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对于微生物学证实肺结核的成年患者的营养支持:在Jharkhand,印度的RATIONS试验中嵌入的编程队列中的结果
Anurag Bhargava1, Madhavi Bhargava2, Ajay Meher3
1Department of Medicine, Yenepoya Medical College, Mangalore, India; Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India; Department of Medicine, McGill University, Montreal, QC, Canada.
The Lancet. Global health
|August 11, 2023
概括
营养支持显著降低了印度体重不足患者的结核病死亡率. 在这种高负担环境中,早期体重增加,特别是在两个月内,对于提高生存率和治疗成功至关重要.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 营养科学 营养科学
背景情况:
- 营养不良是结核病 (TB) 患者的重要伴随性疾病,特别是在印度等高负担国家.
- 在RATIONS试验中,研究了营养支持对家庭接触者结核病发病率的影响.
- 这项研究专门评估了营养支持对RATIONS试验队列患者结果的影响.
研究的目的:
- 评估营养支持对印度成年结核病患者结核病死亡率,治疗成功和其他临床结果的影响.
- 在接受营养支持的队列中确定结核病死亡率的预测因素.
- 评估体重增加与结核病死亡风险之间的关联.
主要方法:
- 一项基于现场的集群随机对照试验招募了2800名经微生物学证实肺结核的成年患者.
- 患者接受6-12个月的营养支持 (食物配给和微量营养素药片).
- 记录了包括治疗成功,死亡率,随访损失,体重增加,BMI和绩效状态的变化在内的结果. 使用Poisson和Cox回归分析了死亡率的预测因素.
主要成果:
- 超过82%的受试患者在基线时体重不足 (BMI <18.5 kg/m2).
- 在93.7%的患者中,治疗成功,3.9%的患者患有结核病的死亡率.
- 2个月后体重增加5%与死亡风险显著降低有关 (调整后HR为0.39). 低绩效状态和糖尿病是死亡率的预测因素.
结论:
- 营养支持对于改善营养不良结核病患者治疗结果至关重要.
- 早期和显著的体重增加,特别是在治疗的前两个月内,与减少结核病死亡率密切相关.
- 将营养支持整合到以患者为中心的护理中,对于在资源有限的环境中管理结核病至关重要.
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