摘要
目的分析全球领导人营养不良倡议(GLIM)标准、患者全面主观营养评估(PG-SGA)和血清白蛋白(ALB)诊断肿瘤患者营养不良的一致性。方法随机抽取2020年1—12月四川省宜宾市第一人民医院肿瘤患者218例,分别采用GLIM标准、PG-SGA和血清ALB诊断其营养不良情况。比较3种方法在营养不良诊断中的一致性。结果 (1) 218例肿瘤患者《营养风险筛查工具2002 (NRS 2002)》评分为(3.12±1.08)分,营养风险发生率53.67%(117/218)。不同年龄段、肿瘤类型及肿瘤分期患者的NRS 2002评分和营养风险发生率比较,差异有统计学意义(P<0.05或P<0.01)。(2) GLIM标准的5个表型指标中,体质量下降、低体质量指数、肌肉减少、进食减少或消化功能障碍以及疾病或炎症负担发生率依次为44.04%(96/218)、16.51%(36/218)、42.20%(92/218)、77.06%(168/218)、40.37%(88/218)。依据GLIM标准共诊断营养不良81例,阳性率为37.16%,不同年龄段、肿瘤类型和肿瘤分期患者的营养不良发生率比较,差异有统计学意义(P<0.05或P<0.01)。(3)采用PG-SGA诊断营养不良95例,阳性率为43.58%;以ALB<35 g/L为标准共检出营养不良87例,阳性率为39.91%;不同年龄段、肿瘤类型和肿瘤分期患者的营养不良发生率比较,差异有统计学意义(P<0.05或P<0.01)。(4)以GLIM为金标准,PG-SGA诊断营养不良的Kappa值为0.73,灵敏度和特异度分别为91.4%和84.7%;ALB诊断营养不良的Kappa值为0.75,灵敏度和特异度分别为87.7%和88.3%。结论肿瘤患者营养风险和营养不良发生率高。GLIM标准与PG-SGA、ALB诊断营养不良的一致性良好,临床应用中需要根据情况合理选择诊断工具。
Objective To analyze the consistency of Global Leadership Initiative on Malnutrition(GLIM) standard, Patient-generated Subjective Global Assessment(PG-SGA) and serum albumin(ALB) in diagnosis of malnutrition in cancer patients. Methods From January to December 2020, a total of 218 cancer patients were randomly selected from the first People′s Hospital of Yibin City in Sichuan Province, and their malnutrition states were diagnosed by GLIM standard, PG-SGA and serum ALB, respectively. The consistency of three methods in diagnosing malnutrition was compared. Results(1) The score of Nutrition Risk Screening Tool 2002(NRS 2002) in 218 cancer patients was(3.12±1.08) points, and the incidence of nutritional risk was 53.67%(117/218). There was significant differences in incidence of nutritional risk among patients with different age groups, tumor types and tumor stages(P<0.05).(2) Among the five phenotypes of GLIM standard, the incidences of weight loss, low body mass index, muscle loss, decreased food intake or digestive dysfunction, and disease or inflammatory burden were 44.04%(96/218), 16.51%(36/218), 42.20%(92/218), 77.06%(168/218)and 40. 37%( 88/218),respectively. A total of 81 cases were diagnosed as malnutrition according to GLIM standard,and the positive rate was 37. 16%. There were significant differences in the incidences of malnutrition among patients with different age groups,tumor types and tumor stages( P <0. 05 or P < 0. 01).(3) A total of 95 cases were diagnosed as malnutrition by PG-SGA,and the positive rate was 43. 58%;a total of 87 cases were diagnosed as malnutrition according to standard of ALB < 35 g/L,and the positive rate was 39. 91%;there were significant differences in the incidences of malnutrition among patients with different age groups,tumor types and tumor stages( P <0. 05 or P < 0. 01).(4) Taking GLIM as the gold standard,the Kappa value of PG-SGA in the diagnosis of malnutrition was 0. 73,and the sensitivity and specificity were 91. 4% and 84. 7% respectively;the Kappa value of ALB in the diagnosis of malnutrition was 0. 75,and the sensitivity and specificity were 87. 7% and 88. 3% respectively. Conclusion The incidences of nutritional risk and malnutrition are high in cancer patients. GLIM standard is consistent with PG-SGA and ALB in the diagnosis of malnutrition,and it is necessary to reasonably select diagnostic tools according to the situation in clinical application.
作者
杨宇
练玉颖
赵铟
YANG Yu;LIAN Yuying;ZHAO Yin(Department of Oncology,the First People′s Hospital of Yibin City in Sichuan Province,Yibin,Sichuan,644000)
出处
《实用临床医药杂志》
CAS
2022年第2期82-87,共6页
Journal of Clinical Medicine in Practice
基金
2018年四川省卫生和计划生育委员会科研课题(18PJ575)。
关键词
全球领导人营养不良倡议
患者全面主观营养评估
肿瘤
营养不良
白蛋白
Global Leadership Initiative on Malnutrition
Patient-generated Subjective Global Assessment
cancer
malnutrition
albumin
