GLIM标准下3种营养评估工具对老年消化系统肿瘤患者的适用性分析

Applicability analysis of three nutritional assessment tools under GLIM standard in elderly patients with digestive system tumors

目的探讨在全球领导人营养不良倡议(GLIM)标准下,患者主观整体评估(PG-SGA)、预后营养指数(PNI)和老年营养风险指数(GNRI)在老年消化系统肿瘤患者中的适用性。方法选取2021年3月至2022年6月在徐州医科大学附属医院接受消化系统肿瘤切除术的老年患者,以GLIM为诊断营养不良的“金标准”,应用PG-SGA、PNI和GNRI进行营养评估。计算并比较3种营养评估工具的灵敏度、特异度、阳性预测值和阴性预测值,绘制受试者操作特征(ROC)曲线并使用Delong检验比较曲线下面积(AUC),探究各工具的适用价值。结果经GLIM诊断下营养不良阳性率为29.3%,PG-SGA、PNI和GNRI评估分别有37.0%、44.0%和45.7%的患者为营养不良。体质指数(BMI)、肌肉质量和相位角(PA)水平显示更差,血清白蛋白(ALB)、前白蛋白(PA)、血红蛋白(HB)水平均较低,差异存在统计学意义(P<0.05)。GLIM标准下,PG-SGA的灵敏度最差(44.1%),特异度一般(65.9%),与GLIM诊断无一致性(Kappa=0.09,P=0.311);PNI的灵敏度(61.8%)和特异度(63.4%)均一般,与GLIM诊断的一致性一般(Kappa=0.22,P=0.013);GNRI特异度(88.2%)和灵敏度(72.0%)均表现最佳,与GLIM诊断具有良好的一致性(Kappa=0.52,P<0.001)。ROC曲线图中,GNRI的预测价值最高(AUC=0.817,95%CI=0.734~0.882),PNI次之(AUC=0.621,95%CI=0.526~0.709)。Delong检验显示GNRI与PG-SGA、GNRI与PNI的预测价值比较均具有统计学差异(Z=3.83,4.85,P<0.001)。GNRI评估为营养不良组术前、术后1d及术后3~5d的PA、ALB、TP和HB指标均显著低于营养良好者;此外,营养不良者90d内手术部位感染发生率也更高(χ^(2)=5.03,P=0.036)。结论GNRI在老年消化系统肿瘤患者的营养评估中表现出较好的适用性。GNRI可能预测出患者围手术期的营养状况和短期预后。

Objective To explore the applicability of patient-generated subjective nutrition assessment(PG-SGA),prognostic nutrition index(PNI)and geriatric nutrition risk index(GNRI)in the nutritional assessment of elderly patients with digestive system tumors based on Global Leadership Initiative on Malnutrition criteria(GLIM).Method Elderly patients who underwent digestive system tumor resection in Affiliated Hospital of Xuzhou Medical University from March 2021 to June 2022 were selected.With GLIM as the"gold standard"for the diagnosis of malnutrition,PG-SGA,PNI and GNRI were used for nutritional assessment,and the sensitivity、specificity、positive predictive value and negative predictive value were calculated and compared.The receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was compared by Delong test to explore the clinical value of each tool comparison between groups was conducted.Result The positive rate of malnutrition diagnosed by GLIM was 29.3%.The positive rates of PG-SGA,PNI and GNRI were 37.0%,44.0%and 45.7%,respectively.The body mass index,muscle loss and phase angle indexes were worse in the patients with malnutrition,and the serum albumin(ALB),prealbumin(PA)and hemoglobin(HB)indexes were decreased,with statistical significance(P<0.05).Compared with GLIM standard,PG-SGA showed the worst sensitivity(44.1%)and middle specificity(65.9%),with no diagnostic consistency(Kappa=0.09,P=0.311);The sensitivity(61.8%)and specificity(63.4%)of PNI were average,and there was weak agreement with GLIM diagnosis(Kappa=0.22,P=0.013).GNRI had the best specificity(88.2%)and sensitivity(72.0%),and had a good concordance with GLIM diagnosis(Kappa=0.52,P<0.001).In the ROC curve,GNRI had the highest predictive value(AUC=0.817,95%CI=0.734-0.882),followed by PNI(AUC=0.621,95%CI=0.526-0.709).Delong test showed that the predictive value of GNRI and PG-SGA,GNRI and PNI were statistically significant(Z=3.83,4.85,P<0.001).The indexes of PA,ALB,TP and HB before、1 day after and 3-5 days after the surgery of the malnourished patients were significantly lower(P<0.05).In addition,the incidence of surgical site infection(SSI)was also higher in malnourished patients(χ^(2)=5.03,P=0.036).Conclusion GNRI has shown good applicability in the nutritional assessment of elderly patients with digestive system tumors.In addition,GNRI may be able to predict a patient's perioperative nutritional status and short-term prognosis.