GLIM标准对初诊NHL患者营养不良诊断及预后的研究

Application of GLIM criteria for the diagnosis and prognosis of malnutrition in newly diagnosed NHL patients

目的探讨全球营养不良领导倡议(GLIM)标准对非霍奇金淋巴瘤(NHL)患者营养不良的诊断价值,评估GLIM标准下营养不良与患者生存之间的关系。方法选择2020年7月—2021年12月在空军军医大学第二附属医院血液内科初诊的157例NHL患者。采用GLIM标准和患者主观整体营养评估(PG-SGA)量表诊断营养不良状况,使用受试者工作特征(ROC)曲线评价GLIM标准对NHL患者营养不良的诊断效能。应用Kaplan-Meier生存曲线分析GLIM标准下不同营养状况患者的生存状况。采用Cox比例风险回归模型评估GLIM标准下的营养状况对患者预后的影响。结果157例初诊NHL患者中107例(68.15%)存在营养不良风险(NRS 2002≥3分),使用GLIM标准进一步诊断后营养不良率为42.68%(67/157),低于PG-SGA诊断的62.42%(98/157)。GLIM标准和PG-SGA量表在诊断营养不良时一致性中等(Kappa=0.496,P<0.001),ROC曲线下面积为0.77(95%CI 0.71~0.83)。中位随访时间为33(1~39)个月,GLIM标准下营养不良组与营养良好组患者的2年总生存率分别为83.1%和91.1%(χ^(2)=4.222,P=0.040);重度营养不良组、中度营养不良组与营养良好组的2年总生存率分别为81.7%、84.5%和91.1%,重度营养不良和营养良好组患者的生存曲线差异有统计学意义(χ^(2)=5.543,P=0.019)。Cox模型显示,GLIM标准下的营养不良是NHL患者总生存期(OS)的独立危险因素(P<0.05)。结论GLIM标准不仅可诊断NHL患者营养不良及严重程度,对预后生存也有一定的预测作用。

Objective To explore the diagnostic value of the Global Leadership Initiative on Malnutrition(GLIM)criteria for malnutrition in patients with non-Hodgkin lymphoma(NHL)and to evaluate the relationship between malnutrition under the GLIM criteria and patient survival.Methods A total of 157 newly diagnosed NHL patients who were admitted to Department of Hematology,the Second Affiliated Hospital of the Air Force Medical University between July 2020 and December 2021 were enrolled and their clinical data were collected.Their nutritional status was assessed using both the GLIM criteria and the Patient-Generated Subjective Global Assessment(PG-SGA)scale.Receiver Operating Characteristic(ROC)curves were plotted to evaluate the diagnostic efficiency of the GLIM criteria for malnutrition.Kaplan-Meier survival curves were plotted to analyze the survival outcomes of patients with different nutritional statuses under the GLIM criteria.The Cox proportional hazards regression model was employed to assess the impact of nutritional status based on GLIM criteria on patient prognosis.Results Among the 157 newly diagnosed NHL patients,107(68.15%)were identified as being at risk of malnutrition(NRS 2002 scores≥3).According to the GLIM criteria,the malnutrition rate was 42.68%(67/157),which was lower than 62.42%(98/157)identified by PG-SGA.The consistency between the GLIM criteria and PG-SGA in diagnosing malnutrition was moderate(Kappa=0.496,P<0.001).The area under the ROC curve(AUC)was 0.77(95%CI 0.71-0.83).The median follow-up time for the prognosis study was 33 months(1-39 months).The 2-year overall survival rates for the well-nourished group and the malnourished group under the GLIM criteria were 91.1%and 83.1%,respectively(χ^(2)=4.222,P=0.040).The 2-year overall surivival rates for the severely malnourished group,moderately malnourished group,and well-nourished group were 81.7%,84.5%,and 91.1%,respectively.A statistically significant difference in survival curves was observed between the severely malnourished group and the well-nourished group(χ^(2)=5.543,P=0.019).The Cox proportional hazards model indicated that malnutrition under the GLIM criteria was an independent risk factor for overall survival in NHL patients(P<0.05).Conclusions The GLIM criteria can diagnose malnutrition and its severity in NHL patients,and can serve as a predictor of patient prognosis and survival.