营养支持对存在营养风险的老年患者的质量生命调整年的影响

Effect of nutrition support on quality adjusted life year in elderly patients with nutritional risk

目的 总结近年发表文献中营养支持对存在营养风险的老年患者的质量生命调整年（QALY）的影响，同时评价以QALY为结局指标的可行性。方法 计算机检索1980至2013年万方数据知识服务平台、中国知网、PubMed、Nature等，查找已经发表的以“营养支持对有营养风险的患者的结局的影响用QALY和成本效用评价的可行性是怎样的？”为研究问题的中、英、日文文献。采用Jadad量表结合Schulz隐蔽分组对随机对照研究的质量进行评价，采用Newcastle-Ottawa量表对队列研究的质量进行评价。结果 共检索到10篇文献，6篇随机对照试验，2篇队列研究，余2篇不符合要求予以排除。共计1 130例患者。6个随机对照试验有4篇试验组QALY高于对照组、总费用试验组低于对照组（或成本效益试验组高于对照组）。2个队列研究的结果表明对长期营养不良的患者进行长期在家庭环境下的全胃肠外营养支持可以改善患者的QALY，而且成本比需要在医院提供营养支持时的成本小。结论 对存在营养风险的患者进行营养支持可以改善患者预后并可以减少成本，提高QALY。今后需要更多样本容量更大、质量较高的随机对照研究评价营养支持对存在营养风险的老年患者的QALY的影响。

Objective To summarize the progress of research on the influence of nutrition support on quality adjusted life year （QALY） in elderly patients with nutritional risk, and to evaluate the feasibility of QALY as an outcome indicator.Methods Literature in Chinese, English and Japanese relating to “the feasibility of QALY and cost-utility in evaluating the influence of nutrition support on the outcomes of patients with nutritional risk” published from 1980 to 2013 were searched in Wanfang, China National Knowledge Infrastructure, PubMed, Nature databases.The methodological quality of randomized controlled trials was assessed using Jadad scale combined with Schulz allocation concealment, and the quality of cohort studies with Newcastle-Ottawa scale.Results Totally 10 articles were found, in which 8 were selected, including 6 randomized controlled trial and 2 cohort studies, covering 1 130 patients; the other 2 were excluded for not conforming to inclusion criteria.Four of the 6 randomized controlled trial indicate that QALY is higher and all-cost is lower in the treatment group compared with the control group （or cost-utility is higher in the treatment group）.The 2 cohort studies indicate that total parenteral nutrition support at home could improve the QALY of malnourished patients and could save cost compared with nutrition support at hospital when necessary.Conclusions Nutrition support for patients with nutritional risk can improve prognosis, reduce cost, and increase QALY. More large-scale, high-quality randomized controlled trials are needed to evaluate the effect of nutrition support on the QALY of elderly patients with nutritional risk.