NRS-2002与MNA-SF营养评估对恶性梗阻性黄疸患者术后生存期的预测价值

目的本研究通过营养风险评估表(NRS-2002)与简易营养评价精法(MNA-SF)评分筛查恶性梗阻性黄疸(MOJ)患者营养状态并探讨其与术后总生存期(OS)的关系。方法 选取2016年1月-2018年1月在北京市空军特色医学中心就诊并行经皮肝穿刺胆道引流术+胆道支架植入术的78例MOJ患者。入院24 h内进行营养筛查。计量资料多组间比较采用方差分析,进一步两两比较采用SNK- q 检验;计数资料组间比较采用χ 2检验。采用一致性检验评估NRS-2002与MNA-SF的一致性;采用多元线性回归分析NRS-2002与MNA-SF的独立影响因素;根据单因素及多因素Cox比例风险回归分析OS的独立危险因素。采用Kaplan-Meier法绘制不同营养状态患者的生存曲线,并用log-rank检验进行分析。结果 NRS-2002评估中,营养正常10例(12.8%),营养不良风险53例(67.9%),营养不良15例(19.2%)。MNA-SF评估中,营养正常7例(9.0%),营养不良风险32例(41.0%),营养不良39例(50.0%)。年龄、BMI均是NRS-2002与MNA-SF的独立影响因素( P 值均<0.05)。NRS-2002与MNA-SF的一致性评价较好(Kappa=0.418, P <0.001)。两种营养评分量表均表明,营养不良患者OS低于营养不良风险及营养正常患者(χ2=42.081, P <0.001);营养不良风险患者OS低于营养正常患者(χ2=33.723, P <0.001)。NRS-2002营养不良(风险比=3.874,95%可信区间:1.065~14.099)]、MNA-SF营养不良风险(风险比=15.544,95%可信区间:2.324~103.968);营养不良(风险比=42.535,95%可信区间:6.179~292.798)]是患者OS的独立影响因素( P 值均<0.05)。结论 MNA-SF筛查MOJ患者营养状态具有优越性,能更准确预测OS。因此,将其推荐为MOJ患者入院时营养筛查工具并根据筛查结果进行营养干预。

Value of Nutritional Risk Screening 2002 and Mini Nutritional Assessment-Short Form in predicting the survival time of patients with malignant obstructive jaundice after surgery

Objective To investigate the value of Nutritional Risk Screening 2002 (NRS-2002) and Mini Nutritional Assessment-Short Form (MNA-SF) in assessing the nutritional status of patients with malignant obstructive jaundice (MOJ) and their association with overall survival (OS) after surgery. Methods A total of 78 patients with MOJ who attended Air Force Medical Center from January 2016 to January 2018 and underwent percutaneous transhepatic cholangial drainage and biliary stent implantation were enrolled. Nutritional screening was performed within 24 hours after admission. An analysis of variance was used for comparison of continuous data between multiple groups, and the SNK- q test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between groups. The consistency test was used to evaluate the consistency between NRS-2002 and MNA-SF. A multivariate linear regression analysis was used to investigate the independent influencing factors for NRS-2002 and MNA-SF, and univariate and multivariate Cox regression analyses were used to identify the independent risk factors for OS. The log-rank test was used for comparison of OS between patients with different nutritional status. Results According to NRS-2002, there were 10 patients with normal nutrition (12.8%), 53 patients with the risk of malnutrition (67.9%), and 15 patients with malnutrition (19.2%). According to MNA-SF, there were 7 patients with normal nutrition (9.0%), 32 patients with the risk of malnutrition (41.0%), and 39 patients with malnutrition (50.0%). Age and body mass index were independent influencing factors for NRS-2002 and MNA-SF (all P <0.05). There was good consistency between NRS-2002 and MNA-SF (Kappa=0.418, P <0.001). Both nutritional scales showed that the patients with malnutrition had significantly shorter OS than those with the risk of malnutrition or normal nutrition (χ 2 =42.081, P <0.001), and the patients with the risk of malnutrition had significantly shorter OS than those with normal nutrition (χ 2 =33.723, P <0.001). Malnutrition based on NRS-2002 (hazard ratio HR]=3.874, 95% confidence interval CI]: 1.065-14.099), risk of malnutrition based on MNA-SF (HR=15.544, 95%CI: 2.324-103.968), and malnutrition (HR=42.535, 95%CI: 6.179-292.798) were independent influencing factors for OS ( P <0.05). Conclusion MNA-SF is superior to NRS-2002 in screening the nutritional status of MOJ patients and can predict OS more accurately. Therefore, it is recommended as a nutritional screening tool for MOJ patients on admission and nutritional intervention can be given based on the results of screening.