预后营养指数和患者主观整体评估对食管癌患者围手术期营养预测的比较研究

目的探讨预后营养指数(prognostic nutritional index,PNI)和患者主观整体评估(patientgenerated subjective global assessment,PG-SGA)对食管癌患者围术期营养状况的预测价值及一致性。方法回顾性分析我院2017年11月至2018年8月224例接受食管癌根治手术患者的临床资料,其中男186例、女38例,平均年龄(63.08±8.42)岁。根据患者入院首次血常规及生化检验结果计算PNI并进行PG-SGA评估。根据PNI值将患者分为营养良好组(PNI≥45,60例)和营养不良组(PNI<45,164例),根据PG-SGA评分将患者分为营养良好组(PG-SGA<4,75例)和营养不良组(PG-SGA≥4,149例),分别比较两组患者围手术期营养相关血液学指标及体重指数(BMI)的纵向变化,并分析PNI与PG-SGA对营养评估的一致性。结果不同PNI分组患者的营养相关血液学指标在围手术期的纵向变化差异有统计学意义(P<0.01);不同PG-SGA分组患者的前白蛋白在围手术期纵向变化差异有统计学意义(P<0.05);不同PG-SGA分组患者的BMI在围手术期纵向变化差异有统计学意义(P<0.01);两者一致性Kappa系数为0.589(P<0.001)。结论 PNI和PG-SGA均能一定程度上预测食管癌患者围术期的营养风险,PNI为客观监测指标,PG-SGA为主观评价指标,两者联合使用对食管癌患者进行营养评估能更全面地反映和预测患者的营养状况,为制定个体化营养支持方案提供重要参考依据。

Comparative study of prognostic nutritional index and patient-generated subjective global assessment in perioperative nutritional prediction in patients with esophageal cancer

Objective To investigate the prognostic value and consistency of prognostic nutritional index(PNI) and patient-generated subjective global assessment(PG-SGA)in perioperative nutritional status of patients with esophageal cancer.Methods Clinical data of 224 patients,including 186 males and 38 females with an average age of63.08±8.42 years,who underwent esophageal cancer surgery in our hospital from November 2017 to August 2018 were retrospectively reviewed.The PNI was calculated according to the results of the first time blood and biochemical tests,and the PG-SGA assessment was also performed.According to the PNI value,the patients were divided into a good nutrition group(PNI≥45,60 patients)and a malnutrition group(PNI<45,164 patients).According to the PG-SGA score,the patients were divided into a good nutrition group(PG-SGA<4,75 patients)and a malnutrition group(PG-SGA≥4,149 patients).Nutrition-related haematological indexes and body mass index(BMI)were compared between the two groups,and the consistency of PNI and PG-SGA for nutritional assessment was analyzed.Results The nutrition-related haematological indexes in different PNI groups were statistically different in the perioperative period(P<0.01).The longitudinal changes of prealbumin in patients of different PG-SGA groups were statistically different(P<0.05);the BMI of patients in different PG-SGA groups was statistically different in the perioperative period(P<0.01).The Kappa coefficient of the two indicators was 0.589(P<0.001).Conclusion Both PNI and PG-SGA can predict the nutritional risk of patients with esophageal cancer to some extent.PNI is an objective monitoring indicator,and PG-SGA is a subjective evaluation indicator,the combined use of which can more comprehensively reflect and predict the nutritional status of patients,and provide an important reference to the development of individualized nutrition support programs.