四种营养风险筛查工具对肺结核患者的适用性评价

Assessment of the applicability of four kinds of nutritional risk screening tools in tuberculosis patients

目的评价营养风险筛查2002（NRS2002）、微型营养评定法（MNA）、营养不良通用筛查工具（MUST）、主观全面评定法（SOA）4种常用营养风险筛查工具对肺结核患者的适用性。方法按住院号连续选取2016年3月广州市胸科医院新人院肺结核患者124例进行问卷调查，内容包括患者一般情况调查表、NRS2002评分表、MNA评分表、MUST评分表、SGA评分表，共发出调查问卷124份，回收有效问卷110份，有效率为88．71％；同时测量白蛋白（Alb）及计算体质量指数（BMI），以BMI〈18．5（和）或Alb≤30g／L为营养不良评价标准，计算4种筛查工具与营养不良评价标准的敏感度、特异度、阳性预测值、阴性预测值、一致率。结果肺结核患者总营养不良发生率为47．27％（52／110），其中蛋白一能量营养不良发生率为38．18％（42／110）、蛋白营养不良及混合性营养不良发生率均为4．55％（5／110）。4种营养风险筛查工具对结核病患者营养风险评价存在较大差异，NRS2002筛查出存在营养风险的患者为57例（51．82％）、MNA筛查出存在营养风险的患者为89例（80．91％）、MUST筛查出存在营养风险的患者为52例（47．27％）、SGA筛查出存在营养风险的患者为9例（8．18％），4种营养风险筛查工具营养风险检出率比较，差异有统计学意义（X^2=118．33，P〈0．01）。NRS2002筛查时间为（4．03±0．25）min、MNA筛查时间为（8．99±1．25）min、MUST筛查时间为（4．06±0．31）min、SOA筛查时间为（4．18±0．56）min，差异有统计学意义（F=1292．88，P〈0．01）。结论NRS2002较其他3种筛查工具更适用于肺结核患者临床营养风险筛查。

Objective To assess the applicability of the four kinds of common nutritional risk screening tools, nutritional risk screening 2002 （NRS2002）, mini nutritional assessment （MNA）, malnutrition universal screening tool （MUST） and subjective comprehensive evaluation method （SGA）） in the patients with tuberculosis （TB）. Methods Based on the inpatient number, 124 pulmonary TB patients admitted into Guangzhou Chest Hospital in March 2016 were continuously enrolled in this assessment and received the questionnaire investigations with the following forms： general information form, NRS2002 form, MNA form, MUST form and SGA form. A total of 124 questionnaires were sent out and 110 valid questionnaires were collected, the questionnaire-reclaiming efficiency was 88. 71~. Meanwhile, albumin （Alb） and body mass index （BMI） were measured. BMI 〈18.5 and/or Alb 430 g/L was regarded as the standard of malnutrition. The sensitivity, specificity, positive predictive value, nega tive predictive value and consistence rate of the 4 kinds of nutritional risk screening tools were calculated respectively by comparing with the malnutrition standard. Results The overall incidence of malnutrition was 47.27% （52/110） in TB patients, and of whom 38.18% （42/110） were protein-energy malnutrition and 4.55% （5/110） were protein-malnutrition or mixed malnutrition. The assessment results of four kinds of nutritional risk screening tools were significantly different in the nutritional risk assessment to TB patients. The number of TB patients with malnutrition who were screened out by NRS2002, MNA, MUST and SGA, were 57 （51.82% ）, 89 （80.91 %）, 52 （47.27%） and 9 （8.18%） respectively. There was significant difference in the detection rate of nutritional risk be tween the 4 kinds of nutritional risk screening tools （X^2=-118. 33, P〈0.01）. The screening time by using NRS2002, MNA, MUST and SOA was （4.03±0.25） minutes, （8.99±1.25） minutes, （4. 06±0.31） minutes and （4.18±0.56） minutes respectively. There were significant differences in the screening time of the 4 nutritional risk screening tools （F=1292.88, P〈0. 01）. Conclusion Compared with the others, NRS2002 is the most suitable nutritional risk screening tool used for pulmonary TB patients.