改良版患者主观整体评估可用于原发性肝癌患者营养不良的评估

The modified patient-generated subjective global assessment can be used for the assessment of malnutrition in patients with primary liver cancer

目的研究原发性肝癌患者的营养状况,比较患者主观整体评估(PG-SGA)和改良版患者主观整体评估(mPG-SGA)评估营养不良的能力。方法纳入2022年4月至2023年9月于西南医科大学附属医院首诊为原发性肝癌的249例患者,采用PG-SGA和m PG-SGA评估患者营养状况,通过Spearman相关分析比较不同营养指标与两种量表评估结果的相关性,绘制受试者操作特征(ROC)曲线评价m PG-SGA的准确性,计算Kappa系数评价两种量表的一致性。结果249例原发性肝癌患者中,PG-SGA和m PG-SGA分别诊断出中、重度营养不良患者196例(78.71%)、189例(75.90%)。以PG-SGA为标准,对于营养良好/轻度营养不良、中度营养不良及重度营养不良3种不同营养状态,mPG-SGA均表现出较好的准确性,AUC值分别为0.982、0.938、0.977(P<0.001),并具有强一致性(Kappa=0.951,P<0.001)。通过性别、年龄、吸烟史、饮酒史、临床分期、体质指数(BMI)分层分析发现,BMI<18.5 kg/m^(2)的患者中,mPG-SGA对营养良好/轻度营养不良、中度营养不良及重度营养不良3种不同营养状态表现出较强的一致性(Kappa=0.762,P=0.001),除外BMI<18.5 kg/m^(2)的其余临床特征分层分析中,mPG-SGA对3种不同营养状态均表现出强一致性(Kappa>0.9,P<0.001)。结论原发性肝癌患者营养不良发生率高,mPG-SGA与PG-SGA具有良好的准确性及一致性,是一种更简便、适用于评估原发性肝癌患者营养不良的工具。

Objective To evaluate the nutritional status of patients with primary liver cancer,and to compare the ability of PG-SGA and m PG-SGA to assess malnutrition.Method Clinical data of 249 patients diagnosed with primary liver cancer for the first time at Affiliated Hospital of Southwest Medical University between April 2022 and September 2023 were collected.PG-SGA and m PG-SGA were used to assess the nutritional status of patients.Spearman correlation analysis was used to compare the correlation between different nutritional indicators and two scales.The ROC curve was used to evaluate the accuracy of m PG-SGA.The Kappa coefficients were used to evaluate the concordance between two scales.Result Among 249 patients with primary liver cancer,196(78.71%)and 189(75.90%)were diagnosed with moderate to severe malnutrition using PG-SGA and m PG-SGA,respectively.Using PG-SGA as a criterion,m PG-SGA showed good accuracy for good/mild malnutrition,moderate malnutrition and severe malnutrition,with AUC values of 0.982,0.938,and 0.977,respectively(P<0.001).It also showed almost perfect consistency with PG-SGA(Kappa=0.951,P<0.001).Analysis by gender,age,history of smoking,alcohol consumption,clinical stage,and body mass index(BMI)subgroups revealed that m PG-SGA showed strong consistency for good/mild malnutrition,moderate malnutrition and severe malnutrition among patients with BMI<18.5 kg/m^(2)(Kappa=0.762,P=0.001).All subgroups,with the exception of BMI<18.5 kg/m^(2),showed almost perfect consistency for the three different nutritional stages(Kappa>0.9,P<0.001).Conclusion Malnutrition is prevalent in patients with primary liver cancer.m PG-SGA has been shown to have good accuracy and concordance with PG-SGA.It is a simpler tool for assessing malnutrition in patients with primary liver cancer.