| 姜逍瑶,陆召军,高修银.老年营养风险指数对慢性心力衰竭合并 2型糖尿病病人的预后价值[J].安徽医药,2023,27(11):2279-2284. |
| 老年营养风险指数对慢性心力衰竭合并 2型糖尿病病人的预后价值 |
| Prognostic value of geriatric nutritional risk index in patients with chronic heart failure complicated with type 2 diabetes |
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| DOI：10.3969/j.issn.1009-6469.2023.11.036 |
| 中文关键词: 营养评价 心力衰竭 老年人营养风险指数 营养状态 预后 |
| 英文关键词: Nutrition assessment Heart failure Geriatric nutritional risk index Nutritional status Prognosis |
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| 中文摘要: |
| 目的评价老年人营养风险指数( GNRI)对住院慢性心力衰竭( CHF)合并 2型糖尿病( T2DM)病人预后的预测价值。方法回顾性分析 2018年 10月至 2020年 10月于徐州医科大学附属医院住院治疗的 CHF合并 T2DM的病人 304例，根据 GNRI水平将病人分为三组， G1组( GNRI<96.35)G2组( 96.35≤GNRI<103.71)G3组( GNRI≥103.71)对三组进行观察随访至 2021年 10月 31日，不良预后观察主要终点是心血管，死亡或心力衰竭再住院。，采用 Kaplan-Meier法绘，制生存曲线分析不同 GNRI水平对病人的不良预后的影响，并采用 Cox比例风险回归模型分析影响 CHF合并 T2DM病人不良预后的相关危险因素；采用受试者操作特征( ROC)曲线分析 GNRI、身体质量指数( BMI)、血清白蛋白分别对 CHF合并 T2DM病人终点事件的预测价值。结果中位随访时间是 19个月，随 GNRI降低，不良预后的发生率明显升高。绘制 Kaplan-Meier生存曲线分析显示低 GNRI组病人发生事件的生存率最低( P<0.001)。构建的多因素 Cox比例风险回归模型，在对年龄、心功能 NYHA分级( Ⅳ级)、左心室射血分数( EF)、 DPP-4抑制剂用药史及 eGFR等混杂因素调整后， GNRI对 CHF合并 T2DM病人的不良预后的预测价值仍差异有统计学意义( P<0.05)。 GNRI的 ROC曲线下面积［ AUC为 0.84，95%CI:(0.78，0.89)］大于血清白蛋白［ AUC为 0.82， 95%CI:(0.76，0.87)］及 BMI［AUC为 0.70，95%CI:(0.64，0.76)］所以 GNRI预测 CHF合并 T2DM病人不良预后的能力优于血清白蛋白和 BMI。结论营养不良是老年 CHF合并 T2DM病人不良，预后的危险因素， GNRI对预测 CHF合并 T2DM病人不良预后有预测价值。 |
| 英文摘要: |
| Objective To evaluate the predictive value of the geriatric nutritional risk index (GNRI) for the prognosis of hospitalizedpatients with chronic heart failure (CHF) complicated with type 2 diabetes mellitus (T2DM).Methods This study retrospectively analyzed 304 patients with CHF and T2DM hospitalized in the Affiliated Hospital of Xuzhou Medical University from October 2018 to October 2020. According to the level of GNRI, the patients were divided into three groups,G1 Group (GNRI < 96.35), G2 Group (96.35 ≤GNRI < 103.71) and G3 Group (GNRI ≥ 103.71). The three groups were observed and followed up until October 31, 2021. The primaryendpoint was cardiovascular death or rehospitalization for heart failure. Kaplan Meier method was used to draw the survival curve to analyze the impact of different GNRI levels on the poor prognosis of patients, and Cox proportional hazards regression model was used toanalyze the relevant risk factors affecting the poor prognosis of patients with CHF and T2DM. The receiver operating characteristic(ROC) curve was used to analyze the predictive value of GNRI, body mass index (BMI) and serum albumin on the end events of CHF patients with T2DM.Results The median follow-up time was 19 months. With the decrease of GNRI, the incidence of adverse prognosisincreased significantly. Kaplan Meier survival curve analysis showed that patients with low GNRI had the lowest survival rate of events(P<0.001). We constructed a multivariate Cox proportional hazards regression model. After adjusting for confounding factors such asage, NYHA grade (grade Ⅳ) of cardiac function, left ventricular ejection fraction (EF), history of DPP-4 inhibitors and EGFR, the predictive value of GNRI for the adverse prognosis of patients with CHF and T2DM was still statistically significant (P<0.05). The area under the ROC curve of GNRI [AUC 0.84, 95%CI:(0.78, 0.89)] was greater than serum albumin [AUC 0.82, 95%CI:(0.76, 0.87)] and BMI [AUC 0.70, 95%CI:(0.64, 0.76)], so the ability of GNRI to predict the adverse prognosis of patients with CHF and T2DM was betterthan that of serum albumin and BMI. Conclusion Malnutrition is a risk factor for poor prognosis in elderly patients with CHF andT2DM. GNRI is negatively correlated with the prognosis of patients with CHF and T2DM. |
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