恶性肿瘤患者营养不良发生率调查及诊断指标探讨

Incidence of malnutrition among malignant patients and exploration on relationship of NRS-2002 with diagnosis indexes

目的用《营养不良筛查指南2002》(NRS-2002)调查恶性肿瘤初诊患者营养不良发生情况,探讨NRS-2002评分与体格检查指标和生化指标的相关性。方法根据住院号采用单纯随机抽样抽取住院的初诊恶性肿瘤患者496例,用NRS-2002进行营养风险筛查,同时进行体格检查,计算对应指标[包括体质量指数(BMI)、肱三头肌皮褶厚度(TSF)、上臂围(MAC)、上臂肌围(MAMC)和去脂体质量指数(FFMI)],测定血生化指标[包括血红蛋白(Hb)、白蛋白(ALB)和前白蛋白(PA)],分析NRS-2002评分与体格检查指标和生化指标的相关性。结果 496例初诊恶性肿瘤患者营养不良风险(NRS-2002≥1分)发生率47.0%,营养不良(NRS-2002≥3分)发生率11.1%,不同年龄段和不同肿瘤类型间营养不良风险发生率差异有统计学意义(P<0.05)。NRS-2002评分与2个体格检查指标(BMI和FFMI)有关联,其关联系数r分别为0.37和0.25;NRS-2002评分和3个生化指标(Hb、ALB和PA)也存在关联性,其关联系数r分别为0.11、0.47和0.12(P<0.05)。结论恶性肿瘤患者营养风险和营养不良发生率较高,老年和消化系统肿瘤患者尤甚。NRS-2002适合作为恶性肿瘤患者营养风险筛查工具,但在临床应用中应结合患者的体格检查指标和生化指标进行全面综合营养评估。

Objective To investigate the prevalence of malnutrition among first-diagnosed patients with malignancy and to explore the relationship between NRS-2002 and indexes of physical examination and biochemical indicators.Methods By simple random sampling according to the admission number,496 first-diagnosed patients with malignancy were randomized to screen nutrition risk by NRS-2002,and obtain the related physical examination indexes,including body mass index,triceps skinfold thickness,upper-arm circumference,arm muscle circumference and fat free mass index,and biochemical indicators including hemoglobin,albumin and prealbumin.Simultaneously the relevance was analyzed between NRS-2002 and indexes of physical examination and biochemical indicators.Results The incidence rate of nutrition risk（the score of NRS-2002≥1）and malnutrition（the score of NRS-2002≥3）were 47.0% and 11.1%respectively among 496 first-diagnosed patients with malignancy.The significant differences of malnutrition incidence rate were observed among different age brackets and tumor types（P〈0.05）.The relevance also was observed between NRS-2002 and 2 physical indexes（BMI and FFMI）with the correlation coefficient 0.37 and 0.25 respectively and 3 biochemical indicators（Hb,ALB and PA）with the correlation coefficient 0.11,0.47 and 0.12 respectively（P〈0.05）.Conclusions The incidence rate of nutrition risk and malnutrition are very high among patients with therioma,especially among old patients or patients with gastrointestinal cancer.NRS-2002 is a suitable nutritional risk screening tool for malignant patients,but a comprehensive nutrition assessment should combine proper nutritional risk screening tool with physical examination indexes and biochemical indicators in clinical applications.