Cox proportional hazards models were employed to assess the independent association between PNI and delirium as well as prognosis,and ROC curves were used to evaluate its predictive performance.Subgroup analysis was further utilized to assess the generalizability of PNI’s predictive value.Results A low PNI(≤35.72)is an independent risk factor for delirium.The competing risk model showed that the cumulative incidence of delirium in the low PNI group was 37.8% at 10 days,significantly higher than the 10.0% in the high PNI group.Multivariate analysis indicated that for each unit decrease in PNI,the risk of delirium increased by 17.2% approximately.Restricted cubic spline analysis suggested a linear negative correlation between PNI and delirium risk.ROC curve analysis demonstrated that the AUC of PNI for predicting delirium was 0.721,with its predictive performance surpassing that of albumin and SOFA score.Subgroup analysis further confirmed that the protective effect of PNI was consistent across patients with different clinical characteristics.Conclusions PNI is an independent predictor of delirium risk in patients with sepsis and heart failure,with superior predictive performance compared to traditional single indicators.Risk stratification based on PNI aids in the early identification of patients at high risk for delirium,providing an important basis for precise nursing interventions.
目的 分析对肺癌化学治疗(化疗)患者采取个性化营养干预联合分级步行运动方案的应用价值。方法 将郑州大学附属郑州中心医院2023年7月—2024年7月符合标准的198例肺癌化疗患者作为研究对象,通过随机数字表法分为观察组和对照组各99例。对照组仅采用个性化营养干预方案,观察组则联合分级步行运动方案,两组患者均在同一时间内入组并接受持续干预3个月。对两组干预前后癌因性疲乏[Piper疲乏修订量表(PFS-R)]、营养状况、睡眠质量[匹茨堡睡眠质量指数(PSQI)]、生活质量[生活质量评估量表(SF-36)]水平予以比较。结果 相较于对照组,干预后观察组PFS-R、PSQI评分较低,白蛋白、前白蛋白、血红蛋白、铁转蛋白水平和SF-36评分较高(P<0.05)。结论 对肺癌化疗患者采取个性化营养干预联合分级步行运动方案,有利于促进其癌因性疲乏的减轻和营养状态、睡眠质量及生活质量水平的提高。
Objective To analyze the effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy.Methods A total of 198 lung cancer patients undergoing chemotherapy who met the criteria in our hospital from July 2023 to July 2024 were selected as the research subjects.They were divided into an observation group and a control group,with 99 cases in each group,by the random number table method.The control group only received individualized nutritional intervention,while the observation group received graded walking exercise additionally.Both groups of patients were enrolled at the same time and received continuous intervention for three months.Cancer-related fatigue(Piper’s Fatigue Scale-Revised[PFS-R]),nutritional status,sleep quality(Pittsburgh Sleep Quality Index[PSQI]),and quality of life(Quality of Life Scale[SF-36]) before and after the intervention were compared between the two groups.Results Compared with the control group,the observation group had lower PFS-R and PSQI scores and higher albumin,prealbumin,hemoglobin,transferrin levels and SF-36 scores after the intervention(P<0.05).Conclusions Adopting personalized nutritional intervention combined with graded walking exercise for lung cancer patients during chemotherapy is beneficial to promote the reduction of cancer-caused fatigue and the improvement of their nutritional status,sleep quality and quality of life.
