脑卒中后吞咽障碍患者PG-SGA评分与不良预后风险的相关性

余文娟; 郑红建; 余双娟; 董锦疆

doi:10.16766/j.cnki.issn.1674-4152.003456

脑卒中后吞咽障碍患者PG-SGA评分与不良预后风险的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003456

浙江省人民医院淳安分院神经外科，浙江杭州 311700

基金项目:

浙江省教育厅一般科研项目 Y202146057

详细信息

通讯作者:
董锦疆，E-mail：312141727@qq.com

中图分类号: R743.3
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- 被引次数: 0
出版历程
- 收稿日期: 2023-11-28
- 网络出版日期: 2024-05-29

Association between PG-SGA scores and the risk of poor outcomes in stroke patients with dysphagia

Department of Neurosurgery, Chun'an Branch of Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的脑卒中患者常伴有吞咽障碍，这种伴随症状会影响机体营养状态，本研究探讨脑卒中后吞咽障碍患者主观整体营养评估法(PG-SGA)评分与不良预后风险的相关性。方法选取浙江省人民医院淳安分院2021年10月—2022年10月收治的116例脑卒中后吞咽障碍患者作为研究对象。根据改良Rankin量表(mRS)评分分为预后良好组(mRS≤2分)和预后不良组(mRS评分3~5分)。应用多因素logistic回归分析及限制性立方样条探讨患者营养状态与不良预后风险间的相关性。结果随访观察90 d，88例(75.86%)患者mRS≤2分归为预后良好组，其余28例(24.14%)为预后不良组。预后不良组患者年龄较预后良好组大，入院时美国国立卫生研究院卒中量表(NIHSS)、PG-SGA评分较预后良好组高，血清白蛋白水平、肱三头肌皮褶厚度较预后良好组低(P＜0.05)。多因素logistic回归分析显示，年龄大(OR=1.179，95% CI：1.059~1.314)、入院时NIHSS评分高(OR=1.775，95% CI：1.161~2.713)、PG-SGA评分高(OR=1.741，95% CI：1.069~2.834)为不良预后的危险因素，血清白蛋白高(OR=0.883，95% CI：0.804~0.970)为不良预后的保护因素(P < 0.05)。限制性立方样条显示，脑卒中后吞咽障碍患者PG-SGA评分与不良预后间存在剂量-反应关系(χ²=0.029，P < 0.05)。结论脑卒中后吞咽障碍患者营养状态与不良预后风险有关，临床需引起重视，及时根据情况行营养支持。
- 脑卒中 /
- 吞咽障碍 /
- 营养状态 /
- 预后 /
- 相关性
Abstract: Objective Dysphagia is commonly observed in stroke patients and can have an impact on their nutritional status. This study aims to investigate the correlation between the patient-generated subjective global assessment (PG-SGA) score and the risk of poor prognosis in stroke patients with dysphagia. Methods A total of 116 patients with post-stroke dysphagia from Chun'an Branch of Zhejiang Provincial People's Hospital between October 2021 and October 2022 were selected as the study objects. According to the modified Rankin scale (mRS), the patients were divided into a good prognosis group (mRS≤2 points) and a poor prognosis group (mRS 3-5 points). Multivariate logistic regression analysis and restricted cubic spline were used to investigate the association between nutritional status and the risk of poor prognosis. Results After a 90-day follow-up observation, 88 cases (75.86%) with mRS≤2 scores were classified as the good prognosis group, while the remaining 28 cases (24.14%) were categorized as the poor prognosis group. The admission National Institutes of Health stroke scale (NIHSS) and PG-SGA scores were higher in the poor prognosis group compared to the good prognosis group, whereas the serum albumin level and triceps skin fold thickness were lower (P < 0.05). Multivariate logistic regression analysis revealed that older age (OR=1.179, 95% CI: 1.059-1.314), high NIHSS score on admission (OR=1.775, 95% CI: 1.161-2.713), and high PG-SGA score (OR=1.741, 95% CI: 1.069-2.834) were risk factors for poor prognosis. Conversely, high serum albumin (OR=0.883, 95% CI: 0.804-0.970) was identified as a protective factor for poor prognosis (P < 0.05). The restricted cubic spline analysis showed a dose-response relationship between PG-SGA score and poor prognosis in stroke patients with dysphagia (χ²=0.029, P < 0.05). Conclusion The nutritional status of stroke patients with dysphagia is related to the risk of poor prognosis, highlighting the importance of timely clinical attention and nutritional support based on individual needs.
- Stroke /
- Dysphagia /
- Nutritional status /
- Prognosis /
- Correlation

