Objective  To investigate the influencing factors of enteral nutrition therapy intolerance in HIV/AIDS patients, establish and validate a Nomogram model.

Methods  A retrospective analysis was conducted on the clinical data of hospitalized HIV/AIDS patients admitted to the Fourth people's Hospital of Nanning, from January 1, 2015 to September 30, 2021. Through the binary Logistic regression model, the risk factors for feeding intolerance in HIV/AIDS patients were explored, a Nomogram model was constructed and validated.

Results  A total of 174 HIV/AIDS patients were included, among which 76 patients experienced early enteral nutrition feeding intolerance (43.68%). Multivariate analysis showed that mean arterial pressure ≤ 80 mmHg [OR=2.822, 95%CI(1.267, 6.287)], Acute Physiology and Chronic Health Status Score  Ⅱ > 15 points [OR=5.625, 95%CI(1.435, 22.048)], mechanical ventilation application [OR=5.459, 95%CI(2.046, 14.564)], highly active anti-retroviral therapy [OR=2.428, 95%CI(1.118, 5.275)], muscle relaxant use [OR=3.833, 95%CI(1.758, 8.357)], CD4⁺T cell count  ≤200·μL^-1[OR=3.785, 95%CI(1.126, 12.724)], the number of antibiotics used  >2 [OR=2.365, 95%CI(1.039, 5.384)] were influential factors of feeding intolerance in enteral nutrition therapy in HIV/AIDS patients. A nomogram prediction model was constructed, the model AUC value was 0.849[95%CI(0.794, 0.905)], with the maximum Youden index of 0.555. The optimal threshold was 0.331. The sensitivity was 88.16%, and the specificity was 67.35%. The calibration curve and decision curve indicated good consistency and benefit of the model.

Conclusion  The prediction model for the risk of enteral nutrition therapy intolerance in HIV/AIDS patients constructed in this study can provide a reference for medical staff to quickly identify the risk of feeding intolerance in HIV/AIDS patients and take preventive nursing measures in time.

1.沙茵茵, 徐立然, 马秀霞, 等. 成人艾滋病临床指南和共识的质量评价[J]. 中国循证医学杂志, 2022, 22(6): 706-715. [Sha YY, Xu LR, Ma XX, et al. Quality evaluation of clinical guidelines and consensus for adult AlDS[J]. Chinese Journal of Evidence-Based Medicine, 2022, 22(6): 706-715.] DOI: 10.7507/1672-2531.202202085.

2.邓秋霞,孔含含,刘晓宁,等. HIV阳性男男性行为者营养状况调查及其与焦虑、抑郁的关系[J]. 全科护理, 2023, 21(3): 409-412. [Deng QX, Kong  HH, Liu XN, et al. Nutritional status survey of HIV-positive men who have sex with men and its relationship with anxiety and depression[J]. Chinese General Practice Nursing, 2023, 21(3): 409-412.] DOI: 10.12104/j.issn.1674-4748.2023. 03.031.

3.张旭刚, 李维青, 李宝重, 等. 基于倾向性评分匹配法比较食管癌术后早期肠内营养与肠外营养的疗效 [J]. 中国肿瘤临床, 2019, 46(16): 832-835. [Zhang  XG, Li WQ, Li BZ, et al. Comparison of efficacy between early enteral nutrition and total parenteral nutrition after esophageal cancer surgery based on propensity score matching[J]. Chinese Journal of Clinical Oncology, 2019, 46(16): 832-835.] DOI: 10.3969/j.issn.1000-8179. 2019.16.856.

4.王丹, 张丽莉, 程晓娜, 等. 早期肠内营养或肠外营养治疗对胃癌根治术后患者免疫功能和营养状况的影响[J]. 临床肿瘤学杂志, 2017, 22(5): 423-426. [Wang  D, Zhang LL, Cheng XN, et al. The influence of early enteral nutrition or parenteral nutrition therapy on the immune function and nutritional status of gastric cancer patients with radical surgery[J]. Chinese Clinical Oncology, 2017, 22(5): 423-426.] DOI: 10.3969/j.issn.1009-0460. 2017.05.008.

