不同营养筛查工具在克罗恩病病人术前营养筛查中的应用比较

Comparison of the performance of different nutritional screening tools for preoperative patients with Crohn's disease

目的:探讨不同营养筛查工具在克罗恩病病人术前营养不良评估中的应用价值。方法:采用便利抽样法,回顾性分析2021年1月至2022年3月就诊于东部战区总医院普通外科行择期手术的克罗恩病病人资料,了解病人术前营养状况,以营养不良评定(诊断)标准共识(GLIM)为金标准,比较NRS 2002、NS IBD与PNI评分在营养风险筛查中的相关性、差异性及诊断效能。结果:共纳入212例病人,以GLIM为诊断标准,131例(61.79%)病人出现营养不良;使用NRS 2002评分、NS IBD评分和PNI评分得出营养不良风险的发生率为66.04%、85.38%和55.66%。上述三种评分在IBD病人术前营养筛查中的灵敏度分别为81.46%、85.48%、79.63%,特异度分别为62.36%、54.71%、57.12%,曲线下面积分别为0.749、0.763、0.831。结论:对于择期手术的克罗恩病病人,三种营养风险筛查工具均能为营养不良风险筛查提供依据。PNI评分条目客观,简洁方便。诊断效能评价中,NS IBD评分灵敏度最高,NRS 2002特异度最好。

Objective:To explore the application value of different nutritional screening tools in the evaluation of preoperative malnutrition assessment of Crohn's patients.Methods:Using the convenient sampling method,a retrospective analysis was conducted on CD patients who underwent elective surgery at the general surgery department of General Hospital of Eastern Theater Command from January 2021 to March 2022.The preoperative nutritional status of the patients was understood.Taking the consensus on malnutrition assessment diagnosis standards(GLIM) as the gold standard.The correlation,difference and diagnostic efficacy of 3 nutritional risk screening tools were compared.Results:A total of 212 patients were included.Using GLIM as the diagnostic standard,131 patients(61.79%) had malnutrition.The incidence of malnutrition risk was 66.03%,85.38% and 55.66% using NRS 2002 score,NS IBD score and PNI score,respectively.The sensitivities of the above three scores in the preoperative nutritional screening of IBD patients were 81.46%,85.48%,79.63%,respectively;the specificity were 62.36%,54.71%,57.12%,respectively;and the areas under the curve were 0.749,0.763,0.831,respectively.In the evaluation of diagnostic efficacy,NS IBD score had the highest sensitivity,and NRS 2002 had the best specificity.Conclusion:For patients with Crohn's disease undergoing elective surgery,the three nutritional risk screening tools can provide a basis for malnutrition risk screening.The items of PNI score are objective,concise,and convenient.As for the evaluation of diagnostic efficacy,the NS IBD score has the highest sensitivity and the NRS 2002 has the best specificity.