摘要
目的比较全球领导人营养不良倡议(Global Leadership Initiative on Malnutrition,GLIM)标准、简化GLIM标准与患者主观整体评估(patient-generated subjective global assessment,PG-SGA)对中晚期恶性肿瘤患者营养不良诊断的一致性,探讨简化GLIM营养诊断流程的临床适用性。方法选取2024年7月至12月南京医科大学附属泰州人民医院肿瘤科收治的180例中晚期恶性肿瘤患者,运用Kappa一致性检验分别比较两种GLIM标准与PG-SGA诊断营养不良的一致性,采用二元Logistic回归分析营养不良的影响因素,通过受试者操作特征曲线确定炎症指标的敏感度、特异性及最佳临界值。结果简化GLIM标准与PG-SGA诊断营养不良的一致性较强(Kappa=0.716,P<0.001);GLIM标准与PG-SGA的一致性一般(Kappa=0.511,P<0.001)。以PG-SGA为参考标准,简化GLIM标准和GLIM标准诊断营养不良的敏感度分别为82.9%和63.4%,特异性分别为94.7%和98.2%,曲线下面积(area under the curve,AUC)分别为0.888(95%CI:0.844~0.933)和0.808(95%CI:0.762~0.854)。GLIM标准下,炎症指标:白蛋白(albumin,ALB)<35g/L和C反应蛋白(C-reactive protein,CRP)>10mg/L是中晚期恶性肿瘤患者营养不良的危险因素,其中ALB<35g/L是其独立危险因素(P=0.002);ALB和CRP联合检测预测中晚期恶性肿瘤患者营养不良的AUC为0.703,敏感度为70.9%,优于ALB和CRP单一指标检测(ALB的AUC为0.697,敏感度为45.6%;CRP的AUC为0.659,敏感度为53.2%),但其特异性低于单一指标检测。结论对中晚期恶性肿瘤患者,符合“炎症或疾病负担”而简化GLIM标准诊断流程是可行的,ALB和CRP联合检测对其营养不良的发生具有一定的预测价值,但其临床适用性仍有待于进一步验证。
Objective Comparing the consistency between the simplified Global Leadership Initiative on Malnutrition Standard(simplified GLIM),GLIM and patient-generated subjective global assessment(PG-SGA)in the diagnosis of malnutrition in patients with advanced cancer respectively,to explore the clinical applicability of simplifying the GLIM nutritional diagnosis process.Methods We included 180 patients with advanced cancer admitted to Taizhou People’s Hospital affiliated to Nanjing Medical University from July to December 2024.The consistency in the diagnosis of malnutrition between the two GLIM standards and PG-SGA was compared by Kappa consistency test respectively.The influence factors of malnutrition were analyzed by multivariate Logistic regression.The sensitivity,specificity and optimal cutoff value of inflammatory indicators were analyzed by receiver operating characteristic curve.Results The simplified GLIM and PG-SGA had good consistency in the diagnosis of malnutrition(Kappa=0.716,P<0.001),and the consistency between GLIM and PG-SGA was general(Kappa=0.511,P<0.001).Taking PG-SGA as the reference standard,the sensitivity of simplified GLIM and GLIM for diagnosing malnutrition was 82.9%and 63.4%,the specificity was 94.7%and 98.2%,and the area under the curve(AUC)was 0.888(95%CI:0.844-0.933)and 0.808(95%CI:0.762-0.854)respectively.Based on the evaluation results of GLIM,albumin(ALB)<35g/L and C-reactive protein(CRP)>10mg/L were the risk factors of malnutrition in patients with advanced cancer,and ALB<35g/L was the independent risk factor(P=0.002).The AUC of the combined prediction of malnutrition in patients with advanced cancer by ALB and CRP was 0.703,and the sensitivity was 70.9%,which was superior to the single indicators of ALB and CRP.The AUC of ALB was 0.697,and the sensitivity was 45.6%.The AUC of CRP was 0.659,and its sensitivity was 53.2%.But its specificity was lower than that of single-index detection.Conclusion It is feasible to simplify the GLIM diagnostic process by considering that patients with advanced cancer meet the criteria of“inflammation or disease burden”,and the combined detection of ALB and CRP has a certain predictive value for the occurrence of malnutrition,while its clinical applicability still needs to be further verified.
作者
张金风
侯莉莉
夏阳
ZHANG Jinfeng;HOU Lili;XIA Yang(Department of Clinical Nutrition,Taizhou People’s Hospital Affiliated to Nanjing Medical University,Taizhou 225300,Jiangsu,China;Department of Oncology Ward Area 4,Taizhou People’s Hospital Affiliated to Nanjing Medical University,Taizhou 225300,Jiangsu,China)
出处
《中国现代医生》
2026年第3期24-29,共6页
China Modern Doctor
