【摘要】 目的 比较四种营养评估工具对老年慢性心力衰竭（chronic heart failure,CHF）患者死亡风险的预测价值。方法 本研究为前瞻性研究，收集2017年1月1日至2018年6月30日于南京医科大学第一附属医院住院的老年CHF患者203例，分别采用微营养评价简表（MNA-SF）、老年人营养风险指数（GNRI）、控制营养状态（CONUT）量表、预后营养指数（PNI）对患者进行营养评估，随访患者出院后全因死亡事件，绘制受试者工作特征曲线（ROC），进行Kaplan-Meier生存分析和Cox比例风险回归模型分析。结果 随访中位时间为1107 d，死亡104例，存活99例。MNA-SF评分、GNRI评分、CONUT评分、PNI评分的ROC下面积分别为0.771、0.691、0.691、0.651。四种营养评估工具的Kaplan-Meier曲线均显示，营养状态越差，患者的生存率越低（log-rank P<0.01）。Cox多因素比例风险回归模型分析显示，MNA-SF评分（RR=0.74,95%CI:0.67～0.81）、CONUT评分（RR=1.21,95%CI:1.09～1.35）、GNRI评分（RR=0.92,95%CI:0.92～0.98）、PNI评分（RR=0.92,95%CI:0.88～0.96）是老年CHF患者出现死亡事件的独立危险因素（P<0.01）。各评估工具行分组后比较，MNA-SF评分中营养不良风险组是营养正常组死亡风险的1.71倍，95%CI:1.03～2.82,(P<0.05)，营养不良组是营养正常组死亡风险的6.00倍，95%CI:3.29～10.94,(P<0.01)。CONUT评分中高营养不良风险组是营养正常组死亡风险的4.39倍，95%CI:1.33～14.47,(P=0.01)。GNRI评分中重度营养不良组的死亡风险是营养正常组6.78倍，95%CI:2.94～15.67,(P<0.01)。结论 老年CHF患者的营养状况是患者预后的独立危险因素，营养状态越差，死亡风险越高。MNA-SF评分对老年CHF患者死亡风险的预测价值优于GNRI量表、CONUT量表及PNI量表。更多还原

【Abstract】 Objective To compare the predictive value of four nutritional assessment tools for all-cause mortality in elderly patients with chronic heart failure(CHF). Methods A prospective study was conducted on 203 elderly CHF patients admitted to Nanjing Medical University First Affiliated Hospital between January 1, 2017, and June 30, 2018.Nutritional status was assessed by the Mini Nutritional Assessment-Short Form(MNA-SF), Geriatric Nutritional Risk Index(GNRI), Controlling Nutritional Status(CONUT) score, and Prognostic Nutritional Index(PNI). Patients were followed for all-cause mortality after discharge. Receiver operating characteristic(ROC) curves were plotted to calculate areas under the curve(AUC). Kaplan Meier survival analysis and Cox proportional hazards regression model analysis were performed sequentially. Results The median follow-up time was 1107 days,during which 104 patients died and 99 survived. The AUCs for MNA-SF score, GNRI score, CONUT score, and PNI score are 0.771, 0.691, 0.691, and 0.651, respectively. Kaplan Meier curves showed that poorer nutritional status was associated with lower survival(log rank P<0.01 for all tools). In multivariate Cox analysis, MNA-SF score(RR=0.74, 95%CI: 0.67～0.81), CONUT score(RR=1.21, 95%CI: 1.09～1.35), GNRI score(RR=0.92, 95%CI: 0.92～0.98), PNI score(RR=0.92, 95%CI:0.88～0.96) were independent risk factors for mortality(P<0.01). Comparing various assessment tool groups, the MNA-SF malnutrition risk group had a 1.71-foldhigher risk of death 95%CI: 1.03～2.82,(P<0.05) and the malnutrition group a 6.00-fold higher risk 95%CI: 3.29～10.94,(P<0.01). The high-risk CONUT group had a 4.39-fold higher risk 95%CI: 1.33～14.47,(P=0.01), and the severe-risk GNRI group had a 6.78-fold higher risk 95%CI: 2.94～15.67,(P<0.01). Conclusion Nutritional status is an independent risk factor in elderly CHF patients:the poorer the nutrition, the higher the mortality risk. The MNA-SF demonstrates superior predictive value for mortality risk compared with GNRI, CONUT, and PNI.更多还原