【作者】 刘新；

【导师】 张晨； 刘继文；

【作者基本信息】 新疆医科大学 ， 公共卫生（专业学位）， 2015， 硕士

【摘要】 目的:掌握昌吉州地区结核病人的营养水平,并对结核病人的用药状况进行调查,为指导结核病患者均衡膳食、合理用药,改善健康状况提供科学依据。方法:将病例组设为1980名昌吉州地区的结核患者,将对照组设为1980名非结核患者,按年龄、性别等指标对两组样本进行匹配,再由经调查人员进行面对面采集的问卷调查,调查项目包含基本信息、体格检查、膳食营养、用药情况四个部分;受访样本的饮食品种与食用频率购买状况以及饮食营养素摄取情况依次由食物频率表和二十四小时膳食回顾法进行独立采集。同时对该1980例肺结核患者进行ld用药频率调查法,采集其用药资料进行分析。结果:根据膳食多样化评分(DDS)的统计分析:对照组样本的平均DDS评分是6.42,而病例组是6.11,显著降低,两组数据具有统计学意义(P<0.05)。两组样本各水平DDS评分所占总体比例展开分析:能保证每日饮食7种以上(含7种)食物品种的样本比例,病例组是37.67%,与对照组的45.5%相比有显著降低;能保证每日饮食3类食物品种的样本比例,病例组是2.9%,与对照组的0.7%相比有显著提高(P<0.05)。这说明昌吉州地区结核患者的日常膳食营养种类较为单一。两组样本摄取的膳食品种中,谷物、菜蔬以及油脂的比重最多,均达到总样本的98%以上,鱼虾饮食购买比例最低,病例组的样本率为4.1%,而对照组的则为2.6%。根据能量营养素摄取程度(由二十四小时膳食统计报告所得)表明,除元素Na外,昌吉州地区结核患者的每日其他营养素摄取量都比同地区对照组样本的有显著降低,其中摄取量最低的是Ca元素与视黄醇,依次是208.75 mg和170.92μg视黄醇当量,仅是对照样本的89.5%和87.2%(P<0.05),仅是推荐摄取水平的27.4%和22.3%;脂肪、蛋白质、Vit B1、Vit B2、烟酸、K、Na、Zn、Se等营养素的摄取量都比对照组营养素摄取量的85.0%有明显降低(p均<0.05),说明昌吉州地区每日结核患者膳食营养素摄取量存在显著匮乏。营养知识了解情况抽样调查分析显示,昌吉州地区对营养知识有总体了解的结核病人占总结核病人的10.9%,与对照组的19.4%相比明显偏低(P<0.05)。昌吉州地区结核患者使用最多的抗结核药物是乙胺丁醇,占比为27.98%,利福喷丁(RFPT)占比24.67%,异烟肼(INH)占比22.15%,联合4种药物进行抗结核治疗的比重最大,占到了49.64%。用药1~5天后出现各种不良反应的占40.61%;用药31~50天出现不良反应的占38.23%,用药100天以上,出现药物不良反应所占比例最小。昌吉地区1980人抗结核治疗后出现不良各种药物(联合)用药后的构成比,大于20%的药物有,异烟肼(INH)占20.10%,利福平(RFP)占22.82%,利福喷丁(RFPT)占20.50%。其余构成比均小于10%。结论:昌吉州地区肺结核患者身体营养水平略差,有待加强改善;该地区结核病患与健康群体的Vit A、Ca等营养元素的摄取量均处于较低水平,其中肺结核病人的营养不足状态更加严峻,这很大程度上是饮食不均衡引发的。建议将膳食结构进行适度改变,合理增强营养摄取,使得昌吉州地区肺结核病情得到有效控制。昌吉州地区结核患者的抗结核药物使用方案多数较为合理,传统抗结核药的使用仍占主导地位,但新型药物的使用也在不断增加,必嗽平等部分辅助药物的使用,尚存在少数不合理现象,某些病人的联用药物种类过多,医生合理用药水平有待进一步提高。更多还原

【Abstract】 Objective:The article surveyed the TB patients’ dietary nutritional status and the situation of medication in Hui Autonomous Prefecture of Changji,in order to provide a reasonable basis for tuberculosis patients of diet guidance and health promotion of tuberculosis patients.Methods:1,980 patients with tuberculosis in Hui Autonomous Prefecture of Changji were selected as the case group,and 1980 normal people were selected as the control group.Two groups were matched by age and gender.Then the trained professional investigators conductes a face-to-face questionnaire,which included basic information,physical examination,awareness rate of dietary nutrition, health knowledge and knowledge about diet;use the investigation of dietary frequency to collect the consumption of food types,and the recall method of 24-hour food intake to collect the dietary intake.Results:According to statistical analysis of DDS,was 6.42,which is lower than control group 6.11,P <0.05),DDS get 7 or more points in case group was37.67%,significantly lower than the control group,45.5%;2.9%of case group got 3 points,significantly higher than control group 0.7%(P <0.05).It was showed that TB patients’ daily dietary was very monotonous.The consumption of vegetables,cereals and oils in both two groups were highest,reaching at mole than 98%,but the consumption of fish and shrimp was only 4.1%and 2.6%in the two groups.Intake levels of energy and nutrients according from the recall method of 24-hour showed,except Sodium,TB patients daily intake of other nutrients were significantly lower than control group,the intake of Retinol and Calcium in TB patients were 208.75 lag and retinol equivalent170.92 rag, only 89.5%and87.2%of the control group P<0.05), only 27.4%and22.3%ofthe Recommended Nutrient Intakes;Protein,F Riboflavin,Thiamin,Nick acid,Potassium,Sodium,Zinc,Selenium and other nutrients intake were less than 85%of the control group Q<0.05).Comparison showed that TB patients’ daily dietary nutrients intake was significantly not sufficient.Survey of awareness rate about nutrition and health knowledge showed that awareness rate of TB patients was10.9%,lower than the control group 19.4%(P <0.05). Changji Prefecture tuberculosis patients with the largest number of anti tuberculosis drugs was ethambutol, accounting for 27.98%, accounted for rifapentine(RFPT) than 24.67% and isoniazid(INH) accounted for than 22.15%. Combined with four kinds of drugs for anti tuberculosis treatment of the largest proportion, accounting for 49.64%. Adverse reactions occurred in 40.61% days after treatment, and the adverse reactions occurred in 38.23% of 31~50 days, 100 days, and days, the proportion of adverse drug reactions was the smallest. Changji area of 1980, anti tuberculosis treatment after use(joint) use of a variety of adverse drug composition ratio, greater than 20 percent of the drugs, isoniazid(INH) accounting for 20.10% and rifampicin(RFP) accounted for 22.82%, rifapentine(RFPT) accounted for 20.50%. The rest are less than 10%. Conclusion:The overall level of dietary nutritional status of TB patients was not high.The dietary nutritional status needs to be improved in Hui Autonomous Prefecture of Changji;The intake of Vit A and Ca of TB patients at a lower level.Meanwhile, the malnutrition of TB patients is very serious,which is mostly causes by dietary imbalance.In a word,the author suggests diet structure should be improved for TB patients so that the Tuberculosis condition can be controlled in Hui Autonomous Prefecture of Changji. Anti tuberculosis drugs in patients with tuberculosis in Changji area use most of the programs is more reasonable, traditional anti tuberculosis drug use is still dominant, but the use of new drugs also continues to increase, will use auxiliary medicine of cough of equal parts, there are still a few unreasonable phenomenon, some disease kinds of combination of drugs in too much, the level of rational use of drugs in the doctor needs to be further improved.更多还原