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Article(id=1241022948203614657, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411476, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732464000000, receivedDateStr=2024-11-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812527943, onlineDateStr=2026-03-18, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812527943, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812527943, creator=13701087609, updateTime=1773812527943, updator=13701087609, issue=Issue{id=1241022939957621542, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812525976, creator=13701087609, updateTime=1773815469296, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035285174219432, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035285174219433, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1058, endPage=1062, ext={EN=ArticleExt(id=1241022948618850772, articleId=1241022948203614657, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Short term effects of personalized nutritional support on serum albumin in middle-aged and elderly patients, columnId=1228016572783063333, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Food Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the short-term effects of personalized nutritional support on serum albumin (ALB) levels in middle-aged and elderly patients using real-world data and multiple factors.

Methods

A retrospective study was conducted on patients aged 50 and above who were at nutritional risk in the nutrition consultation cases at the Second People’s Hospital of Chengdu from August 2020 to June 2024. Clinical data and laboratory test results were collected, and patients were grouped according to different nutritional intervention methods. The ALB decline of patients after 1week of nutritional intervention was analyzed, and the impact of different nutritional intervention methods on ALB decline was evaluated using a logistics regression model.

Results

A total of 1 136 patients were included in the study, with 627 patients showing a decrease in ALB and 509 patients showing no decrease in ALB. Univariate analysis revealed statistically significant differences in age, tube feeding, nutritional intervention methods, chronic kidney disease, cerebral infarction, other site infections, and tumor morbidity. Multivariate analysis was conducted with the dietary guidance group as the control group. Oral nutritional supplementation (OR=0.683, 95%CI: 0.500-0.933), personalized nutritional support intervention (OR=0.409, 95% CI: 0.279-0.601), and other site infections (OR=0.776, 95% CI: 0.607-0.994) were protective factors for ALB decline; Tube feeding (OR=1.766, 95% CI: 1.317-2.369) and cerebral infarction (OR=1.866,95% CI: 1.424-2.444) are risk factors for the decline of ALB.

Conclusion

Personalized nutritional support can effectively prevent the decline of serum albumin in middle-aged and elderly hospitalized patients, and has potential clinical value.

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目的

利用真实世界数据，综合多因素探讨个性化营养支持对中老年患者血清白蛋白（serum albumin，ALB）短期变化的影响。

方法

采用回顾性研究方法，以成都市第二人民医院 2020年8月至2024年6月营养科会诊病例中50岁以上且存在营养风险的患者为研究对象，通过收集患者临床资料及实验室检查结果，根据不同营养干预方式对患者分组，分析营养干预一周后患者ALB下降情况，采用logistics回归模型评估不同营养干预方式对ALB下降的影响。

结果

共1 136例患者纳入研究，其中627例患者ALB下降，509例患者ALB未下降。单因素分析发现年龄、管饲喂养、营养干预方式、慢性肾病、脑梗死、其他部位感染、肿瘤患病率差异均有统计学意义。多因素分析以膳食指导组为对照，口服营养补充（OR=0.683，95% CI：0.500～0.933），个性化营养支持干预（OR=0.409，95% CI：0.279～0.601），其他部位感染(OR=0.776,95% CI:0.607～0.994)为ALB下降的保护因素；管饲喂养(OR=1.766,95% CI:1.317～2.369)、脑梗死(OR=1.866,95% CI:1.424～2.444) 为ALB下降的危险因素。

结论

个性化营养支持能有效防止中老年住院患者血清白蛋白的下降，具有临床价值。

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杨春霞，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=WCiTfiQWOFBA1FccH2zvDg==, magXml=ORmr+EEEQol0tb7ReAtKCQ==, pdfUrl=null, pdf=tb7Oh//hLfw+8dfmBO2/uA==, pdfFileSize=525643, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=4tBpWh6BCZHVjiJnLS+gcA==, mapNumber=null, authorCompany=null, fund=null, authors=

