NRS-2002和PG-SGA在晚期初治消化系统肿瘤化疗患者中的应用比较

发布时间：2018-04-09 07:40

本文选题：晚期消化系统肿瘤　切入点：营养风险　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:联合NRS-2002、PG-SGA两种方法调查晚期初治消化系统肿瘤化疗患者营养状况,分析两种方法的适用性,评估营养风险和营养不良对化疗后相关副反应发生率的影响,分析营养风险与临床结局(包括医疗总费用和住院时间)之间的关系,为临床预防、治疗晚期消化系统肿瘤患者的营养不良提供指导依据。方法:本研究采用前瞻性研究方法,选择山西医科大学附属长治市人民医院2016年6月~11月于肿瘤内科、普外科、消化内科就诊的晚期初治消化系统肿瘤99例患者作为研究对象。当天入院后48小时内取得患者及家属知情同意。收集患者资料包括患者(1)一般情况:姓名、住院号、床位号、性别、年龄、入院时间、出院时间、住院费用;(2)疾病情况:疾病诊断、肿瘤部位、既往治疗情况;(3)饮食情况、活动情况;(4)体格检查情况:身高、体重、肌肉丢失情况;(5)实验室指标:血红蛋白、白细胞、中性粒细胞、血小板、前清蛋白、清蛋白。随后进行NRS-2002、PG-SGA量表评定。所有统计采用SPSS17.0软件包完成。计数资料采用频数、率表示,组间比较采用χ2检验。计量资料采用(均数±标准差)或中位数表示,组间比较采用t检验或t,检验,或Wilcoxon秩和检验。一致性分析采用Kappa一致性检验。P0.05为差异有统计学意义。结果:1.PG-SGA调查显示营养不良发生率50.50%;NRS-2002营养风险发生率37.37%,χ2=8.471,P=0.002,差异有统计学意义。PG-SGA、NRS-2002经Kappa一致性检验,k=0.657,P0.001,差异有统计学意义。以NRS-2002为标准,PG-SGA阳性预测值70%,阴性预测值95.92%。2.以NRS-2002结果分组,BMI在无营养风险组和有营养风险组间有统计学差异(P0.001)。以PG-SGA结果分组,前清蛋白、清蛋白在无营养风险组和有营养风险组间有统计学差异(P=0.032,0.014)。3.全组患者消化道反应、疲劳、骨髓抑制的发生率分别为72.7%、59.6%、60.6%。经PG-SGA评定,营养风险越高,恶心/呕吐的发生率越高,差异有统计学意义(P0.05)。存在营养风险的患者化疗后疲劳、骨髓抑制发生率有增加的趋势,差异无统计学意义(P0.05)。4.PG-SGA、NRS-2002两种筛查结果中有营养风险组较无营养风险组的住院时间更长,医疗总费用更高,差异均有统计学意义(P0.05)。结论:1.PG-SGA、NRS-2002都可应用于晚期初治消化系统肿瘤患者营养风险筛查,但PG-SGA营养不良检出率更高,更利于发现机体慢性营养状态的改变;2.肿瘤患者化疗前营养风险越高,化疗相关不良反应发生率增加;3.营养风险可预测临床结局。
[Abstract]:Objective: to investigate the nutritional status of patients with advanced digestive system neoplasms treated with PG-SGA combined with NRS-2002PG-SGA, analyze the applicability of the two methods, and evaluate the effects of nutritional risk and malnutrition on the incidence of side effects after chemotherapy.The relationship between nutritional risk and clinical outcome (including total medical expenses and hospital stay) was analyzed to provide guidance for clinical prevention and treatment of malnutrition in patients with advanced digestive system tumors.Methods: a prospective study was conducted on 99 patients with advanced digestive system tumors in Changzhi people's Hospital affiliated to Shanxi Medical University from June to November 2016 in Department of Oncology, General surgery and Department of Digestive Medicine.Informed consent was obtained within 48 hours after admission.The data of the patients were collected including the general information of the patient: name, hospital number, bed number, sex, age, time of admission, time of discharge, cost of hospitalization: disease diagnosis, tumor location, past treatment and diet.Physical examination: height, weight, muscle loss. Laboratory indicators: hemoglobin, white blood cells, neutrophils, platelets, prealbumin, albumin.Then the NRS-2002 PG-SGA scale was evaluated.All statistics were completed by SPSS17.0 software package.The counting data were expressed by frequency and rate, and 蠂 2 test was used for comparison between groups.The measurement data were expressed as (mean 卤standard deviation) or median. T test, t test, or Wilcoxon rank sum test were used for comparison between groups.Consistency analysis using Kappa consistency test. P05 as the difference was statistically significant.Results: 1. PG-SGA investigation showed that the incidence of malnutrition in NRS-2002 was 37.37% (蠂 ~ 2 / 8.471P ~ (0.002)), the difference was statistically significant (P < 0.05). The difference was statistically significant after the Kappa consistency test (P 0.001).The positive predictive value of PG-SGA was 70 and the negative predictive value of PG-SGA was 95.92.2.According to the results of NRS-2002, there was significant difference between non-nutrition risk group and nutrition risk group (P 0.001).According to the results of PG-SGA, there were significant differences in prealbumin and albumin between non-nutritional risk group and nutritional risk group.The incidence of digestive tract reaction, fatigue and bone marrow suppression were 72.7%, 59.6% and 60.6%, respectively.According to PG-SGA, the higher the nutritional risk, the higher the incidence of nausea and vomiting, and the difference was statistically significant (P 0.05).The incidence of bone marrow suppression increased in patients with nutritional risk after chemotherapy. There was no significant difference between the two screening results (P0.05N. 4. PG-SGAN NRS-2002). The patients with nutritional risk had longer hospital stay and higher total medical cost than those with no nutritional risk.The difference was statistically significant (P 0.05).Conclusion: 1. PG-SGANRS-2002 can be used to screen the nutritional risk of patients with advanced digestive system tumor, but the detection rate of PG-SGA malnutrition is higher, which is more helpful to detect the change of chronic nutritional status.The higher the nutritional risk of cancer patients before chemotherapy, the higher the incidence of chemotherapy-related adverse reactions.Nutritional risk can predict clinical outcome.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735;R730.53

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