改良版NRS2002在急性创伤骨折患者营养风险筛查中的效果评价

Evaluation of the effect of modified NRS2002 in nutritional risk screening in patients with acute traumatic fractures

目的将营养风险筛查表(nutritional risk screening,NRS2002)与改良版营养风险筛查表(改良版NRS2002)应用于创伤性骨折患者的营养评估中,评估2种筛查表达的检验效能,以便合理选择筛查工具,及时发现创伤性骨折患者营养不足并给予支持。方法选取因急性创伤收治的骨折患者271例,采用NRS2002及改良版NRS2002对患者进行营养风险筛查,分析2种筛查工具的敏感度、特异度,再通过计算Kappa值判断2种筛查工具的一致性,并验证体格检查指标及实验室指标与营养风险的相关性。结果271例患者中,NRS2002筛查出有营养风险的患者68例(25.1%),改良版NRS2002筛查出有营养风险的患者103例(38.0%)。传统NRS2002筛查和改良版NRS2002筛查得出的存在营养风险的患者(≥3分)上臂围(arm muscle circumference,AMC)、肱三头肌皮褶厚度(triceps skinfold,TSF)、握力(grip strength,GS)、总蛋白(total protein,TP)、白蛋白(albumin,ALB)、前白蛋白(prealbumin,pALB)、钙、磷、镁、红细胞(red blood cell,RBC)和血红蛋白(hemoglobin,HGB)均低于不存在营养风险者,小腿围(calf circumference,CC)、氯、白细胞(white blood cell,WBC)和C反应蛋白(C-reactive protein,CRP)均高于不存在营养风险者(P<0.05)。采用改良版NRS2002及NRS2002筛查出的存在营养风险患者(≥3分)的体格检查指标及化验指标差异无统计学意义。改良版NRS2002及NRS2002筛查结果一致性检验良好(Kappa=0.673,P<0.05),改良版NRS2002营养风险筛查表ROC曲线下面积为0.894。1周后,对不存在营养风险(<3分)的患者进行复筛时发现NRS2002复筛的阳性率明显高于改良版NRS2002(P<0.05)。AMC、TSF、GS、ALB、pALB、HGB与NRS2002、改良版NRS2002均呈负相关(P<0.05);CC与NRS2002、改良版NRS2002呈正相关(P<0.05)。结论改良版NRS2002及NRS2002的筛查结果一致性一般,在营养风险筛查方面改良版NRS2002敏感度较高,且1周后复筛阳性率较低,说明其发现患者存在营养风险的能力优于NRS2002。BMI、AMC、TSF、GS、ALB、pALB、HGB等与营养风险发生相关的因素,可与改良版NRS2002联合应用评估患者营养风险。

Objective To apply the nutritional risk screening 2002(NRS2002)and the modified version of NRS2002(the modified NRS2002)in the nutritional assessment of patients with traumatic fractures,and to evaluate the efficacy of the two screening expressions in order to rationally select screening tools,detect nutritional deficiencies as early as possible and provide nutritional support for patients with traumatic fractures.Methods A total of 271 fracture patients admitted for acute trauma were selected for nutritional risk screening by using NRS2002 and the modified NRS2002.The sensitivity and specificity of the two screening tools were analyzed,the consistency of the two screening tools was judged by calculating Kappa values,and the correlation of physical examination indicators and laboratory indicators with nutritional risk was verified.Results Among the 271 patients,68(25.1%)were screened for nutritional risk by NRS2002,and 103(38.0%)were screened for nutritional risk with the modified NRS2002.In patients with nutritional risk(≥3 points)screened by NRS2002 and the modified NRS2002,their upper arm muscle circumference(AMC),triceps skinfold(TSF),grip strength(GS),total protein(TP),albumin(ALB),prealbumin(pALB),calcium,phosphorus,magnesium,red blood cells(RBCs),and hemoglobin(HGB)were lower than those without nutritional risk,while calf circumference(CC),chloride,white blood cells(WBC),and C-reactive protein(CRP)were higher than those of those without nutritional risk(P<0.05).There was no difference in the physical examination indexes and laboratory indexes of patients with nutritional risk(≥3 points)screened by the modified NRS2002 and NRS2002.The consistency test of the modified NRS2002 and NRS2002 results was good(Kappa=0.673,P<0.05),and the area under the receiver operating characteristic(ROC)curve of the modified NRS2002 was 0.894.At one week afterwards,the positive rate of NRS2002 re-screening of patients without nutritional risk(<3 points)was significantly higher than that of the modified NRS2002(P<0.05).AMC,TSF,GS,ALB,pALB,and HGB were negatively correlated with NRS2002 and the modified NRS2002(P<0.05),while CC was positively correlated with NRS2002 and the modified NRS2002(P<0.05).Conclusion The screening results of the modified NRS2002 are generally consistent with those of NRS2002.The sensitivity of the modified NRS2002 is higher in nutritional risk screening,and the positive rate of re-screening after one week is low,indicating that its ability to detect the nutritional risk of patients is superior to that of NRS2002.BMI,AMC,TSF,GS,ALB,pALB,HGB and other factors related to the occurrence of nutritional risk.Therefore,it can be used in combination with the modified NRS2002 to assess the nutritional risk of patients.