沈晓丽（1988—），女，硕士在读，研究方向：流行病学

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(In Chinese), articleTitle=Survey on nutritional status of elderly inpatients and analysis of nutritional intervention, refAbstract=null), Reference(id=1241022963001118993, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, doi=null, pmid=null, pmcid=null, year=2018, volume=25, issue=2, pageStart=95, pageEnd=97, url=null, language=null, rfNumber=[24], rfOrder=24, authorNames=张鑫, 庄媛媛, journalName=肠外与肠内营养, refType=null, unstructuredReference=张鑫，庄媛媛．养老院管饲老年人膳食及营养状况调查[J].肠外与肠内营养，2018, 25(2): 95-97., articleTitle=养老院管饲老年人膳食及营养状况调查, refAbstract=null), Reference(id=1241022963118559509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, doi=null, pmid=null, pmcid=null, year=2018, volume=25, issue=2, pageStart=95, pageEnd=97, url=null, language=null, rfNumber=[24], rfOrder=25, authorNames=Zhang X, Zhuang YY, journalName=Parenteral & Enteral Nutrition, refType=null, unstructuredReference=Zhang X, Zhuang YY. Survey of dietary and nutritional status of the tube feeding elderly in nursing home[J]. Parenteral & Enteral Nutrition, 2018, 25(2): 95-97. (In Chinese), articleTitle=Survey of dietary and nutritional status of the tube feeding elderly in nursing home, refAbstract=null), Reference(id=1241022963223417116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, doi=null, pmid=null, pmcid=null, year=2010, volume=13, issue=33, pageStart=3715, pageEnd=3717, url=null, language=null, rfNumber=[25], rfOrder=26, authorNames=王艳丽, 李淑娟, journalName=中国全科医学, refType=null, unstructuredReference=王艳丽，李淑娟．重症急性脑梗死患者并发症的早期监测[J].中国全科医学，2010, 13(33): 3715-3717., articleTitle=重症急性脑梗死患者并发症的早期监测, refAbstract=null), Reference(id=1241022964720783645, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, doi=null, pmid=null, pmcid=null, year=2010, volume=13, issue=33, pageStart=3715, pageEnd=3717, url=null, language=null, rfNumber=[25], rfOrder=27, authorNames=Wang YL, Li SJ, journalName=Chinese General Practice, refType=null, unstructuredReference=Wang YL, Li SJ. Monitoring of medical complications in acute cerebral infarction[J]. Chinese General Practice, 2010, 13(33): 3715-3717. (In Chinese), articleTitle=Monitoring of medical complications in acute cerebral infarction, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241022952137872026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, xref=1．, ext=[AuthorCompanyExt(id=1241022952146260636, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, companyId=1241022952137872026, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Health Statistics, West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241022952150454939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, companyId=1241022952137872026, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1．四川大学华西公共卫生学院／华西第四医院流行病与卫生统计学系，四川　成都　610041)]), AuthorCompany(id=1241022952297255592, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, xref=2．, ext=[AuthorCompanyExt(id=1241022952309838505, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, companyId=1241022952297255592, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2．成都市第二人民医院营养科)]), AuthorCompany(id=1241022952414696115, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, xref=3．, ext=[AuthorCompanyExt(id=1241022952586662586, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, companyId=1241022952414696115, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3．成都市妇女儿童中心医院病案科)]), AuthorCompany(id=1241022952716686023, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, xref=4．, ext=[AuthorCompanyExt(id=1241022952720880328, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, companyId=1241022952716686023, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4．成都市第二人民医院医务科)])], figs=[ArticleFig(id=1241022957586272289, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, language=EN, label=Table 1, caption=

