微型营养评定精法在老年恶性肿瘤住院患者应用的多中心研究

The application value of mini-nutritional assessment short-form in screening and evaluating nutritional status in the elderly hospitalized patients with malignant tumor： a multicenter study

目的探讨微型营养评定精法（MNA—SF）在筛查和评价老年恶性肿瘤住院患者营养状态的应用价值。方法2012年4—5月对≥65岁的老年恶性肿瘤住院患者，应用MNA—SF的方法，进行前瞻性调查研究，了解其营养状态；总结临床结局指标，并分析MNA—SF与体重指数（BMI）、握力和营养风险筛查2002（NRS2002）结果的一致性；分析不同营养状态与临床结局的相关性。结果本研究纳入符合人选标准及不符合排除标准的各种老年恶性肿瘤患者1472例，平均（72．1±5．9）岁，BMI（22．3±3．7）kg／m2，握力（21．7±19．0）kg；老年恶性肿瘤患者营养不良发生率为16．7％，胰腺癌30．9％、胆管癌24．1％、食管癌21．2％居前三位，乳腺癌5．4％发生率最低；营养不良和营养不良危险合并为存在营养问题者，本组发生率为59．2％（营养不良16．7％＋营养不良危险42．5％），其中胆管癌82．8％最高，乳腺癌28．6％最低；MNA—SF识别的营养不良（评分在0～7分）与BMI诊断的营养不良（〈18．5）的一致性高度符合；而与握力诊断的营养不良一致性较差；MNA—SF识别的存在营养问题（营养不良＋营养不良危险）与NRS2002发现的营养风险（评分≥3分）结果一致性高度符合；存在营养问题（营养不良及营养不良危险）的老年恶性肿瘤患者感染并发症为9．29％，高于营养正常者的5．14％（P=0．006）；总住院时间为（15．4±10．7）d，长于营养正常者的（12．8±10．4）d（P=0．00）。结论老年恶性肿瘤的住院患者营养不良和营养不良危险发生率较高，并且可能恶化临床结局，MNA—SF可用于老年肿瘤患者的营养筛查。

Objective To investigate the application value of mini-nutritional assessment short form（MNA-SF） in screening and evaluating nutritional status in elderly hospitalized patients with malignant tumor. Methods 1472 elderly hospitalized patients（≥65 years old）with malignant tumor were enrolled and prospectively studied for evaluating the nutritional status by nutritional risk screening 2002 （NRS 2002） assessment. Indicators of clinical outcomes were summarized. The consistencies of MNA-SF with body mass index（BMI）,grip and results of NRS 2002 assessment,and the relationship between the different nutritional status and clinical outcomes were analyzed. Results The patients meeting the inclusion/exclusion criteria were aged （ 72.1 ± 5.9） years, with BMI of（22.3 ±3.7）kg/m2 and grip of（21.7±19.0）kg. Among 16.7% of the malnourished patients with malignant tumors, pancreatic cancer （ 30.9 %）, bile duct cancer （ 24.1 % ） and esophageal cancer （ 21.2 % ） occupied the top three incidence of malnutrition, with the lowest （5.4%）incidence in breast cancer. Among 59.2% of patients being malnourished （16.7%）or at risk （42.5%）of malnutrition, the highest incidence was in bile duct cancer（82. 8%）, and lowest one was in breast cancer（28.6%）. MNA-SF- discriminated malnutrition（0-7 points）showed a great agreement with malnutrition evaluation by BMI（〈18.5） ,but had a poor agreement with grip in screening malnutrition. MNA-SF-discriminated nutrition problem（malnourishment plus at risk of malnutrition）showed a great agreement with NRS 2002-discovered nutrition problem （score ≥ 3 ）. Under-nourished patients had a higher infection complication（9.29% vs. 5.14% ,P=0. 006）and longer hospital stays（15.4 d vs. 12.8 d,P〈0.01）as compared with patients with normal nutrition status. Conclusions The prevalence and risk factors for malnutrition are higher in elderly patients with malignant tumor. Poor nutritional status is correlated with poor clinical outcomes. MNA-SF can be used as a tool for evaluating the nutritional status of elderly patients with malignant tumor.