GLIM中两种筛查工具对住院老年人营养不良的诊断价值比较

Comparison of two screening tools in GLIM for the diagnosis of malnutrition in hospitalized elderly

目的:分析全球领导人发起的营养不良诊断共识(GLIM)两步骤中不同营养筛查工具和不同标准组合诊断住院老年人营养不良的一致性。方法:回顾性选取2019年6月至2020年6月浙江医院老年病科住院的130例(≥65岁)老年患者,收集受试者一般资料并完成简易微营养评定法(MNA-SF)、营养风险筛查2002评分(NRS2002)等问卷评估,营养筛查阳性的患者按GLIM第二步符合至少一项病因学标准及一项临床学标准诊断为营养不良。Kappa值分析NRS2002、MNA-SF分别作为GLIM第一步营养筛查工具诊断营养不良的一致性和GLIM第二步2种病因学标准分别与各项临床学标准组合下诊断营养不良的一致性。同时通过Logistic回归分析确定营养不良的独立影响因素。结果:采用NRS2002和MNA-SF分别作为筛查工具,最终诊断营养不良患者23例(17.69%)、25例(19.23%),一致性较高(Kappa=0.71,P<0.001)。NRS2002和MNASF均筛为阳性的营养不良患者中符合非自主性体质量丢失分别与两项病因学标准组合诊断营养不良一致性一般(Kappa=0.59,P=0.003);肌肉量减少与两项病因学标准各自组合诊断一致性也一般(Kappa=0.51,P=0.007)。而低体质量指数(BMI)与两项病因学标准组合一致性较差(Kappa=0.26,P=0.188)。Logistic回归分析显示抑郁情绪、失眠是老年住院患者营养不良的独立危险因素(P <0.05)。结论:NRS2002及MNA-SF分别作为GLIM第一步筛查工具时诊断营养不良的一致性较高,可以互相替代。GLIM第二步符合各项临床学与病因学标准组合中,符合非自主性体质量丢失或肌肉量减少与两项病因学标准各自组合的一致性一般。

Objective: To analyze the consistency of the results of different nutrition screening tools and different combinations of criteria in diagnosing malnutrition of the global leadership initiative on malnutrition(GLIM). Methods: A total of 130 elderly patients(≥ 65 years old) who were hospitalized in the Geriatrics Department of Zhejiang Hospital from June 2019 to June 2020 were retrospectively selected. The NRS2002and other questionnaires were evaluated, and the patients with positive nutrition screening were diagnosed as malnutrition according to the second step of GLIM who met at least one etiological criterion and one clinical criterion. Kappa value analysis of the consistency of NRS2002 and MNA-SF as the first step of GLIM nutritional screening tool for diagnosing malnutrition and the consistency of the two etiological criteria combined with various clinical criteria respectively for diagnosing malnutrition. At the same time, the independent influencing factors of malnutrition were determined by Logistic regression analysis. Results: Using NRS2002 and MNA-SF as screening tools, 23(17.69%) and 25(19.23%) malnourished patients were finally diagnosed, with high consistency(Kappa=0.71, P<0.001). In malnutrition patients screened positive for both NRS2002 and MNA-SF, consistency in diagnosing malnutrition with the combination of involuntary weight loss and the two etiological criteria was moderate(Kappa=0.59, P=0.003), the diagnostic agreement between muscle loss and the respective variety of the two etiological criteria was also moderate(Kappa=0.51, P=0.007). However, low body mass index(BMI) was less consistent with the combination of the two etiological criteria(Kappa=0.26, P=0.188). In addition, logistic regression analysis showed that depression, insomnia were independent risk factor of malnutrition in elderly hospitalized patients(P<0.05). Conclusion: When NRS2002 and MNA-SF are used as the first screening tools of GLIM, the consistency of diagnosis of malnutrition is high, and they can be substituted for each other. In the standard combination of the second step of GLIM, meeting involuntary weight loss or muscle mass loss with each combination of the two etiological criteria was moderately consistent.