相位角评估喉癌病人营养状况可行性研究

目的:探讨相位角(PA)评估喉恶性肿瘤病人营养状况的可行性.方法:收集140例喉癌住院病人,术前使用Inbody S 10行人体成分分析、记录PA值,同时进行营养筛查与评估、体格测量与实验室检查.分析PA与营养相关指标的相关性,并以病人主观整体评估(PG-SGA)为营养评价标准,绘制PA的受试者工作特征(ROC)曲线,进而根据截断值分为低PA组与高PA组,计算低PA组营养不良的相对危险度.结果:PA与体质量、BMI、上臂围、上臂肌围、总蛋白、前白蛋白、血红蛋白呈正相关(P＜0.05),与年龄、细胞外水分率(ECW/TBW)呈负相关(P＜0.05);PA的ROC曲线下面积0.71(P＜ 0.01),诊断为营养不良的PA截断值为5.89,灵敏度0.69,特异度0.68,约登指数0.37;低PA组营养不良的比例(71.2％)明显高于高PA组(34.3％),与高PA组相比,低PA组发生营养不良的相对危险度为2.28(95％CI,1.53 ～ 3.41).结论:相位角与喉癌病人的营养状况密切相关,在喉癌病人营养不良的诊断中具有一定的临床应用价值.     

相位角预测手术病人营养风险及住院时间

目的:探讨生物电阻抗相位角(phase angle,PA)与胸外手术病人营养风险、住院时间(hospital length of stay,LOS)的关系。方法:60例胸部手术病人,应用营养风险筛查2002(NRS2002)、主观全面评定(Subjective Global Assessment,SGA)、白蛋白、人体成分分析、PA评价其营养风险及LOS。结果 :与对照组比较,手术病人PA偏低,男(6.0±1.0)vs(3.85±1.0),女(5.4±0.9)vs(4.9±0.6),P0.01。与正常PA比较,低PA者营养风险相对危险度,用NRS2002。无风险(RR 2.8,95%CI=1.2~6.9),中度风险(RR 3.9,95%CI=1.8~8.6),重度风险(RR4.2,95%CI=2.0~8.7);用SGA。营养良好(RR 2.5,95%CI=0.9~6.9),中度营养不良(RR 4.4,95%CI=2.1~9.4),重度营养不良(RR 3.9,95%CI=1.9~8.0),与NRS2002相似;与正常PA比较,低PA者住院时间倾向于延长(LOS≥21 d,RR=4.4,95%CI=2.2~8.8)。结论 :低PA与手术病人营养风险、LOS延长密切关联。PA测量有助于快速明确病人的营养风险对于确定病人营养干预和判断疾病转归提供了客观依据。     

头颈胸部恶性肿瘤92例营养状况分析

目的 横断面调查头颈胸部肿瘤患者的营养状况,为临床营养治疗提供依据.方法 采用主观全面评价法(SGA)对92例头颈胸部恶性肿瘤患者进行营养调查,并测定生化指标、人体测量指标及人体成分指标.结果 92例头颈胸部恶性肿瘤患者SGA评定营养不良的发生率为29.4％,不同肿瘤类型及临床分期营养不良的发生率也不同,分别为22.7％ ～ 37.5％和11.1％ ～38.5％;SGA与多数传统营养指标之间有相关性(r=0.212 ～0.422,P＜0.05);生化、人体测量及人体成分指标比较,除淋巴细胞总数及细胞外水无差异外,营养不良组水肿指数高于营养正常组(P＜0.05),其他指标均低于营养正常组(P＜0.05).结论 恶性肿瘤患者存在一定程度的营养不良,应结合多种指标早期持续地监测恶性肿瘤患者的营养状况,从而制定相应的营养治疗方案.     

