主观综合营养评价法评判消化系统恶性肿瘤病人营养状况和预后

The value of subjective global assessment in assessing the nutritional status and predicting the prognosis of the patients with digestive system malignant tumor

目的:评价主观综合营养评价法(SGA)在消化系统恶性肿瘤病人营养状况和预后评判中的作用。方法:采用SGA法、人体测量和实验室检测指标等方法评判626例消化系统恶性肿瘤病人的术前营养状况,并跟踪其预后。结果:①被SGA评为营养不良的有303例,占48.40%。②营养不良的发生率与肿瘤部位相关(P<0.05),以胰腺癌最高(74.19%),肠癌最低(44.94%),食管癌(55.56%)和胃癌(46.12%)介于二者之间;626例病人中有67.25%发生不同程度的体重下降,31.47%有不同程度的摄入量减少。③被SGA评为属不同营养状况组(SGA-A为营养正常,SGA-B为轻～中度营养不良,SGA-C为重度营养不良)病人的血清蛋白、体质指数(BMI)和三头肌皮褶厚度(TSF)值间的差异有统计学意义(P<0.05),但SGA评判结果与血清蛋白、BMI和TSF值间的相关性(r=0.251～0.371)并不令人满意。④有150例病人术后出现并发症,占23.96%,以SGA-C组最高(35.0%)。⑤平均住院天数为(22.05±10.27)d,不同SGA组病人住院天数间的差异有统计学意义(P<0.05),以SGA-C组最长。结论:与血清蛋白水平和人体测量等单指标相比,SGA能更好地评判消化系统恶性肿瘤病人的营养状况及预测并发症和住院天数,可将SGA视为评价肿瘤病人营养状况和预后的较好工具。

Objective To elucidate the value of subjective global assessment（SGA） in nutritional status evaluation and prognosis prediction in the patients with digestive system malignant tumor. Methods The preoperative nutritional status of the 626 patients with digestive system malignant tumor were appraised by SGA, anthropometric parameters and laboratory parameters, the complications of these patients after operation and the length of hospital stay （LOS） were recorded ancl followed up. Results （1）The incidence of malnutrition among the 626 patients were 48.40%（303/626）; （2）The incidence of malnutrition was obviously related to the site of tumor. The highest incidence of malnutrition was found in pancreatic cancer（74.19%）, the lowest in intestinal cancer（44.94%）, and esophageal cancer（55.56% ）and gastric caneer（46.12%）came between. There were 67.25% of patients experiencing weight loss and 31.47% of patients with intake decrease. （3）Classified by SGA, the patients were devided into SGA-A, SGA-B and SGA-C groups with normal nutritional status, mild to moderate malnutrition and severe malnutrition. The difference of the serum protein level, body mass index （BMI） and triceps skinfold thickness（TSF） among the 3 groups was significant（P〈0.05）. But the results of SGA did not correlated satisfactorily with the other parameters（serum protein level, BMI and TSF; r=0.251-0.371）. （4）The incidence of complication was 23.96%（150/626） in this study, the highest being in the SGA-C group（35.0 %）. （5） The average LOS of the 626 patients was （22.05±10.27） days. There existed a significant difference of LOS among the three SGA groups （P〈0.05）, and the longest LOS was in the SGA-C group. Conclusions Compared with the serum protein level and anthropometric parameters, SGA is a better tool to assess the nutritional status and predict the complications rate and LOS in patients with digestive system malignant tumor.