一种智能营养筛查系统用于住院肿瘤患者营养风险的预测性分析
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摘要
目的:比较一种智能营养自动筛查系统与NRS 2002在肿瘤患者中的适用性,从而为营养筛查工作的落实提供一种新的方法和选择。方法:采取连续取样的方法,对205名住院成年肿瘤患者进行观察性的横断面研究。在入院后24h内营养师利用NRS 2002对患者进行营养风险筛查,同时智能营养筛查系统从医院信息系统(HIS)和实验室信息系统(LIS)中提取智能营养相关数据指标,如BMI、体重下降、进食减少、ALB、膳食医嘱等,对患者进行营养风险识别。χ2检验比较两种营养筛查与评估工具结果差异,用灵敏度、特异度、约登指数及Kappa值分析比较两种营养筛查与评估工具的评定效果。结果:采用NRS 2002筛查发现59人(28.8%)存在营养风险,同时智能营养筛选系统检测出78名患者(38%)存在营养风险。与NRS 2002相比,智能营养筛选系统的灵敏度为83%、特异性为80.1%、约登指数为0.63、Kappa为0.58。NRS 2002和智能筛查系统均与体重、体重下降、BMI、影响进食的症状存在明显相关性(P<0.01),但智能筛查系统在影响进食症状、体重下降、BMI的相关性明显优于NRS 2002。NRS 2002与智能筛查系统也存在明显的相关性(r=0.349,P<0.000)。NRS 2002<3分组较NRS 2002≥3分组的体重、BMI、TP、ALB、LY、HGB、RBC存在统计学差异(P<0.05);智能筛查系统无营养风险组与营养风险组在体重、BMI、ALB、HGB、RBC存在统计学差异(P<0.05)。结论:智能营养筛查系统的敏感性和特异性用于住院肿瘤患者尚可以被接受,可用于筛查和早期识别存在营养风险的住院肿瘤患者,但需要在更多的病种和患者中进行验证。
Objective To evaluate the appilication of NRS 2002 and automated nutrition screening system in tumor patients. Method Successive fixed-point sampling was used to enroll tumor patients. The nutritional risk was evaluated by NRS 2002 and automated nutrition screening system within 24 h. Automated screening system data were extracted from electronic oncology prescribing system. This system used BMI,weight loss,eating less,and ALB to identify nutritional risk. The results were tested by χ2 analysis. The efficiencies of two tools were compared by sensitivity,specificity,Kappa value and Youden index. Result The incidience rate of nutritional risk was 28. 8%,38% respectively,by NRS 2002 and automated nutrition screening system. Automated screening system resulted in 83% sensitivity and 80. 1% specificity,0. 63 Youden index,0. 58 Kappa value,respectively. The weight,weight loss,BMI,symptoms of affecting feeding correlated between NRS 2002 and automated nutrition screening system(P < 0. 01),but automated nutrition screening system was significantly better than NRS 2002 in symptoms of affecting feeding,weight loss,and BMI. There was a significant correlation between NRS 2002 and automated nutrition screening system(r = 0. 349,P < 0. 000). The weight、BMI、TP、ALB、LY、HGB、RBC were statistically different between the NRS 2002 < 3 and NRS 2002≥3 groups(P < 0. 05). The weight、BMI、ALB、HGB、RBC were statistically different between the without nutritional risk and nutritional risk groups using automated nutrition screening system(P < 0. 05). Conclusion Preliminary results show that automated nutrition screening system can be used to identify nutritional risk in tumor patients,however,it needs to be verified in more diseases and patients.