主观综合性评估乙型肝炎性肝硬化病人的营养状况

目的:探讨主观综合性营养评估(SGA)在乙型肝炎性肝硬化病人中的应用价值. 方法:回顾分析乙型肝炎性肝硬化病人140例,根据Child-Pugh分级,将病人分为A、B和C组,比较各组间营养指标的差异,并分析Child-Pugh分级与营养指标的相关性. 结果:乙型肝炎性肝硬化病人营养不良的总发生率为42.85％,其中轻-中度营养不良40例(28.57％),重度营养不良20例(14.29％).各组间的体重指数(BMI)、肱三头肌皮皱厚度(TSF)、上臂围(AC)、上臂肌围(AMC)、肌酐身高指数(CHI)、血清转铁蛋白(TF)和清蛋白(ALB)等差异均有显著性统计学意义(P＜0.05).BMI和血清TF与病人Child-Pugh分级相关性不显著(P＞0.05),而AMC、TSF、CHI和血清ALB与病人Child-Pugh分级均呈负相关(r分别为-0.404、-0.673、-0.597、-0.814,P＜0.05). 结论:肝硬化病人多存在不同程度的营养不良,SGA可用于肝硬化病人营养状况的评估.     

预后营养指数与相位角在结直肠肿瘤病人营养不良诊断中的价值

目的：探讨PA和PNI在预测结直肠肿瘤病人营养状态中的应用价值,明确PA与营养状况的相关性,为早期识别营养不良提供依据。方法：467例拟行手术治疗的结直肠恶性肿瘤病人,入院后即运用营养风险筛查量表（NRS 2002）进行筛查,入院后的48 h内完成人体测量、生物电阻抗分析（BIA）和GLIM营养不良诊断,并记录病人的实验室检查及BIA检测值。根据血清白蛋白和外周血淋巴细胞计数计算得到预后营养指标（PNI）。评价相位角（PA）和PNI在结直肠肿瘤病人营养诊断中的价值。根据GLIM营养不良诊断标准运用ROC曲线评估PA和PNI的诊断灵敏度与最佳临界值。结果：42.0%的病人存在营养风险,37.0%的病人出现营养不良。PNI预测营养不良的最佳临界值为47.1(AUC:0.674,灵敏度：0.694,特异性：0.597),PA的截点值为4.75°（AUC:0.845;灵敏度：0.626;特异性：0.936）。两指标相结合的诊断方式更具一定的准确性。PA和PNI分别与BMI、去脂体质量、上臂肌围、腰围、基础代谢率、骨骼肌质量指数、前白蛋白、总蛋白、白蛋白、血红蛋白呈正相关（P <0.05）...     

普外科病人营养状况的调查

目的：了解普外科病人入院时的营养状况。方法：对１００例外科平诊入院正常饮食病人的术前营养状况进行人体测量,人体营养学的实验室检查,膳食调查。结果：发现部分外科病人术前存在营养失调。蛋白质,热能供给基本满足需要,脂肪热能高于２５％,膳食结构有待改进。体脂测量偏高,肌肉组织较少;５０－５９岁年龄组糖代谢失调病人明显增多。结论;外科医师要善于术前发现营养失调的病人;医院营养室应定期进行膳食调查,以指导病     

简易营养评价法在老年糖尿病病人营养状况评估中的应用

采用敏感有效的手段早期发现和积极纠正营养不良,对糖尿病病人的治疗具有极其重要的意义。20世纪90年代初,Guigoz等首先提出了一种适合老年人的营养评价方法,即简易营养评价法(MNA),经广泛应用后被证实是一种对老年人进行营养评价的简易有效方法。我们在此基础上,     

维持性血液透析病人的营养状况评价

目的:应用主观全面评定法(SGA)对维持性血液透析(MHD)病人的营养状况进行评价.方法:采用SGA结合有关生化指标,人体测量指标和饮食评估,对127例MHD病人的营养状况进行综合评价.结果:127例病人中营养良好者75例,轻中度营养不良39例,重度营养不良13例,总营养不良发生率为40.9%.各营养状况组之间血清ALB、PA、肌酐、肱三头肌皮皱厚度、饮食蛋白摄入量和蛋白质分解率差异显著,而三组间Kt/V无显著差异.结论:血液透析病人营养不良的发生率较高,与蛋白质摄入不足、炎症、血液透析过程本身等因素有关.     

MNA和SGA在评价炎症性肠病病人营养状况中的应用

目的:探讨炎症性肠病(IBD)病人营养评估的合理方法. 方法:选择微型营养评定法(MNA)联合营养状况主观综合评估(SGA)对IBD病人进行营养状态评估,同时检测血红蛋白(Hb)、总淋巴细胞计数(TLC)、血清前清蛋白(PA)、清蛋白(ALB)以及钠、钾和钙等指标. 结果:Pearson相关分析显示,MNA值与Hb、ALB、和Na+呈显著相关性.Kendall's tau-b相关方法分析证明,MNA与SGA两种营养评估方法具有很好的相关性(r=0.772,P=0.000). 结论:MNA联合SGA对IBD病人进行营养状况评估方法科学和准确.     

