GLIM标准忽略了部分NRS 2002筛查有营养风险患者的营养支持获益—一项前瞻性队列研究的再分析  

Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS 2002-Re analysis based on a prospective cohort study

作　　者：张献娜 谢浩芬 李卓 揭彬 许静涌[5] 陈成[1] 康维明[6] 叶欣[6] 蒋朱明[6] Zhang Xianna;Xie Haofen;Li Zhuo;Jie bin;Xu Jingyong;Chen Cheng;Kang Weiming;Ye Xin;Jiang Zhuming(Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Nursing,the First Affiliated Hospital of Ningbo University,Ningbo 315010,China;Department of Clinical Nutrition,Beijing Chest Hospital,Capital Medical University,Beijing 101125,China;Department of Medical Psychology,Army Medical University,Chongqing 400038,China;Department of General Surgery,National Center of Gerontology,Beijing Hospital,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing,100730,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科,武汉430022 [2]宁波大学附属第一医院护理部,315010 [3]首都医科大学附属北京胸科医院临床营养科,101125 [4]解放军陆军军医大学医学心理系,重庆400038 [5]北京医院,国家老年医学中心,中国医学科学院老年医学研究院,100730 [6]中国医学科学院,北京协和医学院北京协和医院基本外科,100730

出　　处：《中华临床营养杂志》2023年第2期106-112,共7页Chinese Journal of Clinical Nutrition

基　　金：北京医院科技新星项目(BJ-2020-082);中央高水平医院临床科研业务费-指南专项(BJ-2022-075);中国食品科学技术学会食品科技基金(2021-M01)。

摘　　要：20世纪80年代以来,营养不良诊断标准的不统一给临床工作者带来了极大困惑。在我国公立医院实行疾病诊断相关分组付费后,如何诊断营养不良并在病例首页正确填写营养相关诊断关系到病组的正确分类和医保的付费。因此,临床实践中亟须一个可靠的有关营养不良(尤其是疾病相关营养不良)的诊断标准。2018年9月,全球营养领导层诊断营养不良标准(global leadership initiative on malnutrition,GLIM)共识出台。GLIM标准旨在统一目前成人住院患者营养不良诊断标准较为混乱的状况,但是由于GLIM标准是由33个营养领导人会议投票而产生的,仅属于共识,需要经过前瞻性临床有效性验证,即经GLIM诊断为阳性(即存在营养不良)的人群通过合理营养干预是否可改善临床结局。2020年11月发表于美国杂志《Nutrition》的《Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS 2002》是国内首篇应用营养风险筛查和GLIM标准对于营养支持疗法适应证范围的对比。同时也对两个工具的临床有效性做了回顾性验证。对于正在进行的无肌肉量的GLIM标准的前瞻性临床有效性验证,有参考价值。本文根据该回顾性研究的内容,对重要研究方法进行解读。The inconsistency of diagnostic criteria for malnutrition has confused clinicians since the 1980s.After the implementation of disease diagnosis related group payment(DRG)in China's public hospitals,the diagnosis of malnutrition and the correct documentation of nutrition-related diagnosis on the front sheet of medical records are related to the correct classification of the disease group and the medical insurance payment.Therefore,the reliable diagnostic criteria for malnutrition,especially disease-related malnutrition,is urgently needed in clinical practice.In September 2018,The global leadership Iinitiative on malnutrition(GLIM)diagnostic criteria consensus was launched.GLIM aimed to provide the explicit and unified diagnostic criteria for malnutrition in adult hospitalized patients.However,GLIM criteria was based on the voting by nutritional experts and was merely a consensus in nature.The clinical validity of GLIM criteria needs prospective verification,i.e.,to demonstrate that patients with malnutrition as per GLIM criteria could have improved clinical outcomes with reasonable nutritional interventions.In November 2020,the article titled Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS 2002 was published on the journal Nutrition.It was the first study comparing nutritional risk screening 2002(NRS 2002)and GLIM malnutrition diagnostic criteria among Chinese patients for the indication of nutritional support therapy.The clinical effectiveness of the two tools was retrospectively verified as well.Here we discussed the key points of this retrospective study,including the critical research methods,to inform the currently ongoing prospective validation of the GLIM malnutrition diagnostic criteria(the item of reduced muscle mass not included).

关 键 词：营养风险筛查2002量表 全球营养领导层诊断营养不良标准 营养不良 队列研究 临床有效性验证 

分 类 号：R459.3[医药卫生—治疗学]