本文選題：老年 + 代謝綜合征�。� 參考：《承德醫(yī)學院》2017年碩士論文

【摘要】：目的:探討應用微型營養(yǎng)評估(miniature nutritional assessment,MNA)對老年代謝綜合征(metabolic syndrome,MS)患者的營養(yǎng)狀況進行評價,并研究營養(yǎng)不良的相關因素,以便為進一步采取相應的營養(yǎng)教育和營養(yǎng)治療等提供臨床依據,早期改善營養(yǎng)狀態(tài),輔助臨床治療,提倡健康的生活方式和飲食方式等,改善老年人的營養(yǎng)狀態(tài)和生活質量,減輕家庭和社會的負擔。方法:隨機選擇2015年3月至2016年3月期間承德醫(yī)學院附屬醫(yī)院的老年病科住院的年齡≥60歲的老年MS患者102例作為觀察組,健康老年體檢者120例作為對照組。對兩組均進行MNA測評,對兩組MNA評分進行比較。依據MNA評分,將觀察組分為營養(yǎng)良好組(a)、潛在營養(yǎng)不良組(b)和營養(yǎng)不良組(c),將對照組記錄為(d)。記錄一般臨床指標:年齡、性別、腰圍、臀圍、身高、體重,并計算腰/臀比(W/H)、體質指數(BMI),白蛋白(ALB)、前白蛋白(PA)、淋巴細胞總數(LC)、血紅蛋白(HGB)、鈉(Na)、鉀(K)、鈣(Ca)、鎂(Mg)、磷(P)、氯(Cl)、糖化血紅蛋白(HbA1c)、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、載脂蛋白A1(Apo-A1)、載脂蛋白B(Apo-B)、空腹血糖(Free Blood Glucose,FBG)、餐后2小時血糖(2-hour Postprandial Blood Glucose,2h PBG)(但需重復一次檢驗)、尿酸(UA)、肌酐(Cr)、尿素氮(BUN)、高敏C反應蛋白(sCRP)等。采用SPSS19.0統(tǒng)計學軟件對數據進行分析,計量資料以?x±s表示,資料服從正態(tài)分布,采用單因素方差分析,兩兩比較采用LSD-t檢驗;計數資料描述用例數(百分比),統(tǒng)計差異采用χ2檢驗;相關分析統(tǒng)計采用Spearman相關;應用二分類Logistic回歸分析篩選出老年MS患者營養(yǎng)不良的相關因素。P0.05為差異有統(tǒng)計學意義。結果:1觀察組MNA營養(yǎng)不良檢出率高于對照組,差異有統(tǒng)計學意義(χ2=9.404,P=0.002)。2各臨床指標的組間比較觀察組不同營養(yǎng)狀態(tài)患者及對照組性別構成、BMI、W/H、高血壓病比例、TC、LDL-C、LC、上臂圍、UA、Na、K、Apo-A1、Apo-B等差異無統(tǒng)計學意義(P0.05),觀察組不同營養(yǎng)狀態(tài)患者及對照組年齡、HGB、ALB、PA、2型糖尿病(T2-DM)、TG、HDL-C、sCRP、小腿圍、β2-MG、BUN、Cr等差異有統(tǒng)計學意義(P0.05)。兩兩比較顯示營養(yǎng)不良組患者年齡高于其余三組,營養(yǎng)不良風險組年齡高于營養(yǎng)良好組,差異有統(tǒng)計學意義(P0.05)。營養(yǎng)不良組HGB、ALB、PA低于其余三組,營養(yǎng)不良組HGB低于對照組,差異有統(tǒng)計學意義(P0.05)。營養(yǎng)不良組、營養(yǎng)不良風險組HDL-C對照組。營養(yǎng)不良組sCRP高于營養(yǎng)不良風險組,營養(yǎng)不良風險組高于營養(yǎng)良好組,營養(yǎng)良好組高于對照組,差異有統(tǒng)計學意義(P0.05)。營養(yǎng)不良組HbA1c高于營養(yǎng)不良風險組,營養(yǎng)不良風險組高于營養(yǎng)良好組及對照組,差異有統(tǒng)計學意義(P0.05)。營養(yǎng)不良組糖尿病比例高于其余三組,營養(yǎng)不良風險組亦高于對照組,差異有統(tǒng)計學意義(P0.05)。營養(yǎng)良好組及對照組小腿圍高于其余兩組,營養(yǎng)不良組β2-MG、BUN高于其余三組,差異有統(tǒng)計學意義(P0.05)。3 Spearman相關性分析發(fā)現老年MS患者的MNA評分與年齡、T2-DM、sCRP、HbA1c、β2-MG、BUN等存在負相關關系(P0.05),r值分別為-0.446、-0.314、-0.374、-0.446、-0.300、-0.239;MNA評分與HGB、ALB、PA、HDL-C、小腿圍、Apo-B等存在正相關關系(P0.05),r值分別為0.318、0.525、0.339、0.279、0.309、0.219;與性別、BMI、W/H、高血壓病、TG、TC、LDL-C、LC、上臂圍、Apo-A1不存在相關關系(P0.05)。4二分類Logistic回歸分析顯示高齡、低白蛋白血癥、血清PA偏低、sCRP及HbA1c水平增高與老年MS患者營養(yǎng)不良發(fā)生顯著相關(P0.05),OR值分別為5.622、15.092、5.919、9.591、3.776。結論:1老年代謝綜合征患者營養(yǎng)不良發(fā)生率高于正常體檢老年人。2高齡、高敏C反應蛋白增高及糖化血紅蛋白水平增高與老年MS患者營養(yǎng)不良發(fā)生顯著相關,可能是老年MS患者營養(yǎng)不良的危險因素。
[Abstract]:Objective: To evaluate the nutritional status of elderly metabolic syndrome (metabolic syndrome, MS) patients with miniature nutritional assessment (MNA), and to study the related factors of malnutrition in order to provide clinical basis for further nutrition education and nutrition treatment, and to improve nutritional status in early stage. To assist the clinical treatment, promote healthy lifestyle and diet, improve the nutritional status and quality of life of the elderly and reduce the burden of family and society. Methods: 102 cases of MS patients aged over 60 years of age in the Department of geriatrics in Affiliated Hospital of Chengde Medical College from March 2015 to March 2016 were selected as the observation group. 120 healthy elderly patients were treated as the control group. The two groups were evaluated by MNA, and the two groups of MNA scores were compared. According to the MNA score, the observation group was divided into good nutrition group (a), potential malnutrition group (b) and malnutrition group (c), and the control group was recorded (d). Age, sex, waist, hip, height, weight, and plan were recorded. W/H, body mass index (BMI), albumin (ALB), prealbumin (PA), total lymphocyte count (LC), hemoglobin (HGB), sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), phosphorus (P), chlorine (Cl), glycosylated hemoglobin, triglyceride, high-density lipoprotein cholesterol, low density lipoprotein cholesterol (LDL), apolipoprotein 1 (Apo-A1), apolipoprotein B (Apo-B), fasting blood glucose (Free Blood Glucose, FBG), postprandial 2 hours blood glucose (2-hour Postprandial Blood Glucose, 2h), uric acid, creatinine, urea nitrogen, Gao Min anti stress protein, etc. The data were subject to normal distribution, using single factor analysis of variance, 22 comparison using LSD-t test, counting data to describe use case number (percentage), statistical difference using chi 2 test, correlation analysis and statistical use of Spearman correlation, and using two classified Logistic regression analysis to screen out the related factors of malnutrition in old MS patients.P0.05 Results: in 1 observation group, the detection rate of malnutrition in MNA was higher than that of the control group. The difference was statistically significant (x 2=9.404, P=0.002), and there was no significant difference in sex composition, BMI, W/H, the proportion of BMI, W/H, hypertension, TC, LDL-C, LC, Na, K, K, and other groups in the group of different nutritional state and control group of.2. .05), the age of different nutritional state and control group, HGB, ALB, PA, type 2 diabetes (T2-DM), TG, HDL-C, sCRP, leg circumference, beta 2-MG, BUN, Cr were statistically significant (P0.05). 22 comparison showed that the age of dystrophy group was higher than the other three groups, and the age of dystrophy risk group was higher than that of good nutrition group, the difference was statistically significant ( P0.05). The dystrophy group HGB, ALB, PA were lower than the other three groups, and the HGB in the dystrophy group was lower than the control group, the difference was statistically significant (P0.05). The malnutrition group, the malnutrition risk group HDL-C control group. The malnutrition group sCRP was higher than the dystrophy risk group, the malnutrition risk group was higher than the good nutrition group, the good nutrition group was higher than the control group, the difference was higher than the control group, the difference was there was the difference Statistical significance (P0.05). The dystrophy group HbA1c was higher than the dystrophy risk group, the dystrophy risk group was higher than the good nutrition group and the control group, the difference was statistically significant (P0.05). The proportion of diabetes in dystrophy group was higher than the other three groups, and the dystrophy risk group was also higher than that in the control group (P0.05). The lower leg circumference of the control group was higher than that of the other two groups, and the beta 2-MG and BUN in the dystrophy group were higher than the other three groups. The difference was statistically significant (P0.05).3 Spearman correlation analysis found that the MNA score of the elderly MS patients was related to the age, T2-DM, sCRP, HbA1c, beta 2-MG, BUN, etc. The score was correlated with HGB, ALB, PA, HDL-C, calf circumference, Apo-B and so on, and R values were 0.318,0.525,0.339,0.279,0.309,0.219, and BMI, W/H, hypertension, TG, TC, hypoalbuminemia, low serum albumin, low serum albumin, low serum albumin, low serum albumin. The increase of A1c was significantly associated with malnutrition in elderly patients with MS (P0.05), and the OR value was 5.622,15.092,5.919,9.591,3.776., respectively. The incidence of malnutrition in 1 elderly patients with metabolic syndrome was higher than that of normal aged people with.2, high sensitivity C reactive protein and increased glycosylated blood erythroprotein level and malnutrition in elderly MS patients. Significant correlation may be a risk factor for malnutrition in elderly patients with MS.

【學位授予單位】：承德醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R589

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