目的 探讨多组分运动干预联合多学科指导下营养干预应用于老年慢性心力衰竭(CHF)并发衰弱患者的效果。方法 选择郑州市第七人民医院收治的CHF并衰弱患者102例, 纳入时间为2023年11月—2024年10月, 按照随机数表法分为对照组51例给予常规运动干预+多学科指导下营养干预,观察组51例给予多组分运动干预+多学科指导下营养干预,观察两组衰弱状态、心功能指标、营养状况、生活质量、不良事件发生率。结果 与对照组相比,观察组干预后身体、心理、社会及总分明显更低(P<0.05)。与对照组相比,观察组干预后左室射血分数(LVEF)水平明显更高,超敏心肌肌钙蛋白T(hs-cTnT)、N末端B型利钠肽前体(NT-proBNP)、左室舒张末期内径(LVEDD)水平更低(P<0.05)。与对照组相比, 观察组干预后主观整体营养状况评价表(PG-SGA)评分明显更低,血红蛋白(Hb)、前白蛋白(PA)、白蛋白(ALB)水平更高(P<0.05)。与对照组相比,观察组干预后症状、身体、情感及总分更低(P<0.05)。观察组不良事件发生率(1.96%)低于对照组(15.69%)(P<0.05)。结论 对CHF并发衰弱患者应用多组分运动干预联合多学科指导下营养干预,能够减轻衰弱状态, 改善心功能及营养状况,促进生活质量的提升, 并降低不良事件发生率。
Objective To explore the effect of multi-component exercise intervention combined with nutritional intervention under multidisciplinary guidance in elderly patients with chronic heart failure(CHF)and frailty.Methods From November 2023 to October 2024, 102 CHF patients with frailty admitted to Zhengzhou Seventh People's Hospital were selected and included. According to the computer grouping method, they were divided into a control group with 51 patients, received routine exercise intervention and multidisciplinary nutrition intervention,and an observation group with 51 patients, received multi-component exercise intervention and multidisciplinary nutrition intervention.The frailty status, cardiac function indicators, nutritional status, quality of life and incidence of adverse events were observed in both groups.Results Compared with the control group,the observation group showed significantly lower physical, psychological, social, and total scores after intervention(P<0.05).Compared with the control group, the observation group showed significantly higher levels of left ventricular ejection fraction and lower levels of high-sensitivity cardiac troponin N-terminal pro-B-type natriuretic peptide, and left ventricular end-diastolic dimension after intervention(P<0.05).Compared with the control group,the observation group had significantly lower Patient-Generated Subjective Global Assessment scores and higher levels of hemoglobin, prealbumin, and albumin after intervention(P<0.05).Compared with the control group, the observation group had significantly lower symptoms, physical, emotional, and total scores after intervention(P<0.05).The incidence of adverse events in the observation group(1.96%)was lower than that in the control group(15.69%)(P<0.05).Conclusions Multi-component exercise intervention combined with multidisciplinary nutritional intervention in patients with CHF and frailty can alleviate frailty, improve cardiac function and nutritional status,quality of life, and reduce the incidence of adverse events.
目的 本研究旨在探讨不同俯卧位通气(PPV)时间对重症肺炎合并胃肠功能障碍患者肠内营养耐受性的影响。方法 选择2020年7月—2023年7月在天津市人民医院重症监护病房(MICU)治疗的80例重症肺炎合并胃肠功能障碍患者为研究对象, 按每日PPV时间分为长时组(≥12 h, n=40)和短时组(<12 h, n=40)。比较两组患者一般资料、氧合指数、胃肠功能指标[腹内压、血清促胃液素(GAS)和血管活性肠肽(VIP)]、肠内营养达标率、胃肠并发症率等。结果 短时组治疗后, 1 d、3 d、5 d氧合指数为(189.93±33.72)、(247.53±63.01)、(325.03±58.11)mmHg,高于长时组的(161.63±36.88)、(191.83±57.65)、(267.95±46.25)mmHg,均P<0.05; 胃残留量为(29.00±7.92)、(19.75±4.45)、(11.00±1.87) mL低于长时组的(75.03±23.29)、(53.13±11.99)、(21.70±5.52) mL, 均P<0.05。短时组治疗后腹内压[(8.53±2.05)mmHg vs (9.75±2.05) mmHg]、VIP水平[(61.14±7.63) vs (67.49±4.43) pg/mL]低于长时组,GAS水平[(65.02±8.84) vs (54.22±9.21)pg/mL]升高(均P<0.05)。短时组总胃肠并发症发生率(7.50%)低于长时组(25.00%), P=0.034。结论 对于重症肺炎合并胃肠功能障碍患者,每日PPV时间≤12 h可改善氧合并降低胃肠并发症风险, 可能与减轻腹压、调节胃肠激素分泌及提升肠内营养耐受性相关。