General Information of Patients

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变量总人群膳食指导（n=277）口服营养补充（n=536）个性化营养支持（n=323）χ2/F/HP
性别[n(%)]4.690.096
男636（56.0）145（52.3）318（59.3）173（53.6）
女500（44.0）132（47.7）218（40.7）150（46.4）
年龄 (岁）()78.60±11.32876.61±11.1978.67±11.5380.20±10.887.610<0.001
NRS2002[M(P25, P75)]4（4,5）4(3,5)4(4,5)5(4,5)28.828<0.001
管饲喂养[n(%)]551（48.5）83（30）182（34）286（88.5）290.871<0.001
患病情况[n(%)]
高血压687（60.5）170（61.4）309（57.6）208（64.4）3.9620.138
糖尿病419（36.9）114（41.2）185（34.5）120（37.2）3.4730.176
慢性肾病367（32.3）73（26.4）189（35.3）105（32.5）6.9340.134
脑梗死726（63.9）189（68.2）285（53.2）252（78）56.913<0.001
肺部感染934（82.2）199（71.8）439（81.9）296（91.6）40.055<0.001
其他部位感染573（50.4）125（45.1）283（52.8）165（51.1）4.3750.112
消化道出血204（18.0）46（16.6）88（16.4）70（21.7）4.2300.121
肿瘤159（14.0）41（14.8）92（17.2）26（8）14.107<0.001
ALB(g/L)()32.01±6.1733.73±6.4531.03±6.1832.154±6.1718.130<0.001
ALB<35 g/L[n(%)]772（68.0）151（54.5）398（74.3）223（69）32.927<0.001
), ArticleFig(id=1241022957724684324, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, language=CN, label=表1, caption=

患者一般资料

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变量总人群膳食指导（n=277）口服营养补充（n=536）个性化营养支持（n=323）χ2/F/HP
性别[n(%)]4.690.096
男636（56.0）145（52.3）318（59.3）173（53.6）
女500（44.0）132（47.7）218（40.7）150（46.4）
年龄 (岁）()78.60±11.32876.61±11.1978.67±11.5380.20±10.887.610<0.001
NRS2002[M(P25, P75)]4（4,5）4(3,5)4(4,5)5(4,5)28.828<0.001
管饲喂养[n(%)]551（48.5）83（30）182（34）286（88.5）290.871<0.001
患病情况[n(%)]
高血压687（60.5）170（61.4）309（57.6）208（64.4）3.9620.138
糖尿病419（36.9）114（41.2）185（34.5）120（37.2）3.4730.176
慢性肾病367（32.3）73（26.4）189（35.3）105（32.5）6.9340.134
脑梗死726（63.9）189（68.2）285（53.2）252（78）56.913<0.001
肺部感染934（82.2）199（71.8）439（81.9）296（91.6）40.055<0.001
其他部位感染573（50.4）125（45.1）283（52.8）165（51.1）4.3750.112
消化道出血204（18.0）46（16.6）88（16.4）70（21.7）4.2300.121
肿瘤159（14.0）41（14.8）92（17.2）26（8）14.107<0.001
ALB(g/L)()32.01±6.1733.73±6.4531.03±6.1832.154±6.1718.130<0.001
ALB<35 g/L[n(%)]772（68.0）151（54.5）398（74.3）223（69）32.927<0.001
), ArticleFig(id=1241022957837930540, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, language=EN, label=Table 2, caption=

Single factor analysis of albumin decline

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变量ALB下降ALB未下降χ2/t/ZP
性别[n(%)]0.0150.901
男350(55.0)286(45.0)
女277(55.4)223(44.6)
年龄(岁)（）79.22±11.0777.84±11.602.0380.042
管饲喂养[n(%)]335(53.4)216(42.4)13.592<0.001
营养干预方式[n(%)]10.3170.006
膳食指导176（28.1）101（19.8）
口服营养补充281（44.8）255（50.1）
个性化营养支持170（27.1）153（30.1）
患病情况[n(%)]
高血压388(61.9)299(58.7)1.1580.282
糖尿病238(38.0)181(35.6)0.6940.405
慢性肾病186(29.7)181(35.6)4.4640.035
脑梗死452(72.1)274(53.8)40.603<0.001
肺部感染508(81.0)426(83.7)1.3730.241
其他部位感染298(47.5)275(54.0)4.7480.029
消化道出血109(17.4)95(18.7)0.3120.576
肿瘤71(11.3)88(17.3)8.3040.004
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白蛋白下降单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量ALB下降ALB未下降χ2/t/ZP
性别[n(%)]0.0150.901
男350(55.0)286(45.0)
女277(55.4)223(44.6)
年龄(岁)（）79.22±11.0777.84±11.602.0380.042
管饲喂养[n(%)]335(53.4)216(42.4)13.592<0.001
营养干预方式[n(%)]10.3170.006
膳食指导176（28.1）101（19.8）
口服营养补充281（44.8）255（50.1）
个性化营养支持170（27.1）153（30.1）
患病情况[n(%)]
高血压388(61.9)299(58.7)1.1580.282
糖尿病238(38.0)181(35.6)0.6940.405
慢性肾病186(29.7)181(35.6)4.4640.035
脑梗死452(72.1)274(53.8)40.603<0.001
肺部感染508(81.0)426(83.7)1.3730.241
其他部位感染298(47.5)275(54.0)4.7480.029
消化道出血109(17.4)95(18.7)0.3120.576
肿瘤71(11.3)88(17.3)8.3040.004
), ArticleFig(id=1241022958072811587, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, language=EN, label=Table 3, caption=

