去脂体质量指数在稳定期慢性阻塞性肺疾病患者营养不良筛查中的应用及效度评价

Application and validity evaluation of fat-free mass index in malnutrition screening in patients with stable chronic obstructive pulmonary disease

目的 探讨去脂体质量指数（FFMI）在稳定期慢性阻塞性肺疾病（COPD）患者营养不良筛查中的应用,并对其效度进行评价.方法 从门诊纳入235例稳定期COPD患者,采集患者体测指标以及进行血生化和尿肌酐检查.分别用身体组成评价法（BCA）、FFMI、体质指数（BMI）,微型营养评定法（MNA）等4种方法对患者进行营养筛查.以BCA作为营养不良诊断标准,比较FFMI、BMI、MNA3种方法灵敏度、特异度、约登指数（Youden＇s index,YI）以及与BCA的一致性.结果 BCA、FFMI、BMI、MNA对纳入患者营养不良检出率分别为47.6％、48.5％、18.3％、53.2％.以BCA作为营养不良诊断标准,得出FFMI用于稳定期COPD患者营养不良筛查时的灵敏度为92％,特异度为91％,YI为0.83,Kappa值为0.84（P＜0.01）;BMI灵敏度为33％,特异度为95％,YI为0.28,Kappa值为0.29 （P＜0.01）;MNA灵敏度为86％,特异度为75％,YI为0.38,Kappa值为0.60（P＜0.01）.结论 与MNA和BMI相比,FFMI有灵敏度、特异度及约登指数较高等优势,并与BCA一致性好,适用于稳定期COPD患者营养不良筛查.

Objective To evaluate the validity of fat free mass index in malnutrition screening in patients with stable chronic obstructive pulmonary disease（COPD）.Methods A total of 235 patients with stable COPD were enrolled from out patient,and each of them was measured for anthropometric indicators,urine creatinine and blood biochemical indicators.Body composition was assessed by bioelectrical impedance analysis and their body mass index （BMI） and fat-free mass index （FFMI） were calculated.Body composition assessment （BCA）,BMI,FFMI and mini-nutritional assessment（MNA） were used for screening malnutrition in enrolled patients.Using BCA as the diagnosis standard of malnutrition,the sensitivity,specificity,Youden＇s index （YI） and consistency of FFMI,BMI,MNA with BCA were compared.Results The incidence of malnutrition screened by BCA,FFMI,BMI and MNA were 47.6 %,48.5%,8.3%,53.2% respectively.The sensitivity of FFMI,BMI and MNA screening for malnutrition were 92%,33%,and 86%,the specificity were 91%,95% and 75%,the Youden＇s index （YI） were 0.83,0.28 and 0.38 and Kappa value were 0.84,0.29,0.60 respectively （all P〈0.01）.Conclusions Compared with BMI and MNA,FFMI shows higher sensitivity,specificity,YI and agreement with BCA,which is suitable for patients with stable COPD in screening malnutrition