Objective To evaluate the appilication of NRS 2002 and automated nutrition screening system in tumor patients. Method Successive fixed-point sampling was used to enroll tumor patients. The nutritional risk was evaluated by NRS 2002 and automated nutrition screening system within 24 h. Automated screening system data were extracted from electronic oncology prescribing system. This system used BMI,weight loss,eating less,and ALB to identify nutritional risk. The results were tested by χ2 analysis. The efficiencies of two tools were compared by sensitivity,specificity,Kappa value and Youden index. Result The incidience rate of nutritional risk was 28. 8%,38% respectively,by NRS 2002 and automated nutrition screening system. Automated screening system resulted in 83% sensitivity and 80. 1% specificity,0. 63 Youden index,0. 58 Kappa value,respectively. The weight,weight loss,BMI,symptoms of affecting feeding correlated between NRS 2002 and automated nutrition screening system(P < 0. 01),but automated nutrition screening system was significantly better than NRS 2002 in symptoms of affecting feeding,weight loss,and BMI. There was a significant correlation between NRS 2002 and automated nutrition screening system(r = 0. 349,P < 0. 000). The weight、BMI、TP、ALB、LY、HGB、RBC were statistically different between the NRS 2002 < 3 and NRS 2002≥3 groups(P < 0. 05). The weight、BMI、ALB、HGB、RBC were statistically different between the without nutritional risk and nutritional risk groups using automated nutrition screening system(P < 0. 05). Conclusion Preliminary results show that automated nutrition screening system can be used to identify nutritional risk in tumor patients,however,it needs to be verified in more diseases and patients.
引文
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[15]王秋梅,陈伟,宋长城,等.MNA和NRS2002对老年住院患者营养评估的比较[J].中华老年多器官疾病杂志,2014,13(7):528-531.
[16]王晔,蒋永梅,罗茜,等.比较两种营养评估工具在外科老年病人中的应用价值[J].外科理论与实践,2013,18(4):364-368.
[17]何芳,王蕾蕾,孟雪彬.肿瘤患者营养状况及对临床结局的影响[J].肿瘤营养与代谢杂志:2016,3(3):166-169.
[18]雷桂军,朱萍.肿瘤患者营养不良的筛查与评估报告[J].中国全科医学:2017,20(7):149-150.
[19]林丽,张吉才,谢飞.患者全面主观营养评定和营养风险筛查2002在消化系统肿瘤患者营养评估中的应用比较[J].中国食物与营养,2018,24(3):78-81.
[20]Kyle UG,et al.Comparison of toolsfor nutritional assessment and screening at hospital admission:a population study[J].Clinical Nutrition,2006,25(3):409-417.
[21]Putwatana P,et al.Nutrition screeningtools andthe prediction of postoperative infectious and wound cormplications:comparison of methods in presence of risk adjustment[J].Nutrition,2005,21(6):691-697.
[22]Valero A,Diez MA,Kadaoui LE,et al.Son lasherramientas-recomendadaspor la ASPEN Y la ESPEN equiparables en lavaloraci6n del estadonutricional7 Nutrieion Hospitalaria OrganoOficial De La Sociedad Espanola[J].De Nutricion Parenteral Y Enteral,2005,19(2):85-88.
[23]CSCO肿瘤营养治疗专家委员会.恶性肿瘤患者的营养治疗专家共识[J].临肿瘤学杂志2012,17(1):59-73.
[24]石汉平,许红霞,林宁,等.营养不良再认识[J].肿瘤代谢与营养电子杂志,2015,12(4):1-5.
[25]中国抗癌社会肿瘤营养与支持治疗专业委员会.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015.
[26]毕研霞,洪忠新,张立红,等.肿瘤化疗患者营养风险评估及影响因素分析[J].中国食物与营养,2018,24(3):66-70.
[27]Illa P,Tomiskova M,Skrickova J.Nutritional riskscreening predicts tumor response in lung cancerpatients[J].J Am Coll Nutr,2015,5(1):1-5.
[2]Hopkinson JB.Nutritional support of the elderly cancer patient:the role of thenurse[J].Nutrition,2015,31(4):598-602.
[3]李燕,程垚,徐斌,等.食管癌患者术前营养风险评估与干预的效果评价[J].中华护理杂志,2015,50(2):166-170.
[4]Marian M,August D A.Prevance of malnutrition and current use of nutrition support in cancer patient study[J].Jpen Joumal of Parenteral&Entera l Nutrition,2014,38(2):163-167.
[5]Hebuterne X,et al.Prevalence of malnutrition and current use of nutrition support in patients with cancer[J].Journal of Parenteral and Enteral Nutrition,2014,38(2):196-212.