5.梁芳, 张云城, 陈文林. 益生菌治疗艾滋病相关腹泻的研究现状和进展[J]. 中国微生态学杂志, 2019, 31(12): 1479-1482. [Liang F, Zhang YC, Chen WL. Current status and progress in research on probiotic therapy of AIDS-associated diarrhea[J]. Chinese Journal of Microecology, 2019, 31(12): 1479-1482.] DOI: 10.13381/j.cnki.cjm. 201912024.

6.韩晓旭, 吴苑妮, 张瑞, 等. HIV-1感染者肠道菌群对机体影响的研究进展[J]. 中国艾滋病性病, 2022, 28(2): 228-233. [Han XX, Wu YN, Zhang R, et al. Research progress on the influence of gut microbiota in HIV- 1 infected patients[J]. Chinese Journal of AIDS & STD, 2022, 28(2): 228-233.] DOI: 10.13419/j.cnki.aids.2022. 02.23.

7.Geng S, Zhang J, Wang Y, et al. Pre-digested protein enteral nutritional supplementation enhances recovery of CD4+T cells and repair of intestinal barrier in HIV-infected immunological non-responders[J]. Front Immunol, 2021, 12: 757935. DOI: 10.3389/fimmu.2021.757935.

8.龚贝贝, 韦彩云, 吴锋耀, 等. 艾滋病机械通气病人早期肠内营养管理方案实施效果评价[J]. 护理研究, 2022, 36(20): 3592-3597. [Gong BB, Wei  CY, Wu FY, et al. Implementation effect evaluation of early enteral nutrition management program for AIDS patients with mechanically ventilated[J]. Chinese Nursing Research, 2022, 36(20): 3592-3597.] DOI: 10.12102/j.issn.1009-6493. 2022.20.004.

9.中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 协和医学杂志, 2022, 13(2): 203-226. [Acquired lmmunodeficiency Syndrome and Hepatitis C Professional Group, Society of Infectious Diseases, Chinese Medical Association, Chinese Center for Disease Control and Prevention. Chinese guidelines for diagnosis and treatment of human immunodeficiency virus infection/acquired immunodeficiency syndrome (2021 edition)[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(2): 203-226.] DOI: 10.12290/xhyxzz.2022-0097.

10.中华医学会肠外肠内营养学分会. 中国成人患者肠外肠内营养临床应用指南(2023版)[J]. 中华医学杂志, 2023, 103(13): 946-974. [Chinese Society of Parenteral and Enteral Nutrition. Guidelines for the clinical application of parenteral nutrition in adult patients in China (2023 edition) [J]. National Medical Journal of China, 2023, 103(13): 946-974.] DOI: 10.3760/cma.j.cn112137-20221116-02407.

11.Wang K, McIlroy K, Plank LD, et al. Prevalence, outcomes, and management of enteral tube feeding intolerance: a retrospective cohort study in a tertiary center[J]. JPEN J Parenter Enteral Nutr, 2017, 41(6): 959-967. DOI: 10.1177/0148607115627142.

12.Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. recommendations of the ESICM working group on abdominal problems[J]. Intensive Care Med, 2012, 38(3): 384-394. DOI: 10.1007/s00134-011-2459-y.

13.张晋, 张延英, 尤华琴. 重症监护室老年病人肠内营养相关性腹泻的影响因素[J]. 护理研究, 2022, 36(14): 2624-2626. [Zhang J, Zhang YY, You HQ. Influencing factors of enteral nutrition-related diarrhea in elderly patients in intensive care unit[J]. Chinese Nursing Research, 2022, 36(14): 2624-2626.] DOI: 10.12102/j.issn.1009-6493.2022.14.037.

14.莫航沣, 陈亚萍, 韩慧, 等. 临床预测模型研究方法与步骤[J]. 中国循证医学杂志, 2024, 24(2): 228-236. [Mo  HF, Chen YP, Han H, et al. Research methods and steps for clinical prediction model studies[J]. Chinese Journal of Evidence-Based Medicine, 2024, 24(2): 228-236.] DOI: 10.7507/1672-2531.202308135.

