目的探讨以全球营养领导层诊断营养不良标准(global leadership initiative on malnutrition,GLIM)诊断的营养不良与溃疡性结肠炎(ulcerative colitis,UC)住院患者疾病活动度及不良临床结局的关系。方法前瞻性纳入青岛大学附属医院2019...
详细信息
目的探讨以全球营养领导层诊断营养不良标准(global leadership initiative on malnutrition,GLIM)诊断的营养不良与溃疡性结肠炎(ulcerative colitis,UC)住院患者疾病活动度及不良临床结局的关系。方法前瞻性纳入青岛大学附属医院2019年9月至2023年3月的115例UC住院患者,应用GLIM及欧洲临床与代谢营养学会(European society for clinical nutrition and metabolism,ESPEN)2015标准进行营养不良诊断,分析两种诊断标准的一致性。根据GLIM将UC住院患者分为营养不良组和非营养不良组,进一步研究GLIM诊断的营养不良与疾病活动度及不良临床结局的关系,采用二元Logistic回归,探讨UC住院患者不良临床结局的影响因素。结果GLIM与ESPEN 2015标准具有较好的相关性和高度一致性(AUC=0.875,P<0.001;K=0.809,P<0.001)。根据GLIM标准,UC住院患者营养不良的患病率为32.17%(37例),与非营养不良组相比,营养不良组UC住院患者改良Mayo评分及C反应蛋白更高(P均<0.05)、重度疾病活动期患者比例更高(P=0.005)。营养不良组UC患者住院天数更长(P<0.001)、住院费用更高(P<0.001),12周及54周药物升级/转化治疗、再入院及手术患者比例更高(P<0.05)。二元Logistic回归分析结果显示,高Mayo评分(OR=3.606,P=0.016)、高改良Mayo评分(OR=1.346,P=0.009)及营养不良(OR=1.430,P=0.012)是UC住院患者12周不良临床结局的独立危险因素;高Mayo评分(OR=6.491,P=0.011)及营养不良(OR=6.693,P=0.033)是UC住院患者54周不良临床结局的独立危险因素。结论GLIM与ESPEN 2015标准诊断UC住院患者营养不良具有高度一致性;合并营养不良的UC住院患者病情更重;营养不良可预测UC住院患者不良临床结局,是影响UC住院患者不良临床结局的独立危险因素。
肝硬化患者常面临的一类临床并发症是食管胃静脉曲张,多与门静脉高压形成有关。因为曲张静脉易于破损,导致肝硬化食管胃底静脉曲张患者在临床容易发生出血,甚至导致死亡,这对患者的生存状况及预后造成了严重影响。随着EGVB诊断和治疗的进步,死亡率已显著下降,所以预防食管胃静脉曲张首次出血及预防再次出血显得尤为重要。目前治疗食管胃静脉曲张的方法有以下几种:药物治疗、内镜治疗、三腔两囊管、介入治疗、外科手术、肝移植等。因内镜下治疗与其他方法相比有更多的优点,本文就目前食管胃静脉曲张内镜下治疗相关方法作一综述。One type of clinical complication that patients with liver cirrhosis often face is esophagogastric varices, which are mostly associated with portal hypertension formation. Because varices are easily broken, patients with cirrhosis who have esophagogastric fundic varices are prone to clinical hemorrhage and even death, which has a serious impact on the survival and prognosis of patients. With the advances in the diagnosis and treatment of EGVB, the mortality rate has decreased significantly, so it is particularly important to prevent the first bleeding of esophagogastric varices and prevent rebleeding. Currently, there are several methods of treating esophagogastric varices, including medication, endoscopic treatment, triple-lumen and two-bladder tubes, interventional therapy, surgery, and liver transplantation. Because endoscopic treatment has more advantages than other methods, this article summarizes the current methods related to endoscopic treatment of esophagogastric varices.
暂无评论