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图 1 脑卒中后吞咽障碍患者PG-SGA评分与不良预后间的限制性立方样条图

Figure 1. Restricted cubic spline plots of PG-SGA scores and poor outcomes in patients with dysphagia after stroke

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表 1 2组脑卒中吞咽障碍患者一般资料比较

Table 1. Comparison of general data of stroke patients with dysphagia between the two groups

项目	预后良好组 (n=88)	预后不良组 (n=28)	统计量	P值
年龄(x±s，岁)	53.58±6.61	59.07±3.90	5.384^a	< 0.001
性别[例(%)]			0.119^b	0.730
女性	41(46.59)	12(42.86)
男性	47(53.41)	16(57.14)
吸烟史[例(%)]	43(48.86)	14(50.00)	0.011^b	0.917
合并疾病[例(%)]
高血压	26(29.55)	9(32.14)	0.068^b	0.794
糖尿病	16(18.18)	6(21.43)	0.146^b	0.703
高脂血症	19(21.59)	8(28.57)	0.580^b	0.446
冠心病	24(27.27)	8(28.57)	0.018^b	0.893
脑卒中类型[例(%)]			0.142^b	0.706
缺血性脑卒中	69(78.41)	21(75.00)
出血性脑卒中	19(21.59)	7(25.00)
收缩压(x±s，mmHg)	148.26±10.24	149.65±10.68	0.606^a	0.548
舒张压(x±s，mmHg)	86.69±9.35	87.65±8.97	0.488^a	0.628
血糖(x±s，mmol/L)	7.12±1.61	7.22±1.64	0.282^a	0.779
NIHSS评分(x±s，分)	7.95±1.37	9.21±1.57	3.810^a	< 0.001
注：^a为t值，^b为χ²值。1 mmHg=0.133 kPa。

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表 2 2组脑卒中吞咽障碍患者营养状态比较(x ± s)

Table 2. Comparison of nutritional status between the two groups of stroke patients with dysphagia(x ± s)

组别	例数	BMI	肱三头肌皮褶厚度(cm)	上臂中段围 (cm)	血清白蛋白 (g/L)	血清前蛋白 (g/L)	血红蛋白 (g/L)	PG-SGA (分)
预后良好组	88	22.14±1.65	1.46±0.21	26.31±2.34	40.10±6.42	168.26±18.23	115.65±14.21	3.52±1.12
预后不良组	28	22.10±1.61	1.37±0.18	25.98±2.18	37.02±5.56	165.8±19.11	112.67±15.27	4.18±1.34
t值		0.114	2.210	0.685	2.456	0.600	0.914	2.357
P值		0.910	0.032	0.497	0.017	0.552	0.366	0.024

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表 3 脑卒中后吞咽障碍患者预后的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of prognosis of patients with dysphagia after stroke

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.165	0.055	8.961	0.003	1.179	1.059~1.314
入院时NIHSS评分	0.574	0.216	7.026	0.008	1.775	1.161~2.713
血清白蛋白	-0.125	0.048	6.776	0.009	0.883	0.804~0.970
肱三头肌皮褶厚度	-3.015	1.549	3.787	0.052	0.049	0.002~1.022
PG-SGA评分	0.554	0.249	4.968	0.026	1.741	1.069~2.834

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