中上臂围和三头肌皮褶厚度在肿瘤患儿营养评估中的应用研究

Application of middle and upper arm circumference and triceps skinfold thickness in nutritional evaluation of children with tumor

目的探讨中上臂围(MUAC)和三头肌皮褶厚度(TSFT)在肿瘤患儿营养评估中的应用价值。方法纳入2020年1月至2021年12月华中科技大学协和东西湖医院/武汉市东西湖区人民医院162例肿瘤患儿为研究对象,根据双能X射线吸收法评估患儿营养状态,并根据患儿营养状态分为营养不良组(68例)和正常组(94例),营养不良组男35例,女33例;年龄(8.12±2.01)岁;正常组男58例,女36例;年龄(7.89±1.59)岁。测量所有患儿MUAC、TSFT水平及体质指数、白蛋白水平、前白蛋白水平;采用Spearman相关系数分析MUAC、TSFT水平与体质指数、白蛋白水平、前白蛋白水平的相关性;并分析比较MUAC、TSFT水平单独诊断及联合诊断肿瘤患儿营养不良的价值,诊断价值使用Kappa值表示。结果肿瘤患儿MUAC、TSFT、体质指数、白蛋白、前白蛋白水平略低;Spearman分析显示,MUAC、TSFT与体质量指数、白蛋白、前白蛋白均具相关性(P<0.05),且MUAC在正常组与营养不良组中与白蛋白的相关性更强,TSFT在营养不良组不良组与白蛋白相关性更强,在正常组与前白蛋白相关性更强;MUAC、TSFT诊断肿瘤患儿营养不良的Kappa值分别0.886和0.897,均高于体质指数的0.860及白蛋白联合前白蛋白的0.885,但低于MUAC联合TSFT诊断的0.949(P<0.05)。结论MUAC、TSFT均可用于临床肿瘤患儿营养不良的诊断,但两者联合诊断临床价值更高。

Objective To explore the application value of mid-upper arm circumference(MUAC)and triceps skinfold thickness(TSFT)in nutritional evaluation of children with tumor.Method From January 2020 to December 2021,162 children with tumor in Department of Pediatrics Union East West Lake Hospital and The Second Department of Pediatrics Huangpi District People's Hospital were selected as the research objects.According to the dual-energy X-ray absorption method,the nutritional status of children was evaluated,and they were divided into malnutrition group and normal group according to their nutritional status.The levels of MUAC,TSFT,body mass index,albumin and prealbumin in all children were measured.Spearman correlation coefficient was used to analyze the correlation between MUAC and TSFT levels and body mass index,albumin level and prealbumin level.The value of MUAC and TSFT levels in diagnosis of malnutrition in children with tumor alone and jointly was analyzed and compared,and the diagnostic value was expressed by Kappa value.Result The levels of MUAC,TSFT,BMI,albumin and prealbumin in children with tumor were lower than the reference values.Spearman analysis showed that MUAC and TSFT had correlation with body mass index,albumin and prealbumin(P<0.05).moreover,MUAC had a stronger corelation with albumin in the normal group and the malnutrition group.TSFT had a stronger correlation with albumin in the malnutrition group and with prealbumin in the normal group.Kappa values of MUAC and TSFT were 0.886 and 0.897,respectively,which were higher than 0.860 of BMI and 0.885 of albumin combined with prealbumin,but lower than 0.949 of MUAC combined with TSFT(P<0.05).Conclusion Both MUAC and TSFT can be used in the diagnosis of malnutrition in children with clinical tumors,but their combined diagnosis has higher clinical value.