实用医学杂志 ›› 2022, Vol. 38 ›› Issue (2): 173-178.doi: 10.3969/j.issn.1006⁃5725.2022.02.009

• 临床研究 • 上一篇    下一篇

营养风险筛查结合患者主观整体评估与恶性肿瘤肌肉减少症的相关性

刘莹1 谭寅凤1 王雷2 王玉娇1 陈锡颖2 赵艳金1 祁薇1 张迎1 何抒阳1   

  1. 吉林市人民医院 1 临床营养与老年医学科,2 肿瘤科(吉林吉林 132000)

  • 出版日期:2022-01-25 发布日期:2022-01-25
  • 基金资助:
    吉林省卫健委基金资助项目(编号:2019G010)

Correlation between nutritional risk screening combined with scored patient ⁃generated subjective global assessment and malignant cancer⁃related sarcopenia

LIU Ying*,TAN Yinfeng,WANG Lei,WANG Yujiao, CHEN Xiying,ZHAO Yanjin,QI Wei,ZHANG Ying,HE Shuyang.   

  1. Department of Clinical Nutrition and Geriat⁃ rics,Jilin City People′s Hospital,Jilin 132000,China

  • Online:2022-01-25 Published:2022-01-25

摘要:

目的 探讨营养风险筛查 2002(NRS⁃2002)结合患者主观整体评估(PG⁃SGA)与恶性肿瘤肌 肉减少症(肌少症)的相关性。方法 在吉林省 5 家医院共招募 456 例恶性肿瘤患者,应用 NRS⁃2002 量表 PG⁃SGA 量表分别评估患者营养状况,并根据评分结果将营养状况分为四级 :营养正常(NRS⁃ 2002 < 3 分且PG⁃SGA < 9分)、营养风险(NRS⁃2002 ≥ 3分且PG⁃SGA < 9分)、可能营养不良(NRS⁃2002 < 3 PG⁃SGA ≥ 9分)和营养不良(NRS⁃2002 ≥ 3分且PG⁃SGA ≥ 9分)。按欧洲老年人肌少症工作组(EWGSOP 分级标准分为可能肌少症组(n = 222)、肌少症组(n = 148)和严重肌少症组(n = 86),并检测患者相关理化指 标。结果 不同肌少症组的理化指标不同(P < 0.05);营养状况与身体质量指数(BMI)、上臂围(AC)、上 臂肌围(AMC)、腰围(WC)、内脏脂肪面积(VFA)、基础代谢率(BMR)、总蛋白(TP)、前白蛋白(PA)、白蛋 白(ALB)、高密度脂蛋白胆固醇(HDL⁃C)、血清钠离子(Na+ )、血清钾离子(K+)和血清钙离子(Ca2+)均呈负 相关(P < 0.01),与肌少症分级、谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)均呈正相关(P < 0.001);调整年龄、性别、BMI 后,logistic 回归分析显示,营养不良组患肌少症危险是营养正常组的 1.572 倍(95%CI:1.366 ~ 1.809);不同营养状况组的肌少症患病情况不同(χ2 = 112.941,P < 0.001),营养不良组肌少症和严重肌少症的合计患病率最高为 74.36%。结论 NRS⁃2002 结合 PG⁃SGA 与恶性肿瘤肌肉减少症存在相关性,二 者联合应用可有效提高恶性肿瘤患者肌肉减少症的阳性筛查率。

关键词:

肌肉减少症, 恶性肿瘤, NRS?2002, PG?SGA, 营养不良

Abstract:

Objective To explore the correlation between nutritional risk screening 2002(NRS ⁃ 2002) combined with scored patient ⁃generated subjective global assessment(PG ⁃ SGA)and sarcopenia in patients with malignant cancer. Methods A total of 456 patients with malignant cancer were recruited from 5 hospitals in Jilin Province. NRS⁃2002 scale and PG⁃SGA scale were used to evaluate the nutritional status of the patients. According to the results of scoring,the nutritional status of patients was divided into four levels;normal nutrition(NRS⁃2002 score < 3 and PG⁃SGA score < 9),nutrition risk(NRS⁃2002 score ≥ 3 and PG⁃SGA score < 9),probable malnutrition (NRS⁃2002 score < 3 and PG⁃SGA score ≥ 9)and malnutrition(NRS⁃2002 score ≥ 3 and PG⁃SGA score ≥ 9). The patients were divided into three groups according to the European Working Group on Sarcopenia in Older People(EWGSOP):probable sarcopenia group(= 222),sarcopenia group(= 148)and severe sarcopenia group(= 86). The related physical and chemical indicators of the patients also were measured. Results The physical and chemical indicators of different sarcopenia groups showed difference(< 0.001). Nutritional status was negatively correlated with body mass index(BMI),arm circumference(AC),arm muscle circumference (AMC),waist circumference(WC),visceral fat area(VFA),basal metabolic rate(BMR),total protein(TP), prealbumin(PA),albumin(ALB),high density lipoprotein cholesterol(HDL⁃C),serum sodium ion(Na+ ), serum potassium ion(K+)and serum calcium ion(Ca2+)and the difference was statistically significant(< 0.01). Nutritional status was positively correlated with the grade of sarcopenia,gamma glutamyl transferase(GGT)and alkaline phosphatase(ALP),showing statistical significance(< 0.001). After adjusting for age,sex and BMI, logistic regression analysis showed that sarcopenia in the malnutrition group was 1.572 times higher than that in normal nutrition group(95%Cl:1.366 ~ 1.809). The prevalence of sarcopenia varied in groups with different nutri⁃ tional status,indicating statistical significance(χ2 = 112.941,< 0.001). The combined prevalence of sarcopenia and severe sarcopenia in the malnutrition group was the highest of 74.36%. Conclusion There is correlation between NRS⁃2002 combined with PG⁃SGA and sarcopenia in patients with malignant cancer,and the combination of these two could effectively improve the positive screening rate of sarcopenia in patients with malignant cancer.

Key words:

sarcopenia, malignant cancer, NRS?2002, PG?SGA, malnutrition