GLIM标准“一步法”和“两步法”评估住院肿瘤病人营养不良的一致性研究

Consistency of"One-step"vs"Two-step"methods in malnutrition assessment according to global leadership initiative on malnutrition(GLIM)criteria among hospitalized patients with malignancy

目的:按全球领导人营养不良倡议(GLIM)诊断标准,探讨直接采用GLIM标准诊断(一步法)和先进行营养风险筛查再按GLIM标准诊断(两步法)在住院恶性肿瘤病人中应用的一致性。方法:采用系统抽样方法抽取2019年1月至2020年12月宜宾市第一人民医院住院治疗的恶性肿瘤病人625例,同一病人分别采用“一步法”和“两步法”进行营养不良诊断,比较“一步法”和“两步法”在肿瘤病人营养不良诊断中的一致性。结果:625例恶性肿瘤病人营养风险发生率为53.3%(333/625),不同年龄段、肿瘤类型和肿瘤分期的肿瘤病人营养风险发生率差异有统计学意义(P<0.05)。5个GLIM表型指标,体质量下降、低BMI、肌肉减少、进食减少或消化功能障碍和疾病或炎症负担发生率分别为37.0%(231/625)、18.4%(115/625)、41.6%(260/625)、68.0%(425/625)和38.2%(239/625)。GLIM标准“一步法”和“两步法”诊断营养不良阳性率分别为49.8%(311/625)和38.6%(241/625)。“一步法”和“两步法”诊断的营养不良阳性率都有年龄段、肿瘤类型和肿瘤分期差异(P<0.05)。“一步法”和“两步法”诊断营养不良的一致性较好,kappa值为0.58,若以“两步法”为金标准,“一步法”诊断营养不良的灵敏度为87.1%,特异度为73.7%。结论:恶性肿瘤病人营养风险和营养不良发生率较高,GLIM标准“两步法”和“一步法”诊断营养不良的一致性良好,但需要更多前瞻性研究验证。

Objective:To evaluate the consistency of direct diagnosis by Global Leadership Initiative on Malnutrition(GLIM)criteria(One-step method)versus nutritional risk screening prior to diagnosis(Two-step method)in malnutrition assessment among hospitalized patients with malignancy.Methods:From January 2019 to December2020,625 patients with malignancy were selected from the first people's hospital of Yibin and malnutrition was assessed by GLIM one-step and two-step method respectively.The consistency of two procedures in diagnosing malnutrition was compared.Results:The incidence of nutritional risk among patients with malignancy was 53.3%(333/625),and influenced by age,tumor types and tumor stages(P<0.05).Among the five phenotypes of GLIM criteria,the incidence of weight loss,low body mass index(BMI),skeletal muscle loss,reduced food intake or digestive dysfunction and disease burden or inflammation was 37.0%(231/625),18.4%(115/625),41.6%(260/625),68.0%(425/625)and 38.2%(239/625),respectively.According to the GLIM criteria,the rate of malnutrition diagnosed by"one step method"and"two-step method"was 49.8%(311/625)and 38.6%(241/625),respectively.The rate of malnutrition was significantly different in patients with different age,tumor type and tumor stage(P<0.05),as evaluated by either"one-step method"or"two-step method".There was a good consistency between"one-step method"and"two-step method"in diagnosing malnutrition with kappa value at 0.58.Taken"two-step method"as reference,the sensitivity and specificity of"one-step method"in diagnosing malnutrition are 87.1% and 73.7% respectively.Conclusion:The incidence of nutritional risk and malnutrition among patients with malignancy is high.The consistency between GLIM"two-step method"and’’onestep method’’is high,and more prospective studies are needed to confirm our findings.