Logistic regression assignment

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变量赋值
ALB差值（因变量）<0 g/L=1，≥0 g/L=0
年龄<65岁=1，65～79.99岁=2，≥80岁=3
管饲喂养是=1，否=0
慢性肾病是=1，否=0
脑梗死是=1，否=0
其他部位感染是=1，否=0
肿瘤是=1，否=0
), ArticleFig(id=1241022958190252106, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, language=CN, label=表3, caption=

Logistic回归赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
ALB差值（因变量）<0 g/L=1，≥0 g/L=0
年龄<65岁=1，65～79.99岁=2，≥80岁=3
管饲喂养是=1，否=0
慢性肾病是=1，否=0
脑梗死是=1，否=0
其他部位感染是=1，否=0
肿瘤是=1，否=0
), ArticleFig(id=1241022958295109716, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, language=EN, label=Table 4, caption=

Binary logistic regression analysis of albumin decline

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自变量βSEWald χ2POR(95% CI)
营养干预方式
膳食指导　Reference　1.000
口服营养补充-0.3810.1595.7570.0160.683(0.500～0.933)
个性化营养支持-0.8930.19620.837<0.0010.409(0.279～0.601)
年龄0.1190.0901.7320.1881.126(0.944～1.344)
管饲喂养0.5690.15014.405<0.0011.766(1.317～2.369)
慢性肾病-0.1560.1341.3550.2440.856(0.659～1.112)
脑梗塞0.6240.13820.495<0.0011.866(1.424～2.444)
其他部位感染-0.2530.1264.0470.0440.776(0.607～0.994)
肿瘤-0.3020.1852.6680.1020.739(0.514～1.062)
), ArticleFig(id=1241022958391578716, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948203614657, language=CN, label=表4, caption=

白蛋白下降二元logistics回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量βSEWald χ2POR(95% CI)
营养干预方式
膳食指导　Reference　1.000
口服营养补充-0.3810.1595.7570.0160.683(0.500～0.933)
个性化营养支持-0.8930.19620.837<0.0010.409(0.279～0.601)
年龄0.1190.0901.7320.1881.126(0.944～1.344)
管饲喂养0.5690.15014.405<0.0011.766(1.317～2.369)
慢性肾病-0.1560.1341.3550.2440.856(0.659～1.112)
脑梗塞0.6240.13820.495<0.0011.866(1.424～2.444)
其他部位感染-0.2530.1264.0470.0440.776(0.607～0.994)
肿瘤-0.3020.1852.6680.1020.739(0.514～1.062)
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个性化营养支持对中老年患者血清白蛋白短期影响
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沈晓丽 1, 2 , 彭介入 1, 3 , 杨春霞 1 , 李宏宇 2 , 程渝 4 , 汪玥杉 1 , 龙文成 1
现代预防医学 | 营养与食品卫生 2025,52(6): 1058-1062
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现代预防医学 | 营养与食品卫生 2025, 52(6): 1058-1062
个性化营养支持对中老年患者血清白蛋白短期影响
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沈晓丽1, 2, 彭介入1, 3, 杨春霞1 , 李宏宇2, 程渝4, 汪玥杉1, 龙文成1
作者信息
  • 1．四川大学华西公共卫生学院／华西第四医院流行病与卫生统计学系，四川　成都　610041
  • 2．成都市第二人民医院营养科
  • 3．成都市妇女儿童中心医院病案科
  • 4．成都市第二人民医院医务科

