不同营养评定(诊断)方法在胃癌围术期患者中的相关性研究

Research on the relationship between different nutritional assessment(diagnosis)methods in perioperative patients with gastric cancer

目的评价胃癌围手术期患者的营养状况,探讨不同营养评定(诊断)方法之间的相关性,以期指导临床选择合适的营养评定工具。方法选择2019年6月至12月南京医科大学第一附属医院普外科胃病区收治的123例胃癌围手术期患者,分别使用营养不良评定标准全球领导人共识(GLIM)、欧洲临床营养和代谢学会制定的营养不良诊断标准(ESPEN)及患者主观整体评估(PG-SGA)对患者进行营养评定,采用生物电阻抗技术测量患者的人体组成评定指标,并收集患者近期的血红蛋白、清蛋白、总蛋白、视黄醇结合蛋白值及手握力值,采用Kappa一致性检验分析GLIM、ESPEN及PG-SGA评定结果的一致性,Spearman相关分析GLIM与人体组成评定指标及其他方法间的相关性。结果GLIM与ESPEN评定结果的一致性较好(Kappa=0.267,P=0.010);营养不良组的血红蛋白(111.9±15.8)g/L、清蛋白(33.8±3.8)g/L、脂肪组织(FM)(14.5±5.3)kg、脂肪组织百分比(FM%)(23.9±7.7)%、去脂体质指数(FFMI)(16.0±3.1)kg/m2均低于营养良好组[数值分别为(121.9±16.6)g/L、(36.4±4.3)g/L、(18.8±6.0)kg、(28.1±8.7)%、(17.6±1.9)kg/m2],差异有统计学意义P<0.05);GLIM评定结果与FM、FM%及FFMI间呈负相关(r分别为-0.392、-0.283、-0.299,均P<0.05),与ESPEN评定结果呈正相关(r=0.283,P=0.015)。结论GLIM与ESPEN标准评定结果间存在一致性,但一致性水平较低。临床对患者进行营养评定时,应综合运用GLIM诊断标准、血液生化指标及人体组成评定指标FM、FM%、FFMI,以便更全面、准确地对胃癌围手术期患者进行营养评定。

Objective To investigated the nutritional status of perioperative patients with gastric cancer,in order to explore the correlation among different nutritional assessment methods and provide a guideline for the selection of optimal nutritional assessment tools.Methods A total of 123 perioperative gastric cancer patients admitted in the department of gastric surgery of the First Affiliated Hospital with Nanjing Medical University from June to December 2019 were included.The nutritional status of patients was assessed by Global Leader Initiative on Malnutrition(GLIM),European Society for Parenteral and Enteral Nutrition(ESPEN)and patient-generated subjective global assessment(PG-SGA),respectively.The technology of bioelectrical impedance was used to analyze the body composition of the patients.The recent data of hemoglobin,albumin,total protein,retinol binding protein and hand grip strength of the patients were collected.Kappa consistency test was utilized to analyze the consistency among GLIM,ESPEN and PG-SGA results.Spearman correlation analysis was performed to explore the correlation among GLIM,body composition assessment and others.Results GLIM was well consistent with ESPEN(kappa=0.267,P=0.010).Moreover,hemoglobin(111.9±15.8)g/L,albumin(33.8±3.8)g/L,fat mass(14.5±5.3)kg,fat mass percentage(23.9±7.7)%,and free fat mass index(16.0±3.1)kg/m2 in malnutrition group were significantly lower than that in good nutrition group([121.9±16.6]g/L、[36.4±4.3]g/L、[18.8±6.0]kg、[28.1±8.7]%、[17.6±1.9]kg/m2,respectively).Additionally,fat mass,fat mass percentage,and free fat mass index were negatively correlated with GLIM evaluation results(r=-0.392,-0.283,-0.299,P<0.05).In contrast,GLIM evaluation results were positively associated with ESPEN evaluation results(r=0.283,P=0.015).Conclusions Although there is positive relationship between the evaluation results of GLIM and ESPENC,the level of consistency is low between them.GLIM diagnostic standard should be used in combination with body composition,in order to evaluate the nutritional situation of patients comprehensively and accurately.