营养不良GLIM诊断标准第一步是营养筛查及按中国疾病代码填写营养风险、营养不良于出院病案首页等注意事项

Three steps of Global Leadership(nutritional field)Initiative on Malnutrition(GLIM)and fill the diseases name(Chinese version ICD-10 listed)"nutritional risk"and"malnutrition"on front page of discharge medical record for letting big-data to find it to design the DRG contents for China

多年来,全球肠外肠内营养学界同道们都在寻求营养不良诊断标准的统一,既需要确定营养不良诊断标准,也需要考虑营养不良指标在不同国家、不同种族的正常值和按临床研究得到的切割点(cut-off point)。全球(营养)领导层倡议营养不良(Global Leadership Initiative on Malnutrition,GLIM)诊断标准于2018年9月在美国肠外肠内营养学会(American Society for Parenteral and Enteral Nutrition,ASPEN)和欧洲临床营养和代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)网站发表。2019年初在纸质版杂志《JPEN》及《Clinical Nutrition》发表。GLIM在《全国科学技术名词审定委员会-肠外肠内营养学分名词-2019》有记载。GLIM中的某些阈值可能会随着时间的推移而有演变,但是从主观评定营养不良(如SGA、PG-SGA),发展到用表现型指标、病因型指标诊断营养不良的方向是正确的。高质量的前瞻性临床有效性验证报告和前瞻性多中心临床应用数据分析,将是GLIM改进的基础。2016年《疾病分类与代码》GB/T(中国ICD-10扩充版)及2019年《关于全国三级公立医院绩效考核通知〔2019〕》以及国家医保局信息业务数据库等三个方面文件均收录了营养风险、营养不良、重度(严重)营养不良作为疾病名称。目前临床各学科都在推行个体化医疗,但是临床各科室的实际情况不同。对肠外肠内营养支持疗法的临床应用来说,与对癌症患者的精准医疗、靶向治疗是有很大的距离。2004年12月,中华医学会肠外肠内营养学分会(Chinese Society for Parenteral and Enteral Nutritional,CSPEN)常委会组建营养风险-不足-营养支持-结局-成本效果比(Nutritional risk-undernutrition-support-outcome-cost effectiveness ratio,NUSOC)多中心分享数据库协作组,该协作组的目标是分出哪些患者需要肠外肠内营养支持疗法,合理应用前提下让患者受益。中国的疾病诊断相关分组(Diagnosis Related Groups,DRG)正在用采集大数据办法来完善DRG(初级阶段DIP,即按病种打包)的制定,就需要让大数据收集系统看到有代码的营养风险和营养不良两个疾病名称,需要填写在出院病案的首页。

Global leading scholars in the field of parenteral and enteral nutrition have been seeking for the criteria of diagnosis of malnutrition.In determining the diagnostic criteria for malnutrition,it is also necessary to take into account the normal values and clinically obtained cut-off points of different countries and races.The Global Leadership(nutrition field)Initiative on Malnutrition,GLIM)diagnostic criteria published online on Sep.2&Sep.32018.In January&February 2019,the[American Society for Parenteral and Enteral Nutrition,ASPEN]and the[European Society for Clinical Nutrition and Metabolism,ESPEN]published in print.The GLIM criteria has also been recorded in[National terminology of parenteral and enteral nutrition of China-2019].In 2016"Disease Classification and Code(Chinese expanding version of ICD-10)"having"nutritional risk"and"malnutrition"items officially listed.In 2019"Notice on National Tertiary Public Hospitals"and in the"National Medical Insurance Administration-coding standard"also include the items of"nutritional risks"and"malnutrition"as diseases name.Although promoting individualized medical therapy in China now,but the actual situation of each clinical department is different.As far as parenteral and enteral nutrition is concerned,it was far from"precision medicine"or"targeted therapy"in clinical practice nowadays.The current aim is to identify which patients need nutrition support therapy for reasonable application-benefit to patient.China's DRG being developed by"big data survey system".Therefore,it is necessary for"this system"can find nutritional risk and malnutrition as diseases name with the codes from Chinese expanding version of ICD-10.So,nutritional risk and malnutrition need to be filled in the cover page of discharged medical record.