Standardized phase angle indicates nutritional status in hospitalized preoperative patients

There is currently no criterion standard to assess nutritional status, and different methods have been used in hospitalized patients. The aim of this study was to investigate the agreement and the association between bioelectrical impedance analysis derived by standardized phase angle (SPA) and other methods used for the nutritional assessment of body composition, metabolic status, and functional status in surgical patients. The hypothesis was that the SPA is effective for evaluating nutritional status in surgical patients; therefore, it could be used when the application of other assessment methods is not possible. The sample consisted of 125 patients (20-94 years of age) before elective gastrointestinal or hernia repair. The participants were from the Surgical Clinic 1 at the University Hospital of the Federal University of Santa Catarina, Florianópolis, SC, Brazil. Nutritional status was evaluated during the preoperative period based on the triceps skinfold thickness, mid-arm circumference, body mass index, percent weight loss, nutritional risk screening 2002 (NRS 2002), subjective global assessment (SGA), and SPA. The agreement between the SPA and the other methods was assessed with the k coefficient. The agreement between the SPA and the methods of nutritional assessment that were investigated for diagnosing malnutrition was moderate for NRS 2002 and SGA, weak for percent weight loss, and poor for triceps skinfold thickness, mid-arm circumference, and body mass index. There was a significant association between SPA and both NRS 2002 and SGA (P < .001). Our results suggest that SPA is able to indicate the risk of nutritional deficiency in the patients assessed. However, good agreement between SPA and the methods investigated was not observed.     

Using a nutritional screening tool to evaluate the nutritional status of patients with colorectal cancer

We assessed which nutrition evaluation method [subjective global assessment (SGA); malnutrition universal screening tool (MUST); nutritional risk index (NRI)] provided the most efficacious combination of high validity, low cost, and ease of use to examine and improve the status of malnutrition for colorectal cancer (CRC) patients. The SGA, MUST, and NRI scales were used to analyze the preoperative status of malnutrition for 45 CRC patients in a medical center in Taiwan. Differences in the reliability of the 3 methods were compared using the kappa (κ) coefficient of agreement. Lengths of hospital stays were compared using the Mann-Whitney U test to examine the effect of malnutrition in CRC patients. The SGA κ coefficient was higher with the MUST than with the NRI. Preoperative and postoperative weight losses were significantly different on the NRI, and the longer the length of the hospital stay, the greater was the weight loss. Although the SGA had a higher validity and lower cost than the NRI, we recommend using the MUST method for a routine nutrition evaluation because it is easier to use and is less expensive than the SGA and the NRI.     

The use of anthropometry to assess nutritional status

Anthropometry (the use of body measurements to assess nutritional status) is a practical and immediately applicable technique for assessing children's development patterns during the first years of life. An evaluation of their growth also provides useful insights into the nutrition and health situation of entire population groups. Anthropometric indicators are less accurate than clinical and biochemical techniques when it comes to assessing individual nutritional status. In many field situations where resources are severely limited, however, anthropometry can be used as a screening device to identify individuals at risk of undernutrition, followed by a more elaborate investigation using other techniques. Similarly, growth monitoring permits the detection of individuals with faltering growth, who can then be appropriately referred to specialized care. Thanks to the standardization that has taken place in recent years, changes in trends over time with respect to the nutritional situation can be evaluated in countries where national food and nutrition surveillance systems have been developed, or where nationally representative cross-sectional surveys have been conducted some years apart using identical, or nearly identical, methodologies. Although data that can be used to evaluate trends are limited, some insight can be gained into the nutritional situation and changes occurring over time in a number of countries. Prevalence figures for underweight (low weight-for-age) have been prepared using standard methods of data collection, analysis and presentation, for several countries in Africa, the Americas and Asia. As such, they fail to differentiate between wasting and stunting, or to evaluate differences between age groups. Also, they do not necessarily reflect trends in other countries in the same or other regions. Still, it is interesting, if not statistically significant, that there has been a general improvement in the nutritional status of preschool children. Intercountry trend comparisons are difficult for two main reasons. Firstly, the time between surveys is occasionally different and, secondly, despite efforts to standardize data analysis and presentation, different cut-off points have been used to calculate prevalence figures and estimate the extent of undernutrition. However, the use of identical cut-off points is not essential for making intercountry trend analyses since it is the general trends in growth deficit and nutritional status over time which are being evaluated.(ABSTRACT TRUNCATED AT 400 WORDS)     