    • 沈晓丽（1988—），女，硕士在读，研究方向：流行病学

通讯作者:

杨春霞，E-mail:
Short term effects of personalized nutritional support on serum albumin in middle-aged and elderly patients
Xiao-li SHEN1, 2, Jie-ru PENG1, 3, Chun-xia YANG1 , Hong-yu LI2, Yu CHENG4, Yue-shan WANG1, Wen-cheng LONG1
Affiliations
  • Department of Epidemiology and Health Statistics, West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-03-25 doi: 10.20043/j.cnki.MPM.202411476
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摘要
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目的

利用真实世界数据，综合多因素探讨个性化营养支持对中老年患者血清白蛋白（serum albumin，ALB）短期变化的影响。

方法

采用回顾性研究方法，以成都市第二人民医院 2020年8月至2024年6月营养科会诊病例中50岁以上且存在营养风险的患者为研究对象，通过收集患者临床资料及实验室检查结果，根据不同营养干预方式对患者分组，分析营养干预一周后患者ALB下降情况，采用logistics回归模型评估不同营养干预方式对ALB下降的影响。

结果

共1 136例患者纳入研究，其中627例患者ALB下降，509例患者ALB未下降。单因素分析发现年龄、管饲喂养、营养干预方式、慢性肾病、脑梗死、其他部位感染、肿瘤患病率差异均有统计学意义。多因素分析以膳食指导组为对照，口服营养补充（OR=0.683，95% CI：0.500～0.933），个性化营养支持干预（OR=0.409，95% CI：0.279～0.601），其他部位感染(OR=0.776,95% CI:0.607～0.994)为ALB下降的保护因素；管饲喂养(OR=1.766,95% CI:1.317～2.369)、脑梗死(OR=1.866,95% CI:1.424～2.444) 为ALB下降的危险因素。

结论

个性化营养支持能有效防止中老年住院患者血清白蛋白的下降，具有临床价值。

营养不良  /  个性化营养支持  /  真实世界研究  /  血清白蛋白
Objective

To explore the short-term effects of personalized nutritional support on serum albumin (ALB) levels in middle-aged and elderly patients using real-world data and multiple factors.

Methods

A retrospective study was conducted on patients aged 50 and above who were at nutritional risk in the nutrition consultation cases at the Second People’s Hospital of Chengdu from August 2020 to June 2024. Clinical data and laboratory test results were collected, and patients were grouped according to different nutritional intervention methods. The ALB decline of patients after 1week of nutritional intervention was analyzed, and the impact of different nutritional intervention methods on ALB decline was evaluated using a logistics regression model.

Results

A total of 1 136 patients were included in the study, with 627 patients showing a decrease in ALB and 509 patients showing no decrease in ALB. Univariate analysis revealed statistically significant differences in age, tube feeding, nutritional intervention methods, chronic kidney disease, cerebral infarction, other site infections, and tumor morbidity. Multivariate analysis was conducted with the dietary guidance group as the control group. Oral nutritional supplementation (OR=0.683, 95%CI: 0.500-0.933), personalized nutritional support intervention (OR=0.409, 95% CI: 0.279-0.601), and other site infections (OR=0.776, 95% CI: 0.607-0.994) were protective factors for ALB decline; Tube feeding (OR=1.766, 95% CI: 1.317-2.369) and cerebral infarction (OR=1.866,95% CI: 1.424-2.444) are risk factors for the decline of ALB.

Conclusion

Personalized nutritional support can effectively prevent the decline of serum albumin in middle-aged and elderly hospitalized patients, and has potential clinical value.

