Abstract:

Objective To observe the application effect of graded nutritional intervention based on prognostic nutritional index (PNI) in drug-resistant pulmonary tuberculosis patients for novel evidence for nutritional evaluation and intervention of such group of patients. Methods By random number sampling, we recruited the drug-resistant pulmonary tuberculosis patients treated in the Inpatient Department of Anhui Provincial Chest Hospital from January to July of 2023, and randomly assigned them to experimental group and control group. Patients in both groups were treated with anti-tuberculosis drugs. Then the patients in the experimental group were further divided into normal nutrition, mild malnutrition, moderate malnutrition and severe malnutrition according to PNI, and respectively given graded intervention, including nutrition education, nutrition education + diet instruction, nutrition education + diet instruction + enteral nutrition, nutrition education + diet instruction + enteral nutrition + parenteral nutrition. Patients in the control group just received routine nutritional intervention, mainly focusing on nutritional education. Finally, the two groups were compared regarding the nutritional status, immune function and clinical prognosis after nutritional intervention. Results After 3 months of intervention, the nutritional status indicators of hemoglobin, prealbumin and albumin were higher in the experimental group than those in the control group [(127.80±10.36) g/L, (196.69±28.86) mg/L and (44.78±4.51) g/L, respectively, vs. (123.12±9.93) g/L, (181.26±29.56) mg/L and (39.51±4.32) g/L]. The difference was significant (t=6.157, 4.235, 4.672, respectively, all P<0.05). Percentage of CD3⁺, CD4⁺ T cells and CD4⁺/CD8⁺ in the experimental group were higher than those in the control group following three months of intervention [(62.42±7.32)%, (42.52±4.57)% and (1.51±0.23) vs. (56.41±5.85)%, (39.13±3.57)% and (1.27±0.26), respectively], yet the percentage of CD8⁺ T cells was lower in the experimental group than that in the control group [(31.42±3.42)% vs. (35.01±3.06)%], with significant difference (t=9.121, 7.231, 8.031, 6.731, respectively, all P<0.05). At the 3 months of intervention, the sputum negative conversion rate, the lesion absorption rate and cavity closure rate was 91.67%, 89.58% and 72.92%, respectively, which were higher in the experimental group than those in the control group (77.08%, 72.91% and 56.25%, respectively). The difference was significant (χ²=7.089, 4.232, 7.253, respectively, all P<0.05). Conclusion Graded nutritional intervention based on PNI for drug-resistant pulmonary tuberculosis patients can improve the levels of hemoglobin, albumin and prealbumin, then increase the sputum negative conversion rate, lesion absorption rate and cavity closure rate, thereby improving clinical prognosis of patients.

Key words: Drug-resistant pulmonary tuberculosis, Prognostic nutritional index, Graded intervention, Clinical prognosis