GLIM标准和PG-SGA在老年中晚期肿瘤病人营养不良诊断中的一致性评价

doi:10.3969/j.issn.1003-9198.2023.04.016

摘要/Abstract

摘要： 目的比较全球领导人营养不良倡议(GLIM)标准和病人主观整体评估(PG-SGA)在老年中晚期肿瘤病人营养不良诊断中的一致性。方法对288例老年中晚期肿瘤病人进行营养风险筛查2002(NRS2002)和PG-SGA评估,再对NRS2002≥3分者采用GLIM标准进行营养评定。比较GLIM标准和PG-SGA诊断老年中晚期肿瘤病人营养不良的一致性。结果入组病人NRS2002评分为(3.33±1.34)分,营养风险发生率为71.18%(205/288),不同性别、年龄、肿瘤部位及分期病人的营养风险发生率差异有统计学意义(P<0.05)。采用GLIM标准诊断营养不良的发生率为58.33%(168/288),采用PG-SGA诊断营养不良的发生率为69.79%(201/288)。根据PG-SGA或GLIM标准,性别、年龄、肿瘤部位和分期均是老年中晚期肿瘤病人营养不良的影响因素(P<0.05)。Kappa检验显示,GLIM标准和PG-SGA诊断老年中晚期肿瘤病人营养不良的一致性较好(Kappa=0.71,P<0.01);按病人的一般情况分层,GLIM和PG-SGA诊断不同性别、年龄、肿瘤部位及分期病人营养不良的一致性良好,其Kappa值为0.63~0.78。结论老年中晚期肿瘤病人营养风险和营养不良的发生率较高,GLIM标准和PG-SGA诊断老年中晚期肿瘤病人营养不良的一致性良好。

关键词: 营养风险筛查, 营养不良, 病人主观整体评估, 全球领导人营养不良倡议

Abstract: Objective To compare the effects of global leadership initiative on malnutrition (GLIM) criteria and patient-generated subjective global assessment (PG-SGA) in evaluating malnutrition among the elderly patients with advanced cancer. Methods A total of 288 elderly patients with advanced cancer were screened by nutritional risk screening 2002 (NRS2002) and PG-SGA, then those patients with NRS2002 score≥3 were evaluated with GLIM.The consistency of GLIM criteria and PG-SGA in diagnosing malnutrition among the elderly patients with advanced cancer was analyzed. Results The NRS2002 score of the patients was 3.33±1.34, and the incidence rate of nutritional risk was 71.18% (205/288).There were significant differences in the incidence rates of nutritional risk among the patients with different genders, ages, tumor locations and stages (P<0.05).The incidence rate of malnutrition assessed by GLIM criteria was 58.33% (168/288), which was 69.79% assessed by PG-SGA.According to PG-SGA or GLIM criteria, gender, age, tumor location and stage were the influencing factors of malnutrition in the elderly patients with advanced cancer (P<0.05). Kappa test showed that GLIM criteria and PG-SGA had good consistency in the diagnosis of malnutrition among the elderly patients with advanced cancer (Kappa=0.71,P<0.01).Stratified by the general condition of the patients, GLIM criteria and PG-SGA had good consistency in diagnosing malnutrition in different genders, ages, tumor locations and stages, and their Kappa values ranged from 0.63 to 0.78. Conclusions The incidence rates of nutritional risk and malnutrition are high among the elderly patients with advanced cancer. GLIM criteria and PG-SGA have good consistency in diagnosing malnutrition among the elderly patients with advanced cancer.

Key words: nutritional risk screening, malnutrition, patient-generated subjective global assessment, global leadership initiative on malnutrition

中图分类号:

R 151

吉琳琳, 张欣悦, 金超, 李世阳, 杨勤兵. GLIM标准和PG-SGA在老年中晚期肿瘤病人营养不良诊断中的一致性评价[J]. 实用老年医学, 2023, 37(4): 386-390.

JI Lin-lin, ZHANG Xin-yue, JIN Chao, LI Shi-yang, YANG Qin-bing. Consistency asscessment of global leadership initiative on malnutrition criteria and patient-generated subjective global assessment in diagnosing malnutrition among elderly patients with advanced cancer[J]. Practical Geriatrics, 2023, 37(4): 386-390.

