GLIM标准在胃肠道恶性肿瘤患者营养不良诊断中的应用研究  

Application of GLIM criteria in diagnosis of malnutrition in patients with gastrointestinal malignancy

作　　者：芮红霞[1] 张冬婷 张晓雨[2] 俞会林 杨婷婷[1] 周波[1] Rui Hongxia;Zhang Dongting;Zhang Xiaoyu;Yu Huilin;Yang Tingting;Zhou Bo(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230088,Anhui,China;Health Management Center,the First Affiliated Hospital of Anhui Medical University,Hefei 230088,Anhui,China)

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230088 [2]安徽医科大学第一附属医院健康管理中心,合肥230088

出　　处：《肿瘤代谢与营养电子杂志》2023年第1期113-119,共7页Electronic Journal of Metabolism and Nutrition of Cancer

摘　　要：探讨全球领导人营养不良倡议(GLIM)标准下胃肠道恶性肿瘤患者营养不良发生情况,并比较其与患者主观整体评估(PG-SGA)在营养不良诊断中的一致性,以期为GLIM标准的临床应用提供依据。方法 选取2021年10月至2022年7月安徽医科大学第一附属医院普外科收治的220例胃肠道恶性肿瘤患者,运用GLIM标准及PG-SGA量表对患者进行营养评估,采用生物电阻抗技术测量患者的人体组成成分,通过Kappa一致性检验分析GLIM标准与PG-SGA量表评估结果的一致性。结果 GLIM诊断出营养不良患者112例(50.9%),其中中度营养不良85例,重度营养不良27例。营养不良的严重程度在不同年龄、体重、体质指数、右上臂围、右小腿围、手握力、体脂、体脂百分比、去脂体重、去脂体质指数、肌肉含量以及骨骼肌方面具有显著差异(P<0.05)。PG-SGA诊断出营养不良患者158例(71.8%),其中85例为中度营养不良,73例为重度营养不良。GLIM标准和PG-SGA量表在诊断营养不良时表现出中等程度的一致性(Kappa=0.548,P<0.001),其受试者操作特征曲线下面积为0.821(95%CI=0.745~0.877);但在区分不同严重程度的营养不良患者时,二者一致性水平相对较低(Kappa=0.344,P<0.001)。结论 GLIM标准与PG-SGA在诊断营养不良时一致性尚可,而在区分中度和重度营养不良时一致性较差,但这并不影响GLIM标准的临床适用性。Objective To investigate the occurrence of malnutrition in patients with gastrointestinal malignancy according to the Global Leadership Initiative on Malnutrition criteria( GLIM), and compare the consistency of GLIM and patient-generated subjective global assessment( PG-SGA) in the diagnosis of malnutrition. Method A total of 220 patients with gastrointestinal malignancies admitted to the First Affiliated Hospital of Anhui Medical University were selected from October 2021 to July 2022 for nutritional assessment using the GLIM criteria and PG-SGA. Patients’ body composition was measured by bioelectrical impedance technology, and Kappa consistency test was used to analyze the consistency of GLIM and PG-SGA evaluation results. Result 112 patients( 50. 9%)were diagnosed as malnutrition by GLIM, including 85 moderate and 27 severe malnutrition. The severity of malnutrition was significantly different in age, weight, body mass index, right upper arm circumference, right calf circumference, hand grip strength,fat mass, fat mass percentage, fat free mass, fat free mass index, muscle and skeletal muscle(P < 0. 05). One hundred and 58patients(71. 8%) were diagnosed as malnutrition by PG-SGA, including 85 moderate and 73 severe malnutrition. GLIM and PG-SGA had good consistency in the diagnosis of malnutrition(Kappa = 0. 548, P < 0. 001), and the area under the ROC curve was 0. 821(95% CI= 0. 745-0. 877). When distinguishing patients with different degrees of malnutrition, the level of consistency was relatively low(Kappa = 0. 344, P<0. 001). Conclusion GLIM criteria and PG-SGA have a good consistency in the diagnosis of malnutrition,but a relatively poor consistency in the classification of the severity of malnutrition. However, this does not affect the clinical applicability of GLIM criteria.

关 键 词：全球领导人营养不良倡议 患者主观整体评估 营养不良 恶性肿瘤 

分 类 号：R735[医药卫生—肿瘤] R459.3[医药卫生—临床医学]