两种营养筛查工具在高龄住院患者营养状况评价中的应用分析

Application analysis of two nutritional screening tools in nutritional status assessment of elderly inpatients

目的应用营养风险筛查表2002(NRS2002)评分和微型营养评估简表(MNA-SF)评分两种营养筛查工具评估高龄住院患者的营养状况,并评价两种营养筛查工具的适用性。方法采用随机抽样的方法,对>80岁住院患者进行一般资料采集。根据年龄将其分为≥90岁组和<90岁组两个年龄组,应用两种营养筛查工具进行营养状况评估。同时测定空腹静脉血营养相关指标水平,包括白蛋白(Alb)、血红蛋白(Hb)、C反应蛋白(CRP)、转铁蛋白(TRF)、前白蛋白(PA)和视黄醇结合蛋白(RBP),并将结果进行相关性分析。结果NRS2002评分评估有营养不良风险的患者为404例(48.56%),≥90岁组的营养不良风险发生率高于<90岁组(P<0.01);MNA-SF评分评估营养不良/有营养不良风险的患者为616例(74.04%),≥90岁组的营养不良风险发生率高于<90岁组(P<0.01)。以血清Alb<30 g/L作为参考标准,比较两种营养筛查工具的适用性,发现两种营养筛查工具均适用于高龄住院患者营养状况筛查,且NRS2002评分评估高龄住院患者的营养状况的受试者工作特征(ROC)曲线下面积(AUC)为0.805,灵敏度和特异度分别为88.6%和62.2%,MNA-SF评分评估高龄住院患者的营养状况的ROC AUC为0.814,灵敏度和特异度分别为75.7%和87.7%。分析Hb、CRP、PA、RBP、TRF生化指标与MNA-SF评分和NRS2002评分相关性,结果显示NRS2002评分和MNA-SF评分与PA、RBP和TRF具有相关性。结论高龄住院患者出现营养不良风险的发生率高。NRS2002评分和MNF-SF两种营养筛查工具均适用于高龄住院患者,且具有较高准确性,同时联合营养相关指标评估高龄患者营养状况可提高营养评估的精准性。

Objective To evaluate the nutritional status of elderly inpatients by using the nutritional risk screening table 2002(NRS2002)and the short-form mini-nutritional assessment(MNA-SF),and to evaluate the applicability of the two tools.Methods The general data were collected from the inpatients aged≥80 years old by the random sampling method.They were divided into the two age groups:≥90 years old and<90 years old,and their nutritional status was assessed by using the two nutritional screening tools.Meanwhile,the fasting venous blood nutritional related indicators including albumin(Alb),hemoglobin(Hb),C-reactive protein(CRP),transferrin(TRF),prealbumin(PA)and retinol-binding protein(RBP)levels were detected.Furthermore the results conducted the correlation analysis.Results There were 404 cases(48.56%)of nutritional risk in the NRS2002 evaluation.The occurrence rate of nutritional risk in the≥90 years old group was higher than that in the<90 years old group(P<0.01).There were 616 cases(74.04%)of malnutrition/risk of malnutrition in the MNA-SF evaluation.The incidence rate of malnutrition risk in the≥90 years old group was higher than that in the<90 years old group(P<0.01).With the serum ALB<30 g/L as the reference standard,the applicabilities were compared between the two kinds of nutritional screening tools,the results found that the two kinds of nutritional screening tools all were suitable for the nutritional status screening of elderly inpatients.The area under the receiver operating characteristic(ROC)curve(AUC)of the MNA-SF for evaluating the nutritional status in the elderly inpatients was 0.814,the sensitivity and specificity were 75.7%and 87.7%respectively.AUC of ROC in NRS2002 for evaluating the nutritional status in the elderly inpatients was 0.805,the sensitivity and specificity were 88.6%and 62.2%respectively.The correlation analysis results of Hb,CRP,PA,RBP and TRF biochemical indexes with MNA-SF score and NRS2002 score showed that NRS2002 score and MNA-SF score were correlated with PA,RBP and TRF.Conclusion The incidence rate of nutritional risk in elderly inpatients is high.Both NRS2002 and MNF-SF nutritional screening tools are suitable for elderly inpatients and have high accuracy.Meanwhile,combining nutrition-related indicators to evaluate the nutritional status of elderly patients can improve the accuracy of nutritional assessment.