Malnutrition  /  Personalized nutritional support  /  Real world research  /  Serum albumin
沈晓丽, 彭介入, 杨春霞, 李宏宇, 程渝, 汪玥杉, 龙文成. 个性化营养支持对中老年患者血清白蛋白短期影响. 现代预防医学, 2025 , 52 (6) : 1058 -1062 . DOI: 10.20043/j.cnki.MPM.202411476
Xiao-li SHEN, Jie-ru PENG, Chun-xia YANG, Hong-yu LI, Yu CHENG, Yue-shan WANG, Wen-cheng LONG. Short term effects of personalized nutritional support on serum albumin in middle-aged and elderly patients[J]. Modern Preventive Medicine, 2025 , 52 (6) : 1058 -1062 . DOI: 10.20043/j.cnki.MPM.202411476
正文
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随着我国老龄化进程的加速，中老年人的健康问题日益突出。中老年人由于年龄增长机体功能减退，不良行为生活方式积累等因素，慢性病成为中老年人高发病，且多数存在共病状态，严重影响中老年人健康。
低白蛋白血症在中老年住院患者中常见。血清白蛋白（serum albumin，ALB）是肝脏产生的一种蛋白质，对维持血容量和调节体液平衡至关重要。研究显示低白蛋白血症增加患者住院时间[1]，是住院患者继发感染[2]、静脉血栓[3]、急性心肌梗塞[3]、急性缺血性脑卒中[3]、急性肾衰危险因素[4-5]，增加死亡率[1,4,6-9]，在高龄患者中更加突出[5]。与患者不良预后高度相关，深受临床医师重视。研究表明白蛋白合成可由能量（葡萄糖和脂肪）的增加刺激，对蛋白质的摄入特别敏感[10-11]。
本研究旨在通过真实世界的数据，在中老年患者的个体差异性、多种慢性病的共存等复杂情况下，评估个性化营养干预对中老年住院患者血清白蛋白ALB短期变化的影响，从而为临床治疗策略的优化提供科学依据，并进一步促进中老年患者健康水平的提高。
1　资料与方法
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1.1　研究对象
选择2020年8月至2024年6月成都市第二人民医院住院患者进行营养会诊者。纳入标准：①年龄≥50岁；②营养风险筛查评估表NRS2002（nutrition risk screening 2002，NRS2002）评分≥3。排除标准： ①营养干预开始时及一周后ALB实验检查结果缺失；②肝功能异常；③禁食患者；④重复病例。本研究已通过成都市第二人民医院科研学术伦理委员会审查(审批号：【KY】PJ2024174)，包括生物医学伦理审查及临床实验免知情同意书审查。
1.2　资料获取方法
通过电子病历信息系统采集研究对象数据，获取患者年龄、性别、NRS2002营养风险筛查结果、管饲喂养情况、高血压、慢性肾病、脑梗死、呼吸道感染、其他部位感染、消化道出血、肿瘤等疾病患病情况、干预开始时及一周后ALB指标数据。数据通过专门设计的电子信息表格进行录入，由两名人员分别录入并进行核对，确保数据的准确性和完整性。
1.3　治疗方案
会诊时对患者进行营养状态评估及营养风险筛查，结合筛查及评估结果、实验室检验数据、目标摄入量（根据患者标准体重计算）与进食情况差值、胃肠功能等因素，为患者开具包含碳水化合物、蛋白质、必需脂肪酸、维生素、矿物质和益生菌等营养素补充的个性化营养干预方案。值得注意的是，对已有低蛋白血症、蛋白质消耗增大（尿蛋白阳性、胸水、腹水等情况）或蛋白质摄入不足患者，营养医师会提高方案中蛋白质占比。根据患者接受营养干预方案情况及方案中营养补充剂热量占比，将研究对象被分为三组：①膳食指导组：拒绝营养干预建议的患者，对其进行一次性膳食指导；②口服营养补充组：进食量减少小于目标摄入量60%者，在日常饮食的基础上开具营养补充剂进行肠内营养补充；③个性化营养支持组：进食量减少大于目标摄入量60%者，使用全肠内营养方式进行个性化营养支持。
