MNA-SF、NRS 2002、GNRI在老年住院患者营养筛查中的应用  

Applied Analysis of MNA-SF,NRS 2002 and GNRI in Geriatric In-patients

作　　者：何润莲 沙凤 梁艳平[1] 刘春 尤丽英[1] HE Run-Lian;SHA Feng;LIANG Yan-Ping;LIU Chun;YOU Li-Ying(Dept. of Geriatrics,The First People’s Hospital of Kunming,Kunming Yunnan 650224,China)

机构地区：[1]昆明市第一人民医院老年病科

出　　处：《昆明医科大学学报》2019年第9期18-22,共5页Journal of Kunming Medical University

基　　金：昆明市科技计划基金资助项目(2015-1-S-00453)

摘　　要：目的 通过探讨微营养评定法(简表)[mini-nutritional assessment (short-form),MNA-SF]、营养风险筛查2002(nutritional risk screening 2002,NRS 2002)、老年营养风险指数(geriatric nutritional risk index, GNRI)3种营养筛查工具在老年病科住院患者营养筛查与评估中的应用情况,遴选出简单、特异、敏感的最适合老年患者的营养筛查工具。方法 采用定点连续抽样方法纳入昆明市第一人民医院甘美医院老年病科2015年9月至2016年8月老年住院患者共314例,收集患者的临床资料,包括性别、年龄、诊断、身高、体重、体重指数(body mass index,BMI)、上臂肌围(arm muscle circumference,AMC)、三头肌皮褶厚度(triceps skinfold thickness,TSF)、血清白蛋白(albumin,Alb)、血清前白蛋白(prealbumin,PA)及淋巴细胞计数(total lymphocyte count,TLC)。分别使用3种营养筛查工具对所有患者进行营养筛查与评估。通过统计学分析,计算老年住院患者营养风险发生率,以3种营养筛查方法中任意两种判定为有营养风险,作为有营养风险判定的“金标准”,探讨3种方法一致性,并计算各自灵敏度及特异度。结果 MNA-SF、NRS 2002、GNRI 3种方法筛查老年患者营养风险发生率分别为:47.3%,35.4%,65.6%。MNA-SF、NRS 2002与“金标准”具有较好的一致性(Kappa值> 0.75),而GNRI与“金标准”一致性不理想(Kappa值=0.45)。MNA-SF特异度和灵敏度分别为0.89,0.87;NRS 2002特异度和灵敏度分别为0.77,0.99;GNRI特异度和灵敏度分别为0.91,0.56。结论 老年住院患者营养风险发生率较高,需对其营养状况引起重视。MNA-SF具有较高的特异度及灵敏度,与“金标准”一致性较好,推荐作为老年住院患者营养筛查首选工具。Objective To explore the simplest,the most specific and sensitive tools by the application of the tools for screening malnutrition in MNA-SF(mini-nutritional assessment (short-form)), NRS 2002(nutritional risk assessment 2002) and GNRI(geriatric nutrition risk index). Methods A total of 314 in-patients over 60 years old from the Department of Geriatrics in our hospital of KunMing from September 2015 to August 2016 were enrolled in this study. We used the continuous sampling method to collect clinical data on patients, including gender, age, diagnosis, height, weight, and BMI(Body mass index), AMC(Arm muscle circle), TSF(Tricheps skinfold thickness), Alb(Serum albumin), PA(Prevalence) and TLC(Lymphocyte count). All patients were assessed with MNA-SF,NRS 2002 and GNRI. 3 tools was studied,and their consistencies,specificity and sensitivity as the "gold standard" defined with any two of the three tools were identified as nutritional risk. Results The nutritional risk rates were 47.3 %, 35.4 % and 65.6 % by MNA-SF, NRS 2002 and GNRI.There were good consistencies with MNA-SF, NRS 2002 and "the gold standard"(K>0.75), while GNRI was not ideal with the "gold standard"(0.45 ≤ K < 0.75). The specificity and sensitivity with MNA-SF were 0.89 and 0.87. The specificity and sensitivity with NRS 2002 were 0.77 and 0.99. The specificity and sensitivity with GNRI were 0.91 and 0.56, respectively. Conclusion There is a higher incidence of the nutritional risk in geriatric in-patients. With its higher specificity,the highest sensitivity and consistency with the "gold standard", MNA-SF is recommended as the preferred tool for nutritional screening for geriatric in-patients.

关 键 词：老年人 营养筛查 微营养评定法(简表) 营养风险筛查2002 老年营养风险指数 

分 类 号：R15[医药卫生—营养与食品卫生学]