肿瘤患者营养风险及中医证候的调查分析  

Investigation and Analysis of Nutritional Risk Screening and TCM Syndrome of Cancer Patients

作　　者：陈欢耀 傅婷[1] 姚庆华[2] 

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]浙江省肿瘤医院,浙江杭州310053

出　　处：《中医学报》2015年第11期1552-1555,共4页Acta Chinese Medicine

基　　金：浙江省自然科学基金(LQ12H16006)

摘　　要：目的：了解恶性肿瘤发病的一般情况,关注肿瘤患者营养状况,改善患者住院期间营养不良的状况。了解身体质量（body mass index,BMI）指数、白蛋白（albumin,ALB）及前白蛋白（prealbumin,PA）、Nutritional Risk Screening 2002（NRS 2002）营养筛查量表对营养不良判别的敏感性,比较各项评价指标在统计学中的作用。明确营养不良的肿瘤患者的中医证候。方法：营养不良标准判定：BMI〈18.5 kg·m-2,或PA〈200 mg·L-1,或ALB〈35 g·L-1。NRS 2002营养筛查量表,以总分≥3分为基准,定义营养不良,存在营养风险。通过采集75例存在营养不良风险的患者中医证候学和诊断资料,排除〈5%证候,将余下38个证候进行系统聚类分析,得出证型分布。结果：男性患者多于女性,年龄集中在56~65岁。类别分布前4位分别为肺癌、胃癌、结/直肠癌、肝癌。147例患者中BMI〈18.5 kg·m-2有23例,ALB〈35 g·L-1有30例,PA〈200 mg·L-1有97例,NRS 2002营养筛查量表总分≥3分有75例,相关性检验表明指标间存在不同程度的相关性。75例患者经聚类分析后分为气虚痰湿证13例,阳虚证11例,阴虚血瘀证20例,气阴两虚证31例。结论：前白蛋白在指标判别营养不良中敏感性最高,NRS2002营养筛查量表分析次之,ALB、BMI指数在判别营养不良中敏感性稍差,且其间存在不同程度的相关性。聚类分析结果显示虚证贯穿营养不良恶性肿瘤患者整个病程,主要包括气虚、阴虚、阳虚,夹杂痰湿证及血瘀证。Objective： To understand the general incidence of malignant tumors and concern about nutritional status of patients,in order to detect malnutrition risk as soon as possible. Distinguish the sensitivity of malnutrition discrimination of BMI index,albumin（ ALB）,prealbumin（ PA）,and NRS 2002 scale. Identify the TCM Syndrome distribution of cancer patients with malnutrition risk. Methods： The condition of BMI 18. 5 kg·m- 2,or PA 200 mg·L- 1,or ALB 35 g·L- 1is determined as malnutrition. NRS 2002 Scale is used to assess nutritional status and nutritional risk screening. NRS 2002 score ≥3 is defined as malnutrition with nutritional risk. 75 cases of TCM Syndrome with malnutrition risk were collected. The symptoms occurred less than 5% were exclvded. The remaining 38 syndrome were hierarchical clustering analyzed and contributed to find out the distribution of the syndrome. Results： In 147 cases,male patients were more than female,and patients aged from 56 years to 65 years were the most cases. The top four diseases were lung cancer,stomach cancer,colorectal / colorectal cancer and liver cancer. In 147 cases of patients,with BMI 18. 5 kg·m2in 23 cases,ALB 35 g·L- 1in 30 cases,PA 200 mg·L- 1in 97 cases,and with NRS 2002 score ≥3 in 75 cases. Correlation test suggested that there were certain degrees of correlation among these indicators. After clustering analysis,75 cases were divided into four categories,with 13 cases of Qi deficiency and phlegm dampness syndrome,11 cases of Yang deficiency syndrome,20 cases of Yin deficiency and blood stasis syndrome,and 31 cases of Qi and Yin deficiency syndrome. Conclusion： Indicator＇s sensitivity of malnutrition determination,from high to low,were PA NRS 2002 scale analysis ALB BMI,and there is certain correlation among these indicators. Cluster analysis suggested cancer patients with malnutrition risk would show deficiency syndromes,including Qi deficiency,Yin deficiency,Yang deficiency,along with phlegm dampness syndrome and blood stasis syndrome.

关 键 词：肿瘤 营养不良 中医证候 聚类分析 

分 类 号：R273[医药卫生—中西医结合]