1.4　观察指标
主要终点指标为营养干预一周后ALB下降变化情况，以干预一周后与干预开始时ALB差值是否小于0 g/L为依据，分为ALB下降与ALB未下降两组。次要终点为营养干预前后ALB（g/L）变化情况。
1.5　统计学分析方法
所有数据均使用SPSS 27.0软件进行统计分析。分类变量以频数（n）和百分比（%）表示，定量变量根据其分布特征分别采用不同的描述方式，符合正态分布的采用均值±标准差()表示，不符合正态分布采用中位数及四分位数[M (P25, P75)]表示。不同组别间分类变量比较使用采用χ2检验或Fisher精确概率检验。定量变量两组间比较采用独立样本t检验或Mann-Whitney U检验，三组间采用单因素方差分析（ANOVA）或Kruskal-Wallis H检验。单因素分析中有统计学意义的指标进一步纳入多因素分析，采用多因素logistic回归模型对患者血浆白蛋白变化的影响因素进行分析。所有统计检验均为双侧检验，检验水准α=0.05。
2　结果
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2.1　患者一般资料
本研究共纳入1 136名患者，其中膳食指导277人（24.38%），口服营养补充536人（47.18%），个性化营养支持323人（28.44%），见表1。其中低白蛋白血症（ALB<35g/L）率68.0%。根据干预方式分为三组后，三组间年龄、管饲喂养、NRS2002评分、ALB、脑梗死、肺部感染、肿瘤患病差异具有统计学意义(P<0.05)。
2.2　营养干预对指标的影响
研究对象在营养干预一周后，三组ALB差值均数为膳食指导组-2.12 g/L，口服营养补充组-1.13 g/L，个性化营养支持组-0.78 g/L，ALB均有不同程度下降。比较三组ALB差值差异具有统计学意义(P<0.05)。组间两两比较发三组ALB差值差异均有统计学意义(P<0.05)。
2.3　血浆白蛋白变化状态的单因素分析
将患者按照ALB是否下降分为两组，单因素分析提示年龄、管饲喂养、营养干预方式、慢性肾病、脑梗死、其他部位感染、肿瘤患病率在两组间差异均有统计学意义(P<0.05)，见表2。
2.4　血浆白蛋白变化状态的多因素分析
将单因素分析中差异具有统计学意义的因素纳入多因素logistics回归，因变量及自变量赋值具体见表3。多因素分析结果以膳食指导为对照，口服营养补充（OR=0.683，95% CI：0.500～0.933），个性化营养支持干预（OR=0.409，95% CI：0.279～0.601）为ALB下降保护因子，此外其他部位感染(OR=0.776,95% CI:0.607～0.994)也为ALB下降保护因子。管饲喂养(OR=1.766,95% CI:1.317～2.369)、脑梗死(OR=1.866,95% CI:1.424～2.444) 为ALB下降的危险因素。而年龄、是否患有慢性肾病、肿瘤在多因素分析中对ALB下降无影响，见表4。
3　讨论
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本研究使用的筛查工具为NRS2002，该工具欧洲临床营养与代谢学会推荐的营养不良风险筛查工具[12]。在临床中NRS2002营养风险筛查阳性结果（NRS2002≥3）提示患者可以从营养干预中获利。本研究所有研究对象均需要营养干预（NRS2002≥3），但接受营养干预建议为非随机事件，膳食指导组由拒绝营养补充或营养支持患者组成，该组患者年龄较小，管饲喂养百分比小，营养风险较低，ALB水平较高，提示基础情况较好者更易忽略营养风险从而拒绝营养干预。研究对象慢性非传染性疾病高发，其中高血压患病率60.5%，糖尿病患病率36.9%，慢性肾病患病率32.3%，肿瘤患病率14%，存在多种疾病共存，特殊性营养需求显著增加。此外68.0%研究对象营养干预前已患低白蛋白血症。