Objective To explore the effect of different duration of prone position ventilation(PPV)on enteral nutritional tolerance in patients with severe pneumonia combined with gastrointestinal dysfunction.Methods A total of 80 patients with severe pneumonia complicated by gastrointestinal dysfunction were treated in the Medical Intensive Care Unit(MICU)of a hospital from July 2020 to July 2023, and were selected as the research subjects.They were divided into the long-duration group(≥12 hours, n=40)and the short-duration group(<12 hours, n=40)according to the daily duration of PPV.The general data, oxygenation index, gastrointestinal function indicators(intra-abdominal pressure, serum gastrin[GAS] and vasoactive intestinal peptide[VIP]), enteral nutrition achievement rate, and gastrointestinal complications of the two groups were compared.Results The oxygenation index of the short-duration group at 1 d, 3 d,a nd 5 d after treatment([189.93±33.72], [247.53±63.01], and[325.03±58.11] mmHg, respectively)was significantly higher than that of the long-duration group([161.63±36.88], [191.83±57.65], and[267.95±46.25] mmHg,respectively, all P<0.05).The gastric residual volume of the short-duration group([29.00±7.92], [19.75±4.45], and[11.00±1.87] mL, respectively)was significantly lower than that of the long-duration group([75.03±23.29], [53.13±11.99], and[21.70±5.52] mL, respectively, all P<0.05).The intra-abdominal pressure([8.53±2.05] vs [9.75±2.05] mmHg)and VIP level([61.14±7.63] vs [67.49±4.43] pg/mL)of the short-duration group after treatment were significantly lower than those of the long-duration group, while the GAS level([65.02±8.84] vs [54.22±9.21] pg/mL)was significantly higher(all P<0.05).The total incidence of gastrointestinal complications in the short-duration group(7.50%)was significantly lower than that in the long-duration group(25.00%, P=0.034).Conclusions For patients with severe pneumonia complicated by gastrointestinal dysfunction, a daily duration of PPV within 12 hours can improve oxygenation and reduce the risk of gastrointestinal complications, which may be related to the reduction of intra-abdominal pressure, regulation of gastrointestinal hormone secretion, and improvement of enteral nutrition tolerance.
目的 调查江西省南昌市东湖区孕妇2022—2024年碘营养状况与盐碘监测情况,为区域干预提供依据。方法 将江西省南昌市东湖区划分为东、南、西、北、中5个片区,每个片区随机抽取一个街道(管理处),于每年5月份随机抽取各街道(管理处)20名孕妇,每年共抽取100名孕妇,3年共计300名孕妇,采集其尿液样本和家中食用盐样本检测碘含量,以统计学方法进行分析。结果 3年来孕妇家庭食用盐碘含量中位数为23.02 mg/kg,碘盐覆盖率为98.67%,碘盐合格率为95.33%,3年的食用盐碘含量比较差异有统计学意义(H=38.545,P<0.05)。孕妇的尿碘水平中位数为115.15 μg/mL,3年来孕妇的尿碘水平中位数均低于150 μg/mL,有62.67%的孕妇碘缺乏,3年间的尿碘水平比较差异有统计学意义(H=9.392,P<0.05),其中2024年的尿碘水平中位数为140.00 μg/mL,校正后高于2022年(Z=2.693,P<0.0167)和2023年(Z=2.590,P<0.0167)。Spearman相关性分析结果显示孕妇尿碘水平与盐碘含量及碘盐质量均无相关性(均P>0.05),孕妇碘营养状况与盐碘含量及碘盐质量均无相关性(均P>0.05),孕妇尿碘水平与碘营养状况正相关(rs=0.857,P<0.05),盐碘含量与碘盐质量正相关(rs=0.314,P<0.05)。结论 江西省南昌市东湖区2024年孕妇碘缺乏有所改善,但整体形势严峻,超半数的孕妇碘缺乏,食用碘盐基本符合国家消除碘缺乏病标准,但仍需改进。卫生部门要强化孕妇碘营养监测,向孕妇科普碘缺乏病知识,增强补碘意识,促其科学补碘。盐业监管部门需加大监管,严控碘盐质量,确保东湖区居民食盐合格。
Objective To investigate the iodine nutrition status of pregnant women and iodined salt monitoring in Donghu District,Nanchang City,Jiangxi Province from 2022 to 2024,and provide a basis for regional intervention.Methods Donghu District was divided into five areas:East,South,West,North,and Central.A street(management office)was randomly selected from each area,and 20 pregnant women were randomly selected from each street(management office)in May each year.A total of 100 pregnant women were selected each year,for a total of 300 pregnant women over three years.Urine samples and household salt samples were collected to detect iodine content,and statistical analysis was conducted.Results Over the past three years,the median iodine content in the cooking salt consumed by pregnant women’s families was 23.02 mg/kg,the iodized salt coverage rate was 98.67%,and the iodized salt qualification rate was 95.33%.There were differences in the iodine content of cooking salt in the three years(H=38.545,P<0.05).The median urinary iodine level of pregnant women was 115.15 μg/mL.In the past three years,the median urinary iodine levels of pregnant women were all lower than 150 μg/ml,and 62.67% of pregnant women