低血鈉病患與營養狀態相關性之影響

The effect of nutritional status in hyponatremia patients

鍾馨褕(Hsin-Yu Chung)

指導教授 ： 徐成金

中山醫學大學/健康管理學院/營養學研究所/碩士(2016年)

摘要

探討在住院患者中低血鈉與正常血鈉患者間，其營養狀態是否有差異及其相關影響因子。本研究為回溯式研究，統計自西元2010年1月1日至2014年12月31日之間精神科住院患者及精神護理之家住民，並以血鈉值小於135meq/L為低血鈉收案對象，收集其病歷資料包括基本資料、各項生化數據等納入分析。使用營養評估指標包括:身體質量指數、血清白蛋白、總膽固醇、淋巴球總計數等。統計方法使用生物統計軟體IBM® SPSS® Statistics version 22進行各項分析處理，以p＜0.05定義為具有統計意義。收集研究對象共570位，其中男性佔370位(64.9%)，診斷有低血鈉患者共144位，男性83位（57.6%）及女性61位（42.4%），平均年齡為48.31±19.20歲，正常血鈉組共426位，平均年齡為36.35±16.92歲，所有研究對象經皮爾森相關檢定分析後，以年齡與血鈉值為負相關 (r = -1.91 , p = 0.01)，身高(r = 0.085 , p = 0.042)、血清白蛋白( r = 0.271 , p = 0.01)與血鈉值為正相關達顯著差異，依血鈉分組在不同程度營養指標中以卡方檢定分析，以低血鈉組患者血清白蛋白、總膽固醇、淋巴球總計數顯著低於非低血鈉組（p＜0.05）。以階層多元迴歸分析，身體質量指數、血清白蛋白、總膽固醇與淋巴球總計數等指標在低血鈉組中具有正向關係，將所有營養評估指標以羅吉斯迴歸分析，以「身體質量指數」在過輕(OR: 2.82，p＝0.002)與肥胖組(OR: 2.18，p＝0.002)及「血清白蛋白」(OR: 5.86，p＜0.000) 等營養評估指標皆對於低血鈉具有顯著關聯性，以此二項營養評估指標為預測低血鈉風險的最主要因子。在此研究證實，身體質量指數BMI與低血鈉罹病率呈U型關係，即在過輕體位及肥胖體位都會增加低血鈉罹病率。研究結果發現在住院患者中，不良的營養狀態與低血鈉之間有正相關，並且營養不良與疾病間具有共病關係。

關鍵字

低血鈉 ； 營養狀態 ； 營養不良

並列摘要

To investigate the risk factors associated with nutritional status in hospitalized patients with and without hyponatremia.This was a retrospective analyses based on the medical records of patients at psychiatric nursing home and psychiatric hospital in eastern Taiwan. Clinical data were collected from patients administrated from January 2010 to December 2014. Hyponatremia group was defined as [Na+] < 135 mEq/L. Body mass index (BMI), serum albumin (Alb), serum potassium (K), total cholesterol (TC) and total lymphocyte count (TLC) were assessed for hyponatremia group and non-hyponatremia group. IBM® SPSS® Statistics version 22 was used for data analyses. A total of 570 psychiatric inpatients were included, in which 144 cases were hyponatremia, in which 57.6% was male and 42.4% was female (M/F: 83/61) and the mean age was 48.3±19.2 years old. Control group had 426 cases and the mean age was 36.45±16.9 years old. Chi-square test analyses indicated that the hyponatremia group had lower Alb, TC and TLC than non-hyponatremia group (p < 0.05). Hierarchical multiple regression indicated that BMI, Alb, TC and TLC was positively associated with serum sodium level of the hyponatremia group. Binary logistic regression revealed that underweight (OR: 2.82，p = 0.002) or obesity (OR: 2.18，p = 0.002) and Alb (OR: 5.86，p < 0.000) were the main risk factors related with hyponatremia. There was a U-shaped relationship between BMI and hyponatremia morbidity.This study suggested that poor nutritional status associated with hyponatremia is a positive correlation in hospitalized patients. Malnutrition and illness exhibit a comorbid relationship.

並列關鍵字

Hyponatremia ； Nutrition status ； Malnutrition

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