血清白蛋白具有多种功能，包括维持体内及血管内外的胶体渗透压、内源性激素以及外源性药物的载体、氧衍生自由基物种的清除剂以及凝血介质[13]。血清白蛋白水平下降与病毒、细菌和真菌感染的获得性和严重程度有关，可预测非感染性疾病的感染并发症；而严重感染的全身炎症会改变白蛋白的功能和动力学，从而增加临床结局恶化的风险[2]。此外，低白蛋白血症会增加患者静脉血栓、急性心肌梗塞、急性缺血性脑卒中风险[3]，可能与白蛋白维持血管内皮完整性作用有关[14]。低白蛋白血症也可能通过肾毛细血管内胶体渗透压，改变肾小球滤过率，导致急性肾衰风险增高[4-5]。因此减缓或纠正低白蛋白血症具有较高临床价值。研究表明ALB浓度与蛋白质摄入、血清白蛋白合成、毛细血管ALB逃逸相关[15]。既往研究认为低白蛋白血症常由炎症导致，与营养相关性不高[16]，其通过白细胞介素-1[17]、白细胞介素-6和肿瘤坏死因子α[18] 等细胞因子减少白蛋白合成。炎症同时增加数倍毛细血管ALB逃逸率[19-20]。治疗方式选择中，人血白蛋白输注不应该作为常规治疗方式用于纠正低白蛋白血症，短时间内大剂量白蛋白静脉输注可能会因循环血浆容量过度升高而引起肺水肿[21]。而研究表明老年患者口服蛋白质可刺激白蛋白合成，可能是改善低白蛋白血症更优的方式[11]。有别于既往营养干预，个性化营养治疗可根据由疾病、进食情况及特定营养素缺乏对营养成分配比作调整，研究报道个性化营养支持能够显著改善患者的营养状态和临床结局[22]。本研究中三组研究对象营养干预一周后ALB均有不同程度的下降其可能与患者体内炎症状态相关。多因素logistic回归相较于膳食指导组，口服营养补充（OR=0.683，95% CI：0.500～0.933），个性化营养支持（OR=0.409，95% CI：0.279～0.601）能减少ALB下降风险。国内研究报道老年患者入院后1周经营养干预后ALB无变化，入院第二周ALB明显升高[23]。上述研究有别于本研究真实世界研究背景，观察对象数量较小，部分患者无营养风险且排除配合度较低患者可能是导致营养支持疗效优于本研究的原因。此外研究结果中，管饲喂养(OR=1.766,95% CI:1.317～2.369)，研究发现安置胃管后使用热量密度低自制食物匀浆进行管饲可能会加重患者营养不良[24]。脑梗死(OR=1.866,95% CI:1.424～2.444)，研究表明急性脑梗死患者发病后1周低蛋白血症发病率为27.14%，比入院时显著增高[25]。其他部位感染(OR=0.776,95% CI:0.607～0.994)为ALB下降保护因子，其机制不详需进一步研究。综上所述，个性化营养支持及口服营养补充短期有明显减少中老年住院患者ALB下降风险作用，具有临床诊疗价值。
本研究具有一定局限性。一是部分患者数据不完整被排除，可能导致混杂偏倚。二是营养干预方式中，口服营养补充及个性化营养支持方案在组内营养摄入热量，蛋白质补充量具有较大异质性。三是使用历史数据，记录不完整，疾病情况记录中仅有诊断，无疾病严重程度，导致疾病相关分析结果有误。四是各组间研究对象异质性大，使用单因素结合多因素logistic回归分析尽量减少混杂因素对研究结果影响。
综上所述，老年住院患者可能因炎症因素导致ALB下降，此外脑梗死患病及管饲喂养可增加ALB下降风险，在临床治疗中需注意。个性化营养治疗方法包括口服营养补充及个性化营养支持，在满足患者热量需求同时更加注重特殊营养需求，在预防老年住院患者ALB下降中有一定临床价值，可进一步研究。
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doi: 10.20043/j.cnki.MPM.202411476
  • 接收时间：2024-11-25
  • 首发时间：2026-03-18
  • 出版时间：2025-03-25
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  • 收稿日期：2024-11-25
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    1．四川大学华西公共卫生学院／华西第四医院流行病与卫生统计学系，四川　成都　610041
    2．成都市第二人民医院营养科
    3．成都市妇女儿童中心医院病案科
    4．成都市第二人民医院医务科

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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