PDF(1401 KB)
PDF(1401 KB)
PDF(1401 KB)
营养风险筛查对重症肺炎儿童不良临床结局的评估
Value of nutritional risk screening in evaluating adverse clinical outcomes in children with severe pneumonia
目的 采用儿科营养不良评估筛查工具 （STAMP）调查重症肺炎儿童营养风险发生情况，分析营养风险与不良临床结局的关系。方法 选择216例重症肺炎患儿为研究对象，根据STAMP评分分为高度营养风险组 （HR组，n=98）、中度营养风险组 （MR组，n=65）和低度营养风险组 （LR组，n=53）。空腹抽血检测胰岛素样生长因子-1 （IGF-1）、脂联素、瘦素、非酯化脂肪酸 （NEFA）、白蛋白、转铁蛋白、前白蛋白、视黄醇结合蛋白 （RBP）水平，记录不良临床结局。结果 HR组的血清IGF-1、瘦素、脂联素、前白蛋白、RBP水平低于LR组和MR组 （P < 0.05），而血清NEFA水平高于LR组和MR组 （P < 0.05）。HR组中入住ICU患儿的比例高于LR组和MR组 （P < 0.05）；HR组机械通气时间长于LR组和MR组 （P < 0.05）；HR组住院时间长于LR组和MR组 （P < 0.05），并发症发生率高于LR和MR组 （P < 0.05）。结论 营养风险筛查对评估重症肺炎儿童临床结局有重要价值，高度营养风险患儿有更多的不良临床结局，应尽早给予合理的营养支持。
Objective To investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes. Methods According to the STAMP score, 216 children with severe pneumonia were classified into high nutritional risk group (HR group; n=98), moderate nutritional risk group (MR group; n=65), and low nutritional risk group (LR group; n=53). Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1), adiponectin, leptin, non-esterified fatty acid (NEFA), albumin, transferrin, prealbumin, and retinol binding protein (RBP). The adverse clinical outcomes were recorded. Results Compared with the MR and LR groups, the HR group had significantly lower serum levels of IGF-1, leptin, adiponectin, prealbumin, and RBP, as well as a significantly higher serum level of NEFA (P < 0.05). Compared with the MR and LR groups, the HR group had a significantly higher proportion of children admitted to the intensive care unit and a significantly longer duration of mechanical ventilation (P < 0.05). The HR group had a significantly longer mean hospital stay and a significantly higher incidence rate of complications compared with the LR and MR groups (P < 0.05). Conclusions Nutritional risk screening has an important value in evaluating the clinical outcome of children with severe pneumonia, and children at a higher nutritional risk tend to have more adverse clinical outcomes.
Nutritional risk screening / Severe pneumonia / Clinical outcome / Child
[1] 张建华, 李艳华. 儿童重症肺炎临床特征和诊断治疗[J]. 中华临床医师杂志(电子版), 2013, 7(13):5715-5718.
[2] Penagini F, Dilillo D, Borsani B, et al. Nutrition in pediatric inflammatory bowel disease:from etiology to treatment. A systematic review[J]. Nutrients, 2016, 8(6):334-339.
[3] 高中敏, 李廷玉. 住院患儿的营养风险筛查工具及其应用[J]. 重庆医学, 2014, 43(8):991-993.
[4] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会. 儿童社区获得性肺炎管理指南(试行)(上)[J]. 中华儿科杂志, 2007, 45(2):83-90.
[5] 谢周龙龙, 洪莉, 冯一, 等. 运用改良STAMP评分对1201例外科住院患儿进行营养风险评估及临床结局相关性分析[J]. 中华小儿外科杂志, 2012, 33(10):742-746.
[6] Chourdakis M, Hecht C, Gerasimidis K, et al. Malnutrition risk in hospitalized children:use of 3 screening tools in a large European population[J]. Am J Clin Nutr, 2016, 103(5):1301-1310.
[7] Moeeni V, Walls T, Day AS. Nutritional status and nutrition risk screening in hospitalized children in New Zealand[J]. Acta Paediatr, 2013, 102(9):e419-e423.
[8] Teixeira AF, Viana KD. Nutritional screening in hospitalized pediatric patients:a systematic review[J]. J Pediatr (Rio J), 2016, 92(4):343-352.
[9] 李菁菁, 赵醴, 洪莉, 等. 儿科营养不良筛查工具在危重症儿童营养风险筛查中的应用[J]. 中华临床营养杂志, 2014, 22(6):323-328.
[10] McCarthy H, Dixon M, Crabtree I, et al. The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff[J]. J Hum Nutr Diet, 2012, 25(4):311-318.
[11] 何艳, 孙碧云, 陈雪英, 等. COPD患者血清瘦素、脂联素和甲状腺素水平与营养状况关系的分析[J]. 亚太传统医药, 2011, 7(5):67-68.
[12] 林英, 王卫, 刘晓红, 等. 新生儿瘦素水平动态变化与胰岛素样生长因子-1、胰岛素及生长激素关系研究[J]. 中国妇幼保健, 2007, 22(16):2242-2244.
[13] Diener A, Rohrmann S. Associations of serum carotenoid concentrations and fruit or vegetable consumption with serum insulin-like growth factor (IGF)-1 and IGF binding protein-3 concentrations in the Third National Health and Nutrition Examination Survey (NHANES III)[J]. J Nutr Sci, 2016, 5:e13.
[14] Bartz S, Mody A, Hornik C, et al. Severe acute malnutrition in childhood:hormonal and metabolic status at presentation, response to treatment, and predictors of mortality[J]. J Clin Endocrinol Metab, 2014, 99(6):2128-2137.
[15] Chisti MJ, Salam MA, Bardhan PK, et al. Treatment failure and mortality amongst children with severe acute malnutrition presenting with cough or respiratory difficulty and radiological pneumonia[J]. PLoS One, 2015, 10(10):e0140327.
[16] 谢琪, 洪莉, 林媛, 等. 儿科住院患者营养状况及营养风险调查[J]. 临床儿科杂志, 2013, 31(8):748-751.
