摘要
背景目前接受下肢血管腔内治疗的糖尿病足患者的死亡率仍较高,预后较差。利用老年营养风险指数(GNRI)评估的营养不良对患者临床结局的影响尚不清楚。目的本研究旨在探讨基于GNRI评估的基线营养不良对糖尿病足合并下肢动脉病变患者血管腔内治疗临床结局的影响。方法选取2011年1月至2016年12月中山大学孙逸仙纪念医院内分泌科收治的糖尿病足合并下肢动脉病变并接受下肢血管腔内治疗的95例患者为研究对象,并对其随访2年。根据患者的营养状态即GNRI将95例患者分为三组:营养正常组(43例)、轻度营养不良组(31例)、中-重度营养不良组(21例)。收集患者的基线GNRI和其他临床资料,包括性别、年龄、糖尿病病程、吸烟史、体质指数(BMI)、合并疾病(心血管疾病、脑血管疾病)、糖尿病足分级、血压(收缩压、舒张压)、白细胞计数、血小板计数、淋巴细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比值(NLR)、血红蛋白、血糖、糖基化血红蛋白(HbA_(1c))、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白蛋白、肌酐、估算肾小球滤过率(eGFR)。临床结局主要终点事件为全因死亡,次要终点事件为大截肢。采用Kaplan-Meier法绘制生存曲线,采用单因素和多因素Cox比例风险回归分析探讨糖尿病足合并下肢动脉病变患者全因死亡的影响因素。结果95例糖尿病足合并下肢动脉病变患者中营养不良52例(54.7%)。三组患者BMI、白细胞计数、中性粒细胞计数、NLR、血红蛋白、TG、白蛋白水平比较,差异有统计学意义(P<0.05)。随访2年内16例患者死亡,其中10例患者死于心脑血管疾病;5例患者接受了大截肢手术治疗。生存分析结果显示,营养正常组、轻度营养不良组、中-重度营养不良组2年生存率分别为92.1%、75.6%、50.1%;三组患者生存率比较,差异有统计学意义(Log-rank检验:χ^(2)=10.812,P=0.004)。多因素Cox比例风险回归分析结果显示,GNRI≤98是糖尿病足合并下肢动脉病变患者全因死亡的独立危险因素〔HR=3.937,95%CI(1.070,13.942),P=0.037〕。结论营养正常(GNRI>98)患者2年生存率高于营养不良(GNRI≤98)患者;基于GNRI评估的营养不良可能是接受血管内治疗的糖尿病足合并下肢动脉病变患者全因死亡的独立危险因素,评估和调节此类患者营养状态可能更好地改善患者的临床结局。
Background Patients with diabetic foot undergoing endovascular therapy for lower extremity arterial disease exhibit poor outcomes and a high mortality rate.It is unclear whether malnutrition assessed by geriatric nutritional risk index(GNRI)is associated with clinical outcomes in these patients.Objective To investigate the association of baseline malnutrition assessed by GNRI and clinical outcomes of endovascular therapy for lower extremity arterial disease in patients with diabetic foot.Methods Ninety-five patients who were admitted in Department of Endocrinology,Sun Yat-sen Memorial Hospital due to diabetic foot and lower extremity arterial disease were included from January 2011 to December 2016.All of them received endovascular therapy and followed up for two years.Baseline GNRI was assessed,and divided into three levels:normal nutrition (43 cases),mild malnutrition (31 cases) and moderate to severe malnutrition (21 cases).Clinical characteristics were collected,including sex,age,diabetes duration,smoking,body mass index,prevalence of cardiovascular and cerebrovascular diseases,diabetic foot classification,systolic and diastolic blood pressure,and blood test results containing white blood cell count,platelet count,lymphocyte count,neutrophil count,neutrophil-to-lymphocyte ratio,hemoglobin,fasting blood glucose,glycosylated hemoglobin,total cholesterol,triglyceride,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol,albumin,creatinine,and estimated glomerular filtration rate.The primary endpoint was all-cause mortality,and the secondary endpoint was major lower extremity amputation.The Kaplan-Meier curve was used for survival analysis.Univariate and multivariate Cox proportional hazards regression analysis were analyzed to evaluate the risk factors of all-cause mortality.Results Fifty-two cases(54.7%)were assessed with malnutrition(GNRI≤98).Normal nutrition,mild malnutrition,and moderate to severe malnutrition patients had significant differences in average body mass index,leukocyte count,neutrophil count,neutrophil-to-lymphocyte ratio,hemoglobin,triglyceride and albumin (P<0.05).During the follow-up,16 patients died,10 of whom were due to cardiovascular or cerebrovascular diseases;five patients underwent major lower extremity amputation.The two-year survival rate was 92.1%,75.6% and 50.1% in normal nutrition,mild malnutrition,and moderate to severe malnutrition patients,respectively,showing statistically significant difference(Log-rank test:χ^(2)=10.812,P=0.004).GNRI≤98〔HR=3.937,95%CI(1.070,13.942),P=0.037〕was an independent risk factor for all-cause mortality.Conclusion The two-year survival rate of patients in normal nutrition group(GNRI>98)was higher than that in malnutrition group(GNRI≤98).Baseline GNRI-assessed malnutrition may be an independent risk factor for all-cause mortality in diabetic foot patients with lower extremity arterial disease treated by endovascular therapy,so assessing and improving the nutritional status may better improve the clinical outcome of these patients.
作者
吴文霞
陈桂珊
刘兴州
尤丽丽
刘丹
严励
WU Wenxia;CHEN Guishan;LIU Xingzhou;YOU Lili;LIU Dan;YAN Li(Department of General Medicine,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;Department of Endocrinology,the First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Department of Endocrinology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)
出处
《中国全科医学》
CAS
北大核心
2022年第36期4496-4501,4508,共7页
Chinese General Practice
基金
中山大学临床医学研究5010项目(2010010)。
关键词
糖尿病足
老年营养风险指数
营养不良
下肢动脉病变
血管腔内治疗
临床结局
生存率
危险因素
Diabetic foot
Geriatric nutritional risk index
Malnutrition
Lower extremity arterial disease
Endovascular therapy
Clinical outcome
Survival rate
Risk factors
