The Role of Malnutrition and Adiponectin in Acquiring Infections among Nursing Home Residents

探討營養不良及adiponectin於護理之家患者發生感染時所扮演之角色

吳東翰(Tung-Han Wu) ； 趙文震(Wen-Cheng Chao) ； 葉雪梅(Sheue-Mei Yeh) ； 吳杰亮(Chieh-Liang Wu)

《胸腔醫學》 31卷4期 (2016/08) Pp. 204-214

摘要

背景：感染發生影響護理之家住民預後甚鉅，營養不良是其關鍵因子之一。脂聯素（adiponectin）是脂肪激素在瘦的狀態會上升且具有抑制發炎之效。我們旨在探討營養不良與感染之間的關係。方法：以臺中榮總嘉義分院護理之家住民為研究對象，評估營養狀態後追蹤六個月內感染發生。結果：共收案115位護家住民，BMI為21.1±4.1。31位住民於六個月內發生醫療照護相關感染26.3%（31/118）以肺炎（23）及泌尿道感染（21）最為常見。慢性阻塞性肺病（OR: 6.819，95% CI: 1.152- 40.341）、鼻胃管灌食（OR: 7.246，95%CI: 1.462-35.714）及albumin低下（OR: 22.871，95% CI: 2.795- 187.177）為發生感染之獨立危險因子。Adiponectin於偏瘦住民中會上升且可預測其發生感染。結論：本研究提供臨床證據說明營養不良對護理之家住民發生感染之影響可提供於評估住民狀況之參考。

關鍵字

營養不良 ； 脂聯素 ； 護理之家 ； 感染 ； 高齡

並列摘要

Background: High susceptibility to infections has a great impact on nursing home residents, and malnutrition is a critical factor. However, the mechanism by which malnutrition leads to this susceptibility is unknown. In this study, we aimed to investigate the relationship between malnutrition and the development of infections in nursing home residents. Materials and Methods: We prospectively enrolled nursing home residents at Taichung Veterans General Hospital, Chiayi Branch, and assessed their nutrient status, including serum adiponectin levels. We then recorded infection-related data for 6 months. Results: A total of 115 subjects with a mean age of 81.1±9.7 years and a mean body mass index (BMI) of 21.1±4.1 kg/m^2 were enrolled. During the 6-month follow-up period, 26.9% (31/115) of the subjects acquired infections, including pneumonia (20.0%, 23/115) and urinary tract infections (18.3%, 21/115). Chronic obstructive pulmonary disease (OR, 6.819; 95% CI, 1.152-40.314), nasogastric feeding (OR, 7.246; 95% CI, 1.462-34.714), and low serum albumin levels (OR, 22.871; 95% CI, 2.795-187.177) independently predicted the development of infections. An elevated serum adiponectin level predicted infections in thin subjects. A negative correlation was observed between serum adiponectin and 2 proinflammatory cytokines, interleukin-1β and tumor necrosis factor-α, in 32 patients with severe sepsis. Conclusions: This study highlights the influence of malnutrition and adiponectin on the development of infections. An awareness of this effect may be helpful when assessing nursing home residents.

並列關鍵字

malnutrition ； adiponectin ； nursing home ； pneumonia ； elder