15.朱瑞, 徐凤玲, 汪璐璐, 等. 喂养不耐受风险评估表评估神经重症患者肠内营养不耐受风险的有效性[J]. 广东医学, 2019, 40(20): 2902-2906. [Zhu R, Xu  FL, Wang  LL, et al. Validity of feeding intolerance risk assessment scale for risk of high enteral feedingintolerance in the critically patients in neurology department[J].Guangdong Medical Journal, 2019, 40(20): 2902-2906.] DOI: 10.13820/j.cnki.gdyx.20191700.

16.苏小平, 徐静娟, 赵亚东, 等. 危重患者早期肠内营养喂养不耐受风险预测模型的构建[J]. 护理学报, 2022, 29(17): 47-51. [Su XP, Xu JJ, Zhao  YD, et al. Construction of a risk prediction model for early enteral nutrition intolerance in critically ill patients[J]. Journal of Nursing , 2022, 29(17): 47-51.] DOI: 10.16460/j.issn1008-9969.2022.17.047.

17.张庆男, 钱宵佳, 陈洁. 危重症患者肠内营养喂养不耐受的影响因素及对策[J]. 中国老年学杂志, 2019, 39(18): 4516-4518. [Zhang QN, Qian XJ, Chen  J. Influencing factors andcountermeasures of enteral nutrition feeding intolerance incritically ill patients[J]. Chinese Journal of Gerontol, 2019, 39(18): 4516-4518.] DOI: 10.3969/j.issn. 1005-9202.2019.18.047.

18.陈小颉, 段霞, 陶丽. 危重症患者肠内营养喂养不耐受影响因素的Meta分析[J]. 中国循证医学杂志, 2023, 23(11): 1299-1304. [Chen XJ, Duan X, Tao  L. Predictors of enteral nutrition feeding intolerance in critically ill patients: a Meta-analysis[J]. Chinese Journal of Evidence-Based Medicine, 2023, 23(11): 1299-1304.] DOI: 10.7507/1672-2531.202303035.

19.Zevin AS, McKinnon L, Burgener A, et al. Microbial translocation and microbiome dysbiosis in HIV-associated immune activation[J]. Curr Opin HIV AIDS, 2016, 11(2): 182-190. DOI: 10.1097/COH.0000000000000234.

20.张传坤, 张立文. 血乳酸水平与AECOPD患者早期肠内营养耐受性的相关性分析[J]. 当代护士(下旬刊), 2018, 25(12): 9-10. [Zhang CK, Zhang  LW. Correlation analysis between blood lactate level and early enteral nutrition tolerance in patients with AECOPD[J]. Modern Nurse, 2018, 25(12): 9-10.] DOI: CNKI:SUN:DDHZ. 0.2018-12-004.

21.Hasanpour-Dehkordi A, Solati K, Tali SS, et al. Effect of progressive muscle relaxation with analgesic on anxiety status and pain in surgical patients[J]. Br J Nurs, 2019, 28(3): 174-178. DOI: 10.12968/bjon.2019.28.3.174.

22.朱晓雯, 侯金珍, 张奇, 等. 不同目标平均动脉压治疗对合并高血压的脓毒性休克患者胃肠功能的影响[J]. 中华危重病急救医学, 2021, 33(5): 517-522. [Zhu  XW, Hou JZ, Zhang Q, et al. Effects of treatment based on different target mean arterial pressure on gastrointestinal function in septic shock patients with hypertension[J]. Chinese Critical Care Medicine, 2021, 33(5): 517-522.] DOI: 10.3760/cma.j.cn121430-20200713-00515.

23.Bjarnason I, Sharpstone DR, Francis N, et al. Intestinal inflammation, ileal structure and function in HIV[J]. AIDS, 1996, 10(12): 1385-1391. DOI: 10.1097/00002030-199610000-00011.

24.Sharpstone D, Neild P, Crane R, et al. Small intestinal transit, absorption, and permeability in patients with AIDS with and without diarrhoea[J]. Gut, 1999, 45(1): 70-76. DOI: 10.1136/gut.45.1.70.