参考文献

[1] 曹广文.我国恶性肿瘤防治研究和实践需要技术、管理和观念的创新[J]. 中华流行病学杂志,2017,38(1):3-12.
[2] 王维琼.2016年中国恶性肿瘤发病和死亡分析[J]. 临床医药文献杂志:电子版,2017,4(19):3604.
[3] 张珊,姜莹莹,董文兰,等.2007-2016年中国劳动力人口全死因及慢性非传染性疾病死亡水平与变化趋势[J]. 中华流行病学杂志,2018,39(12):1582-1588.
[4] 张学飞,闫贻忠,庞丽娟,等.中国老年人群恶性肿瘤疾病负担[J]. 中国老年学杂志, 2017, 37(21):5325-5329.
[5] 吴学智.某院2015年-2017年恶性肿瘤住院病例统计分析[J]. 中国病案,2018,19(10):58-60.
[6] D’ALMEIDA C A, PERES W A F, DE PINHO N B, et al. Prevalence of malnutrition in older hospitalized cancer patients: a multicenter and multiregional study[J]. J Nutr Health Aging,2020,24(2):166-171.
[7] 张艳华,李晓玲,李增宁.国内恶性肿瘤患者营养不良影响因素Meta分析[J]. 中国临床保健杂志,2020,23(5):649-655.
[8] 曾小庆, 戴婷婷, 饶志勇, 等.恶性肿瘤住院患者营养状况与生活质量分析[J]. 现代肿瘤医学, 2022, 30(10):1836-1839.
[9] CEDERHOLM T, JENSEN G L, CORREIA M I T D, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community[J]. J Cachexia Sarcopenia Muscle, 2019, 10(1):207-217.
[10] JENŞEN G L, CEDERHOLM T, CORREIA M I T D, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community[J]. JPEN J Parenter Enter Nutr,2019,43(1):32-40.
[11] 中华人民共和国国家卫生和计划生育委员会.肿瘤患者主观整体营养评估:WS/T 555-2017[S/OL]. (2017-08-11)[2019-09-30]. http://www.nhc.gov.cn/ewebeditor/uploadfile/2018/06/20180613135631891.pdf
[12] SANZ-PARÍS A, MARTÍN-PALMERO A, GOMEZ-CANDELA C, et al. GLIM criteria at hospital admission predict 8-year all-cause mortality in elderly patients with type 2 diabetes mellitus: results from VIDA Study[J]. JPEN J Parenter Enteral Nutr,2020,44(8):1492-1500.
[13] 徐丹凤,陈艳秋,高键,等. MNA-SF问卷中小腿围对评估老年人营养状况的应用研究:中国老龄化与健康高峰论坛论文汇编[C]. 上海:中国营养学会,2014:12.
[14] 夏昌发,陈万青.中国恶性肿瘤负担归因于人口老龄化的比例及趋势分析[J]. 中华肿瘤杂志,2022,44(1):79-85.
[15] ROBERTS S B, ROSENBERG I. Nutrition and aging: changes in the regulation of energy metabolism with aging[J]. Physiol Rev,2006,86(2):651-667.
[16] OTTERY F D. Rethinking nutritional support of the cancer patient: the new field of nutritional oncology[J]. Semin Oncol,1994,21(6):770-778.
[17] 许静涌,唐普贤,陈伟,等.老年肿瘤患者营养风险、营养不良及营养治疗情况调查[J]. 肿瘤代谢与营养电子杂志,2018,5(2):159-163.
[18] 李娇娇,刘晓红.GLIM营养不良诊断标准临床实践[J]. 中国临床保健杂志, 2020, 23(6):721-724.
[19] 刘娟,丁清清,周白瑜,等.中国老年人肌少症诊疗专家共识(2021)[J]. 中华老年医学杂志, 2021, 40(8):943-952.
[20] 谢林颖,王畅,吴海涛,等.744例住院老年肿瘤患者营养不良状况调查及分析[J]. 肿瘤代谢与营养电子杂志,2018,5(4):380-386.
[21] SCHOBER P, MASCHA E J, VETTER T R. Statistics from A (Agreement) to Z (z Score): a guide to interpreting common measures of association, agreement, diagnostic accuracy, effect size, heterogeneity, and reliability in medical research[J]. Anesth Analg,2021,133(6):1633-1641.