[6]Lochs H,et al.Introductory to the ESPEN guidelines on enteral nutrition:terminology,definitions and general topics[J].Clin Nutr,2006,25(2):180-186.
[7]Kondrup J,et al.ESPEN Guidelines for nutrition screening2002[J].Clin Nutr,2003,22(4):415-421.
[8]J.Abbott L.Teleni D.Mckavanagh J.A novel,automated nutrition screening system as a predictor of nutritional risk in an oncology day treatment unit(ODTU)[J].support Care Cancer,2014,22(1):2107-2112.
[9]Liu P,et al.Three methods assess nutritional status of leukemia patients before hematopoietic stem cell transplantation[J].Chin Med J(Engl),2012,125(3):440-443.
[10]Alvarez-Altamirano K,et al.Prevalence of nutritional risk evaluated with NRS 2002 in Mexican oncology population[J].Nutr Hosp,2014,30(1):173-178.
[11]中华医学会.临床诊疗指南.肠外肠内营养学分册[M].北京:人民卫生出版社,2007:15-19.
[12]丁军.NRS 2002和MUST量表在胃癌患者营养风险筛查中的应用[J].消化肿瘤电子杂志,2017,9(2):103-105.
[13]吉琳琳.营养风险筛查2002,营养不良通用筛查工具盒和患者主观整体评估在住院肿瘤患者中应用和比较[J].营养学报,2017,39(3):242-246.
[14]杨眉,陈誉,王晓杰.NRS2002和PG-SGA在晚期胃癌化疗患者中的应用[J].肿瘤与营养代谢杂志,2016,3(1):45-47.
[15]王秋梅,陈伟,宋长城,等.MNA和NRS2002对老年住院患者营养评估的比较[J].中华老年多器官疾病杂志,2014,13(7):528-531.
[16]王晔,蒋永梅,罗茜,等.比较两种营养评估工具在外科老年病人中的应用价值[J].外科理论与实践,2013,18(4):364-368.
[17]何芳,王蕾蕾,孟雪彬.肿瘤患者营养状况及对临床结局的影响[J].肿瘤营养与代谢杂志:2016,3(3):166-169.
[18]雷桂军,朱萍.肿瘤患者营养不良的筛查与评估报告[J].中国全科医学:2017,20(7):149-150.
[19]林丽,张吉才,谢飞.患者全面主观营养评定和营养风险筛查2002在消化系统肿瘤患者营养评估中的应用比较[J].中国食物与营养,2018,24(3):78-81.
[20]Kyle UG,et al.Comparison of toolsfor nutritional assessment and screening at hospital admission:a population study[J].Clinical Nutrition,2006,25(3):409-417.
[21]Putwatana P,et al.Nutrition screeningtools andthe prediction of postoperative infectious and wound cormplications:comparison of methods in presence of risk adjustment[J].Nutrition,2005,21(6):691-697.
[22]Valero A,Diez MA,Kadaoui LE,et al.Son lasherramientas-recomendadaspor la ASPEN Y la ESPEN equiparables en lavaloraci6n del estadonutricional7 Nutrieion Hospitalaria OrganoOficial De La Sociedad Espanola[J].De Nutricion Parenteral Y Enteral,2005,19(2):85-88.
[23]CSCO肿瘤营养治疗专家委员会.恶性肿瘤患者的营养治疗专家共识[J].临肿瘤学杂志2012,17(1):59-73.
[24]石汉平,许红霞,林宁,等.营养不良再认识[J].肿瘤代谢与营养电子杂志,2015,12(4):1-5.
[25]中国抗癌社会肿瘤营养与支持治疗专业委员会.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015.
[26]毕研霞,洪忠新,张立红,等.肿瘤化疗患者营养风险评估及影响因素分析[J].中国食物与营养,2018,24(3):66-70.
[27]Illa P,Tomiskova M,Skrickova J.Nutritional riskscreening predicts tumor response in lung cancerpatients[J].J Am Coll Nutr,2015,5(1):1-5.