两种营养不良风险筛查工具在原发性肝癌住院患者中的应用比较  

Comparison of Application of Two Malnutritional Risk Screening Tools in Primary Liver Cancer Inpatients

作　　者：朱娅鸽[1] 吴宇超 王娟[1] 陈天艳[1] 杨瑗[1] ZHU Yage;WU Yuchao;WANG Juan;CHEN Tianyan;YANG Yuan(Department of Infectious Diseases,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院感染科,西安710061

出　　处：《医学综述》2021年第8期1616-1620,共5页Medical Recapitulate

基　　金：国家自然科学基金(81770594);陕西省创新能力支撑计划项目(2018KRM092)。

摘　　要：目的评价皇家自由医院-营养优先次序工具(RFH-NPT)和营养风险筛查2002(NRS-2002)在原发性肝癌住院患者中的应用价值。方法选择2018年6月至2019年1月西安交通大学第一附属医院住院的115例原发性肝癌患者为研究对象,患者均进行人体测量、生化检查,计算体质指数(BMI)和上臂肌围(AMC),采用RFH-NTP和NRS-2002工具进行营养不良风险筛查评分,应用主观全面评定法(SGA)对患者进行营养评估。结果NRS-2002与RFH-NPT筛选营养不良风险组BMI显著低于无营养不良风险组(P<0.01),AMC、总蛋白、白蛋白、前白蛋白比较差异无统计学意义(P>0.05)。RFH-NPT筛查原发肝癌患者营养不良风险的阳性率显著高于NRS-2002[79.1%(91/115)比58.3%(67/115)](P<0.01)。在BMI≥18.5 kg/m^(2)、Child-Pugh A级原发性肝癌患者中,RFH-NPT筛查营养不良风险的阳性率均高于NRS-2002[76.0%(76/100)比52.0%(52/100),65.9%(27/41)比34.1%(14/41)](P<0.01)。以SGA营养评估结果作为营养不良的评判标准,RFH-NPT和NRS-2002与SGA的评判结果均具有一致性(Kappa=0.812,P<0.001;Kappa=0.625,P<0.001)。RFH-NPT筛查营养不良风险的灵敏度高于NRS-2002[100.0%(83/83)比78.3%(65/83)](P<0.05),两种营养筛选工具的特异度比较差异无统计学意义(P>0.05)。结论原发性肝癌住院患者营养不良风险高,RFH-NPT在原发肝癌住院患者营养不良风险筛选中优于NRS-2002。Objective To evaluate the applicative value of The Royal Free Hospital-nutritional prioritizing tool(RFHNPT)and the nutritional risk screening 2002(NRS-2002)for the malnutrition risk in inpatients with primary liver cancer.Methods A total of 115 inpatients with primary liver cancer in the First Affiliated Hospital of Xi’an Jiaotong University from Jun.2018 to Jan.2019 were included in the study.Anthropometric and laboratory parameters were measured.Body mass index(BMI)and arm muscle circumference(AMC)were calculated according to the data obtained.RFH-NPT and NRS-2002 were used to score the malnutrition risks of the patients.Subjective global assessment(SGA)was used to assess the nutritional status.Results BMI of NRS-2002 and RFH-NPT screening malnutrition risk group was significantly lower than that of non-malnutrition risk group(P<0.01),and there was no significant difference in AMC,total protein,albumin and prealbumin(P>0.05).The results of malnutritional risk screening by RFH-NPT was higher than NRS-2002[79.1%(91/115)vs 58.3%(67/115)](P<0.01).And more patients with BMI≥18.5 kg/m^(2) or Child-Pugh A were screened at a risk of malnutrition by RFH-NPT than NRS-2002[76.0%(76/100)vs 52.0%(52/100),65.9%(27/41)vs 34.1%(14/41)](P<0.01).The results of screen by RFH-NPT or NRS-2002 were consistent with results of assessment of SGA(Kappa=0.812,P<0.001;Kappa=0.625,P<0.001).The sensitivity of RFH-NPT was higher than NRS-2002[100.0%(83/83)vs 78.3%(65/83)](P<0.05),and there was no significant difference in specificity between the two malnutritional risk screen tools(P>0.05).Conclusion There is high risk of malnutrition in hospitalized patients with primary liver cancer,and RFH-NPT is better than NRS-2002 to screen the malnutritional risk for the primary liver cancer patients.

关 键 词：原发性肝癌 营养不良风险 营养风险筛查2002 皇家自由医院-营养优先次序工具 主观全面评定法 

分 类 号：R459.3[医药卫生—治疗学]