重庆某三甲教学医院用NRS 2002及诊断营养不良(GLIM)标准对癌症患者营养风险和营养不良患病率调查研究初探

Preliminary investigation on the prevalence of nutritional risk and malnutrition in cancer patients using NRS 2002 and malnutrition diagnosis(GLIM)criteria in a tertiary(A)teaching hospital in Chongqing

目的以3种营养不良诊断及评定标准对2个病区癌症患者进行营养不良患病率横断面小样本调查研究。为防止应用全球(营养)领导人对营养不良标准(global leadership initiative on malnutrition,GLIM)中第二步诊断流程可能发生的偏差,提高GLIM在国内应用的理解与认知。方法采用定点整群抽样方法,对2019年2—5月在重庆医科大学附属第三医院肿瘤科和胸外科的住院癌症患者用营养风险筛查2002评分(NRS 2002)进行营养风险筛查;应用包含GLIM标准第二步在内的3种营养不良诊断及评定标准,比较不同标准所得的营养不良患病率,观察其中互相制约的差异。针对GLIM第二步阳性患者,进一步分析重度营养不良患病率。结果总共449例癌症患者中,NRS 2002阳性有85例,营养风险患病率为18.9%。上述患者中,采用体重指数(body mass index,BMI)<18.5 kg/m^2伴一般情况差的标准(简称BMI标准)评定的营养不良有28例,阳性率为6.2%;采用NRS 2002标准3分(简称NRS 2002标准)评定的营养不良有50例,阳性率为11.1%;根据GLIM标准诊断的营养不良有52例,阳性率为11.6%,与采用BMI标准评定的营养不良患病率差异有统计学意义(P<0.05)。进一步对52例GLIM阳性患者进行分析发现:降低的食物摄入或吸收、疾病负担或炎症状态等2个病因型指标分别有49例和52例,占GLIM阳性患者的94.2%和100%;体重下降、低BMI等2个表现型指标则分别有39例和19例,占GLIM阳性患者的75.0%和36.5%。按GLIM流程第三步诊断重度营养不良有34例,占GLIM阳性患者的65.4%。结论研究的两组癌症患者营养风险筛查阳性率为18.9%;利用BMI标准、NRS 2002标准以及GLIM标准进行诊断或评定的营养不良患病率分别为6.2%、11.1%和11.6%。在对癌症患者的营养不良诊断或评定中,GLIM标准及BMI标准、NRS 2002标准有互相制约的差异。

Objective To perform a cross-sectional study in a small sample of cancer patients using three nutritional diagnosis or assessment tools including Global Leadership Initiative on Malnutrition(GLIM)criteria.Methods The hospitalized patients with malignant tumors in Department of Oncology and Department of Thoracic Surgery in The Third Affiliated Hospital of Chongqing Medical University were selected from February 2019 to May 2019 via cluster sampling.Nutritional risk was screened using NRS 2002.Three methods including GLIM criteria were also applied in the assessment of malnutrition in patients.Results Among 449 patients with malignant tumors,85 cases were at nutritional risk as per NRS 2002,amounting to a prevalence of 18.9%.There were 28 cases(6.2%)assessed as malnutrition as per low body mass index(BMI)criteria(BMI<18.5 kg/m^2+impaired general condition)and 50 cases(11.1%)as per NRS 2002(≥3 scores for impaired nutrition status).However,52 cases(11.6%)were diagnosed as malnutrition as per GLIM criteria,which was significantly different with the results as per BMI criteria(P<0.05).Further analysis of 52 GLIM positive cases showed:for etiologic criteria,reduced food intake or assimilation was present in 49(94.2%)cases and disease burden/inflammation was present in 52(100%)cases;for phenotypic criteria,non-volitional weight loss,39(75.0%)cases and low BMI,19(36.5%)cases;34 cases were assessed as with severe malnutrition according to the severity grading step in GLIM criteria.Conclusions In this study,the positive rate of nutritional risk screening was 18.9%;the prevalence of malnutrition assessed as per BMI criteria,NRS 2002,and GLIM criteria,was 6.2%,11.1%and 11.6%,respectively.According to the above three criteria,there may be mutually limiting differences in the diagnosis or assessment of malnutrition among cancer patients in this study.