| 刘 敏,高笑宇,杨海丽,赵历超,李晓玲.AECOPD合并Ⅱ型呼吸衰竭患者发生营养风险的影响因素分析及其预测模型构建[J].,2024,(10):1883-1887 |
| AECOPD合并Ⅱ型呼吸衰竭患者发生营养风险的影响因素分析及其预测模型构建 |
| Analysis of Influencing Factors of Occurrence Nutritional Risk in Patients with AECOPD Combined with Type II Respiratory Failure and Construction of Prediction Model |
| 投稿时间：2023-08-23 修订日期：2023-09-17 |
| DOI：10.13241/j.cnki.pmb.2024.10.017 |
| 中文关键词: 慢性阻塞性肺疾病急性加重期 Ⅱ型呼吸衰竭 营养风险 影响因素 预测模型 |
| 英文关键词: Acute exacerbation of chronic obstructive pulmonary disease Type II respiratory failure Nutritional risk Influencing factors Prediction model |
| 基金项目:内蒙古自治区人民医院院内基金项目（2019YN24）；内蒙古自治区科技计划项目 (201802161) |
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| 中文摘要: |
| 摘要 目的：探讨慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者发生营养风险的影响因素，并构建预测模型。方法：回顾性选择2021年1月至2022年12月内蒙古自治区人民医院收治的AECOPD合并Ⅱ型呼吸衰竭患者177例，根据营养风险筛查2002（NRS2002）评分将患者分为营养风险组（122例）和无营养风险组（55例）。单因素和多因素Logistic回归分析AECOPD合并Ⅱ型呼吸衰竭患者营养风险的影响因素，并根据回归模型构建预测模型。受试者工作特征（ROC）曲线验证预测模型的预测效能。结果：单因素分析显示营养风险组年龄大于无营养风险组（P＜0.05），COPD病程长于无营养风险组（P＜0.05），慢性胃病，急性加重次数≥3次/年，改良版英国医学研究委员会呼吸困难问卷（mMRC）评分3-4级比例高于无营养风险组（P＜0.05），第1秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC），体质量指数（BMI），白蛋白、前白蛋白，握力，氧分压（PO2）低于无营养风险组（P＜0.05），中性粒细胞计数/淋巴细胞计数比值（NLR），慢性阻塞性肺疾病评估测试问卷（CAT）评分，急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分高于无营养风险组（P＜0.05）。多因素Logistic回归分析结果显示高年龄、高mMRC评分、合并慢性胃病、高NLR是AECOPD合并Ⅱ型呼吸衰竭患者发生营养风险的危险因素（P＜0.05），高FEV1/FVC是保护因素（P＜0.05）。基于回归模型预测AECOPD合并Ⅱ型呼吸衰竭患者营养风险的曲线下面积为0.820，灵敏度、特异度分别为81.97%、83.64%，Hosmer-Lemeshow检验P＞0.05，模型拟合效果良好。结论：高龄、高mMRC评分、合并慢性胃病、高NLR是AECOPD合并Ⅱ型呼吸衰竭患者发生营养风险的危险因素，高FEV1/FVC是保护因素。基于回归模型预测AECOPD合并Ⅱ型呼吸衰竭患者发生营养风险具有较高的价值。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the influencing factors of occurrence nutritional risk in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with type II respiratory failure, and to construct a prediction model. Methods: 177 patients with AECOPD combined with type II respiratory failure admitted to the Inner Mongolia Autonomous Region People's Hospital from January 2021 to December 2022 were retrospectively selected, patients were divided into nutritional risk group (122 cases) and non-nutritional risk group (55 cases) according to the Nutritional Risk Screening 2002 (NRS2002) score. The influencing factors of occurrence nutritional risk in patients with AECOPD combined with type II respiratory failure who were analyzed by univariate and multivariate Logistic regression, and prediction model was constructed according to the regression model. The predictive performance of the prediction model was verified by receiver operating characteristic (ROC) curve. Results: Univariate analysis showed that the age in nutritional risk group was older than that in non-nutritional risk group (P<0.05), the course of COPD was longer than that in non-nutritional risk group (P<0.05), chronic gastric disease, number of acute exacerbations≥3 times/year, and the modified British Medical Research Council Dyspnea Questionnaire (mMRC) score of grade 3-4 was higher than that in non-nutritional risk group (P<0.05), the forced expiratory volume in the first second (FEV1), FEV1/forced vital capacity (FVC), body mass index (BMI), albumin, prealbumin, grip strength, and oxygen partial pressure (PO2) were lower than those in non-nutritional risk group (P<0.05), the neutrophil count/lymphocyte count ratio (NLR), chronic obstructive pulmonary disease assessment test questionnaire (CAT) score, acute physiology and chronic health eval uation II (APACHE II) score were higher than those in non-nutritional risk group (P<0.05). Multivariate Logistic regression analysis showed that advanced age, high mMRC score, chronic gastric disease, and high NLR were risk factors for occurrence nutritional risk in patients with AECOPD combined with type II respiratory failure (P<0.05), and high FEV1/FVC was protective factor (P<0.05). The area under the curve based on the regression model to predict the nutritional risk of patients AECOPD combined with type II respiratory failure was 0.820, and the sensitivity and specificity were 81.97% and 83.64% respectively, the Hosmer-Lemeshow test P>0.05, and the model fitting effect was good. Conclusion: Advanced age, high mMRC score, chronic gastric disease and high NLR are risk factors for occurrence nutritional risk in patients with AECOPD combine with type II respiratory failure, and high FEV1/FVC is protective factor. Predicting the nutritional risk of patients AECOPD combine with type II respiratory failure base on regression models has high value. |
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