急性卒中后质地改良饮食摄入率与功能结局之间的关联：一项回顾性观察性研究

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中文摘要

背景/目的： 卒中后常处方质地改良饮食（TMD），但实际摄入量的临床意义仍不清楚。我们考察了TMD摄入率与卒中后出院时及90天功能状态之间的关联。
方法： 这项回顾性单中心研究纳入2012年至2017年间因疑似或确诊吞咽困难而接受TMD的406例缺血性卒中或脑出血患者。总体TMD摄入量按四个TMD等级的餐次加权平均消耗比例计算，并按每增加10%进行分析。针对改良Rankin量表（mRS）评分的序数逻辑回归模型校正了年龄、性别、入院时美国国立卫生研究院卒中量表（NIHSS）评分、病前mRS、卒中类型和入院时老年营养风险指数（GNRI）。作为次要分析，对良好结局（mRS 0-2）进行了二元逻辑回归。
结果： TMD摄入每增加10%，与出院时（校正OR，0.85；95% CI，0.77-0.94）和90天时（校正OR，0.88；95% CI，0.80-0.96）更高mRS类别的几率降低相关。较高摄入与出院时良好结局的几率较高相关（校正OR，1.31；95% CI，1.03-1.66），而90天时的关联无统计学意义（校正OR，1.15；95% CI，0.98-1.35）。饮食特异性关联不一致。
结论： 在多变量校正后，较高的TMD摄入率与更好的功能状态相关。由于TMD摄入也可能反映吞咽障碍、临床状况和早期恢复，这些观察性发现不能确立因果关系。监测TMD摄入可能有助于识别需要更密切营养和吞咽评估的患者。

英文摘要

BACKGROUND/OBJECTIVES: Texture-modified diets (TMDs) are commonly prescribed after stroke, but the clinical significance of the amount actually consumed remains unclear. We examined the association between TMD intake rate and functional status at discharge and 90 days after stroke.
METHODS: This retrospective single-center study included 406 patients with ischemic stroke or intracerebral hemorrhage who received TMDs for suspected or confirmed dysphagia between 2012 and 2017. Overall TMD intake was calculated as the meal-count-weighted mean consumption proportion across four TMD levels and analyzed per 10% increase. Ordinal logistic regression models for modified Rankin Scale (mRS) scores were adjusted for age, sex, admission National Institutes of Health Stroke Scale (NIHSS) score, premorbid mRS, stroke type, and admission Geriatric Nutritional Risk Index (GNRI). Binary logistic regression for a favorable outcome (mRS 0-2) was performed as a secondary analysis.
RESULTS: Each 10% increase in TMD intake was associated with lower odds of a higher mRS category at discharge (adjusted OR, 0.85; 95% CI, 0.77-0.94) and at 90 days (adjusted OR, 0.88; 95% CI, 0.80-0.96). Higher intake was associated with higher odds of a favorable outcome at discharge (adjusted OR, 1.31; 95% CI, 1.03-1.66), whereas the 90-day association was not statistically significant (adjusted OR, 1.15; 95% CI, 0.98-1.35). Diet-specific associations were inconsistent.
CONCLUSIONS: Higher TMD intake rates were associated with better functional status after multivariable adjustment. Because TMD intake may also reflect swallowing impairment, clinical condition, and early recovery, these observational findings do not establish causality. Monitoring TMD intake may help identify patients who warrant closer nutritional and swallowing assessment.