Department of Dermatology, Universitätsklinikum Erlangen, Erlangen.
Department of Internal Medicine, Klinikum Fürth, Fürth.
Eur J Dermatol. 2019 Dec 1;29(6):619-626. doi: 10.1684/ejd.2019.3678.
The possible impact of nutritional status on healing and course of disease in patients with chronic wounds is widely suggested, however, most data are based on small groups of patients with no control group and minor afflictions. Clear diagnostic strategies are missing.
To analyse in detail the nutritional status of chronic wound patients relative to healthy controls based on a large patient population.
We screened a group of 50 patients for their nutritional status based on body mass index (BMI), the Mini-Nutritional Assessment (MNA), and Nutritional Risk Screening (NRS), as well as additional laboratory investigations. Twenty-five patients suffered from chronic venous leg ulcers and were compared with a matching control group of 25 patients with acute surgical wounds.
Patients with chronic venous leg ulcers showed significantly higher BMI, hyperhomocysteinaemia, and higher levels of serum copper but significantly lower levels of vitamin B6, B9 and C, as well as a significantly lower level of zinc. Vitamin D deficiency was present in both groups, however, severe vitamin D deficiency was present only in the leg ulcer group. Mobility was significantly reduced in patients with leg ulcers.
Ulcer patients are often obese but suffer from qualitative malnutrition, including a lack of vitamin D, which might be explained by reduced mobility and being housebound. Hypoalbuminaemia, as a sign of protein deficiency, was observed significantly more often in patients with chronic leg ulcers, irrespective of wound area or wound duration.
营养状况对慢性伤口患者的愈合和疾病进程的可能影响已被广泛提出,但大多数数据基于没有对照组和轻微疾病的小患者群体。缺乏明确的诊断策略。
根据大量患者群体,详细分析慢性伤口患者的营养状况。
我们根据体重指数(BMI)、微型营养评估(MNA)和营养风险筛查(NRS)以及其他实验室检查,对 50 名患者的营养状况进行了筛选。25 名患者患有慢性静脉性腿部溃疡,并与 25 名患有急性手术伤口的匹配对照组进行了比较。
慢性静脉性腿部溃疡患者的 BMI、高同型半胱氨酸血症和血清铜水平显著升高,但维生素 B6、B9 和 C 水平显著降低,锌水平也显著降低。两组均存在维生素 D 缺乏,但仅在腿部溃疡组存在严重维生素 D 缺乏。腿部溃疡患者的活动能力明显降低。
溃疡患者通常肥胖,但存在营养不良,包括维生素 D 缺乏,这可能是由于活动能力下降和长期居家导致的。低白蛋白血症作为蛋白质缺乏的标志,在慢性腿部溃疡患者中更常见,与伤口面积或伤口持续时间无关。