对77例糖尿病患者营养状况的研究

对77例糖尿病患者营养状况进行了研究。结果表明,糖尿病患者的％IBW、AC、Amc、TSF、Hb、Alb等项营养指标均证实糖尿病病人存在着较严重的营养障碍(P<0.05)。采用供热比不同的两组膳食治疗后,营养状况的恢复高蛋白组好于低蛋白组。病情的愈合指标OGTT、Cr,Bun等均无显著差异(P>0.05)。     

对进展期肿瘤病人整体营养状况筛查的研究

目的:探讨病人整体营养状况主观评估(PG-SGA)表作为进展期肿瘤病人营养状况筛查工具的有效性. 方法:选择择期手术的进展期肿瘤病人88例,利用客观营养指标及PG-SGA表判断其营养状况. 结果:以客观指标判断为营养不良的病人有53例(60.2%),而根据PG-SGA表评估,有54例(61.4%)存在营养不良.PG-SGA表评分的灵敏度达94%,特异性为91%.两种筛查方法有高度的相关性. 结论:PG-SGA表作为进展期肿瘤病人的营养状况筛查,具有简单、有效、易行、无创及快速等优点.     

Protein-energy nutritional status of pediatric cancer patients

Surveys of protein-energy nutritional status were conducted in pediatric cancer outpatients (28) and inpatients (71). In the outpatients, the approximate prevalences of severe (greater than 40%) deviations of weight, triceps skinfold, and arm muscle area below the medians for height-age were respectively 0, 14, and 0%. In the inpatients, these prevalences were respectively 1, 20, and 6%. The percentages of inpatients with abnormally low (less than 5th percentile) weight-for-height, triceps skinfold, and arm muscle area were 14, 14, and 20%, respectively. All inpatients with triceps skinfold or arm muscle area less than 60% of the median for height-age had corresponding percentile values of less than 15.     

外科胰腺肿瘤患者营养不足和营养风险发生率的前瞻性调查研究

目的　调查外科胰腺肿瘤患者营养不足和营养风险发生率。方法　对2014年1月至2015年12月,因各种胰腺肿瘤入住北京医院普外科,接受手术治疗的121例住院患者,根据肿瘤性质分为胰腺癌组和其他胰腺肿瘤组,主要应用营养风险筛查2002方法,前瞻性比较不同胰腺肿瘤患者的营养不足和营养风险发生率以及物理测量、体成分和外周血蛋白质水平等,记录临床结局。结果　121例符合入选标准的胰腺肿瘤患者进入本研究,胰腺癌组90例和其他胰腺肿瘤组31例,平均年龄（61.9±13.6）岁;平均体质量指数（23.20±2.95）kg/m2;上臂围（28.8±3.5）cm;肌肉组织量（44.6±7.4）kg;脂肪组织量（16.8±7.6）kg;两组在人体测量和体成分等方面差异无统计学意义（均P＞0.05）;胰腺癌组空腹血糖［（6.45±2.47）mmol/L］显著高于对照组［（4.95±0.79）mmol/L］（P＜0.001）,白蛋白［（39.0±4.7）g/L比(42.3±2.9)g/L,P＜0.001］,总蛋白［（62.8±6.2）g/L比(66.3±2.9)g/L,P＜0.001］和前白蛋白［（136.1±85.4）mg/L比(197.8±112.6),P=0.011］均显著低于对照组;营养不足发生率为4.1%,营养风险发生率78.5%;其中胰腺癌组营养风险发生率显著高于其他胰腺肿瘤组（91.1%比38.7%,χ2=36.525,P＜0.001）。结论　外科胰腺癌患者营养风险发生率较高,蛋白水平低和糖代谢异常,可导致住院时间延长。