25.Epple HJ, Zeitz M. HIV infection and the intestinal mucosal barrier[J]. Ann N Y Acad Sci, 2012, 1258(1): 19-24. DOI: 10.1111/j.1749-6632.2012.06512.x.

26.Monaco CL, Gootenberg DB, Zhao G, et al. Altered virome and bacterial microbiome in human immunodeficiency virus-associated acquired immunodeficiency syndrome[J]. Cell Host Microbe, 2016, 19(3): 311-322. DOI: 10.1016/j.chom.2016.02.011.

27.周雄才, 范立新, 董超雄, 等. HIV/AIDS合并泌尿外科疾病腔镜手术的安全性探讨[J]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(6): 390-393. [Zhou  XC, Fan  LX, Dong CX, et al. The safety of endoscopic surgery for HIV/AIDS patients combined with urologic diseases[J]. Chinese Journal of Endourology (Electronic Edition), 2018, 12(6): 390-393. DOI: 10.3877/cma.j.issn.1674-3253. 2018.06.007.

28.Ceccarelli G, Statzu M, Santinelli L, et al. Challenges in the management of HIV infection: update on the role of probiotic supplementation as a possible complementary therapeutic strategy for cART treated people living with HIV/AIDS[J]. Expert Opin Biol Ther, 2019, 19(9): 949-965. DOI: 10.1080/14712598.2019.1638907.

29.龙海燕, 冯萍. 抗生素相关性腹泻患者艰难梭菌和白色念珠菌检测与临床特征分析[J]. 华西医学, 2018, 33(5): 555-560. [Long HY, Feng P. The investigation of toxin-producing Clostridium difficile and Candida albicans in thepatients with antibiotic-associated diarrhea[J].West China Medical Journal, 2018, 33(5): 555-560.] DOI: 10.7507/1002-0179.201610067.

30.王悦欣. 肠内营养干预对免疫重建不良AIDS患者营养状况改善的研究[D]. 昆明: 昆明医科大学, 2021. [Wang YX. Enteral nutrition intervention of AlDS patients withimpaired immune reconstitution improves their nutritional status[D]. Kunming: Kunming Medical University, 2021.] DOI: 10.27202/d.cnki.gkmyc.2020.000146.

31.李婷婷, 李晓琴, 杨如美, 等. 上消化道肿瘤患者术后早期肠内营养喂养不耐受风险预测模型的构建 [J]. 上海护理, 2024, 24(2): 33-37. [Li TT, Li  XQ, Yang RM, et al. Construction of a risk prediction model for early postoperative enteral feedingintolerance in patients with upper gastrointestinal cancer[J]. Shanghai Nursing, 2024, 24(2): 33-37.] DOI: 10.3969/j.issn.1009-8399. 2024.02.007.

32.刘佳欣, 朱艳华, 程培霞, 等. 重症脑卒中患者肠内营养喂养不耐受风险列线图模型的构建与验证 [J]. 护士进修杂志, 2023, 38(12): 1069-1073, 1102. [Liu JX, Zhu  YH, Cheng PX, et al. Establishment of risk nomograph model for enteral nutrition intolerance in patients with severe stroke and its validation[J]. Journal of Nurses Training, 2023, 38(12): 1069-1073, 1102.] DOI: 10.16821/j.cnki.hsjx. 2023.25.019.

33.董雪, 臧金凤, 徐彩凤, 等. 重症急性胰腺炎患者肠内营养喂养不耐受风险预测模型的构建和验证[J]. 吉林大学学报(医学版), 2023, 49(6): 1586-1592. [Dong  X, Zang JF, Xu CF, et al. Construction and validation of risk prediction model of enteral nutrition feeding intolerance of patients with severe acute pancreatitis[J]. Journal of Jilin University (Medicine Edition), 2023, 49(6): 1586-1592.] DOI: 10.13481/j.1671-587X.20230623.

34.Collins GS, Reitsma JB, Altman DG, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement[J]. Ann Intern Med, 2015, 162(1): 55-63. DOI: 10.7326/M14-0697.