were iodine-deficient.There were differences in the urinary iodine levels in the three years(H=9.392,P<0.05).Among them,the median urinary iodine level in 2024 was 140.00 μg/mL,which was significantly higher than that in 2022(Z=2.693,P<0.0167)and 2023(Z=2.590,P<0.0167)after correcting the significance level.Spearman correlation analysis results showed that there was no correlation between the urinary iodine level of pregnant women with the iodine content and quality of iodized salt(all P>0.05),and there was no correlation between the iodine nutritional status of pregnant women with the iodine content and quality of iodized salt(all P>0.05).The urinary iodine level in pregnant women is positively correlated with their iodine nutritional status(rs=0.857,P<0.05),and the iodine content in salt is positively correlated with the quality of iodized salt(rs=0.314,P<0.05).Conclusions In 2024,the iodine deficiency among pregnant women in Donghu District,Nanchang City,Jiangxi Province was improved,but the overall situation is still severe.More than half of pregnant women were iodine-deficient.The consumption of iodized salt basically met the national standards for eliminating iodine deficiency disorders,but still needed to be improved.The health department should strengthen the monitoring of iodine nutrition among pregnant women,popularize knowledge about iodine deficiency disorders to pregnant women,enhance their awareness of iodine supplementation,and promote their scientific iodine supplementation.The salt industry supervision department needs to strengthen supervision,strictly control the quality of iodized salt,and ensure that the cooking salt of residents in Donghu District is qualified.
目的 探讨降钙素原(PCT)联合营养指标对肝硬化营养状况的评定价值。方法 选取2021年2月—2022年3月在右江民族医学院附属医院感染科住院的140例肝硬化患者,根据营养风险筛查2002(NRS 2002)将其分为有营养风险组和无营养风险组。比较两组肝硬化患者中营养指标体质指数(BMI)、血红蛋白(HGB)、前白蛋白(PA)、白蛋白(ALB)、视黄醇结合蛋白(RBP)水平, 并分析它们与PCT的相关性。结果 BMI、HGB、ALB、PA及RBP水平低于低营养风险组(P<0.05); 营养指标(BMI、HGB、ALB、PA、RBP)与PCT呈负相关(P<0.05)。二元Logistics回归分析发现ALB、PCT是肝硬化患者营养风险的危险因素(P<0.05)。ROC结果显示PCT与ALB的联合营养指标评定肝硬化营养不良的曲线下面积为0.984,(95%CI:0.964~1.000), 灵敏度98.8%, 特异度93.3%, 约登指数0.921; ALB、PCT的AUC分别为0.919、0.974。结论 肝硬化患者PCT水平与其营养状况密切相关, 对营养状况的评定有一定的价值, 联合评定能有效提高其评定价值。
Objective To explore the value of procalcitonin(PCT)combined with nutritional indexes in evaluating the nutritional status of liver cirrhosis.Methods A total of 140 patients with cirrhosis admitted to the Department of Infection of the Affiliated Hospital of Youjiang Medical College for Nationalities from February 2021 to March 2022, they were selected and divided into with and without nutritional risk group according to nutritional risk screening 2002(NRS 2002).The levels of body mass index(BMI), hemoglobin(HGB), prealbumin(PA), albumin(ALB)and retinol binding protein(RBP)in two groups of patients with cirrhosis were compared, and the correlation between them and PCT was analyzed.Results The levels of BMI, HGB, ALB, PA and RBP were lower than those of low nutritional risk group(P<0.05).The nutritional indices(BMI, HGB, ALB, PA, RBP)were negatively correlated with PCT(P<0.05).Binary Logistics regression analysis showed that ALB and PCT were risk factors affecting nutritional risk in patients with cirrhosis(P<0.05).ROC results showed that the area under the curve was 0.984(95% confidence interval:0.964 ~ 1.000), sensitivity 98.8%, specificity 93.3%, and Yoden index 0.921 for the combined PCT and ALB indexes predicting malnutrition in cirrhosis.The AUC of ALB and PCT were 0.919 and 0.974, respectively.Conclusions The level of PCT in patients with cirrhosis is closely related to their nutritional status, which has certain value in the evaluation of nutritional status, and combined prediction can effectively improve the evaluation value.