原发性肝癌营养不良三级诊断的营养筛查手段和评价工具

Nutrition screening methods and evaluation tools for Three-level diagnosis of malnutrition in primary liver cancer

为合理选择营养筛查方法和评价工具,准确测定原发性肝癌患者的营养状态,本资料以中国抗癌协会确立的营养不良三级诊断为依据,查阅国内外文献,就适用于原发性肝癌患者的一级诊断(营养筛查)、二级诊断(营养评估)和三级诊断(综合测定)的方法和评价工具进行归纳分析。一级诊断包括NRS2002、MUST和BMI。NRS2002适用于原发性肝癌患者的营养筛查,MUST敏感性差,BMI是最直接、最简单的营养筛查指标,因易受体成分影响不宜作为独立筛查手段用于原发性肝癌患者。二级诊断包括主观全面评估工具SGA、PG-SGA和MNA。PG-SGA是原发性肝癌患者营养不良的敏感评估工具,SGA、MNA敏感性差。三级诊断除病史采集、体格和体能检查外,人体学测量上臂围、肱三头肌皮褶厚度和手握力,因直接、客观,对测定原发性肝癌患者营养不良有较高的准确性,实验室检查外周血淋巴细胞总数、白蛋白、前白蛋白欠敏感,生物电阻抗分析和L3骨骼肌指数能够精确反映原发性肝癌患者营养状况,但易受设备、条件的影响,不利于临床大范围使用。综合显示NRS2002、PG-SGA是原发性肝癌患者首选的营养筛查手段和评价工具,结合上臂围、肱三头肌皮褶厚度、手握力、生物电阻抗分析、L3骨骼肌指数等指标综合测定,可以准确评定原发性肝癌患者的营养状态。

The aim of this paper is to rationally select nutritional screening methods and evaluation tools and accurately determine the nutritional status of patients with PLC.This paper is based on the three-level diagnosis of malnutrition established by the Chinese Anti-cancer Association.By reviewing domestic and abroad literature,the methods and evaluation tools of the first-level diagnosis(nutritional screening),the second-level diagnosis(nutritional assessment)and the third-level diagnosis(comprehensive evaluation)for PLC patients were summarized and analyzed.The first-level diagnosis methods include NRS 2002,MUST and BMI.NRS-2002 is suitable for nutritional screening of PLC patients while the sensitivity of MUST is poor.BMI is the most direct and simplest nutritional screening method.It is not suitable to be used as an independent screening method for PLC patients because it is easily affected by body weight.The second-level diagnosis methods include SGA,PG-SGA and MNA.PG-SGA is a sensitive assessment tool for malnutrition among PLC patients.The sensitivity of SGA and MNA is poor.In addition to medical history collection,physical aptitude and physical examination,three-level diagnosis includes anthropological measurements of MAC,TSF and HGS,which has a higher accuracy in the determination of malnutrition in PLC patients because its directness and objectivity.Laboratory examination of TLC,ALB,PA,which has a poor sensibility,BIA and L3-SMI,which is able to accurately reflect the nutritional status of PLC patients and is not suitable for large-scale clinical use because it is easily affected by equipment and conditions.The results showed that NRS 2002 and PG-SGA are the preferred nutritional screening method and evaluation tools for PLC patients.Combined with MAC,TSF,HGS,BIA and L3-SMI,the nutritional status of PLC patients are able to be accurately evaluated.