患者参与的主观全面评定量表改良及在胃癌患者中的验证

目的 对患者参与的主观全面评定（Patient-generated Subjective Global Assessment,PG-SGA）量表进行改良,检验改良版PG-SGA的信效度及条目质量。 方法 基于项目反应理论筛选出PG-SGA中质量不佳的条目,修订后形成改良版PG-SGA。2019年9月—2020年2月纳入江苏省某三级甲等医院收治的281例胃癌围手术期患者,利用因子分析法确定改良版PG-SGA的条目权重并赋予相应分值。以主观全面评定（Subjective Global Assessment,SGA）为参照,根据受试者操作特征曲线划分改良版PG-SGA营养评定的截断值。最后评价信效度及条目质量。 结果 经统计测试,确定了11个条目,总分为0~33分。营养评定的截断值如下:评分≥11分表示营养不良,评分<11分表示营养良好。信效度分析示,改良版PG-SGA用于营养评定的准确性高于PG-SGA,约登指数为0.844;总量表的内容效度指数为0.910;探索性因子分析提取4个公因子,累计方差贡献率为83.494%;Cronbach’s α系数为0.707。项目反应理论分析显示,修订后的条目质量显著改善。 结论 形成的改良版PG-SGA信效度良好,条目质量佳,临床可用该量表进行营养评定。

Modification and evaluation of a patient-generated subjective global assessment among gastric cancer patients

Objective To modify the patient-generated subjective global assessment(PG-SGA)scale,and to analyze the reliability,validity and item quality of the modified PG-SGA.Methods Modified items that need to be improved in PG-SGA based on item response analysis were screened out and the revised version of PG-SGA was formed.281 perioperative gastric cancer patients admitted to a level A tertiary hospital from September 2019 to February 2020 were selected.The weight of each item of the scale was determined by factor analysis;the cut-off values of the modified PG-SGA were divided according to the receiver operator characteristic curve.Finally,reliability and validity were evaluated,and item quality was analyzed again based on item response theory.Results The modified PG-SGA included 11 items,with a total score of 0 to 33.The cutoff value was 11 points.Reliability and validity analysis showed that the accuracy of the modified PG-SGA for nutritional assessment was higher than PG-SGA,and the Youden index was 0.844;the content validity index of the total scale was 0.910;4 common factors were extracted by exploratory analysis and the cumulative variance contribution rate was 83.494%;the Cronbach’αcoefficient of the total scale was 0.707.Analysis results of item response theory showed that the discrimination and difficulty parameters of the modified items were improved.Conclusion The modified PG-SGA is a reliable and valid scale,and the quality of items is improved.This scale can be utilized to conduct clinical nutritional assessment.