两种方法评估肝硬化病人营养状况及其与肌肉减少症的关联性

目的比较全球领导人营养不良倡议( GLIM)标准和英国皇家自由医院 -营养优先工具( RFH-NPT)在评估肝硬化病人营养不良中的应用，并分析其与肌少症的关联性。方法 2020年 1月至 2021年 12月采用系统抽样方法抽取宜宾市第二人民医院肝硬化病人 173例，采用营养风险筛查工具 2002(NRS 2002)和 RFH-NPT筛查病人营养风险， GLIM标准诊断病人营养不良，并分析各方法诊断结果的一致性和与肌少症的关联性。结果肝硬化病人 NRS 2002和 RFH-NPT评分分别为( 3.43±0.53)和(1.48±0.36)分，两方法筛查出营养风险发生率分别为 78.6%和 85.6%，年龄越大和 Child-pugh分级越高营养风险发生率越高(P<0.05)。以 GLIM标准确诊营养不良阳性率为 72.8%，肌少症发生率为 53.2%，不同年龄段和 Child-pugh分级营养不良发生率差异有统计学意义( P<0.05)。RFH-NPT与 NRS 2002营养风险筛查、 GLIM标准诊断营养不良的 Kappa值分别为 0.61和 0.45，一致性一般。 RFH-NPT评分与骨骼肌质量指数( SMI)呈负相关，其关联系数 r为0.51(P<0.01)。配对 χ2检验显示: GLIM标准诊断营养不良、 NRS 2002和 RFH-NPT筛查营养风险与肌少症之间的列联系数分别为 0.50、0.29和 0.20(P<0.01)。结论肝硬化病人营养风险、营养不良和肌少症发生率高，采用 NRS 2002、RFH-NPT和 GLIM标准评估病人营养风险和营养不良与病人肌少症有一定关联性。

The nutritional status of patients with liver cirrhosis evaluated by two methods and its correlations with sarcopenia

Objective To compare the application of global leadership initiative on malnutrition (GLIM) standard and royal rree hospital nutrition priority tool (RFH-NPT) in evaluating malnutrition among patients with liver cirrhosis, and analyze its correlations with sarcopenia.Methods One hundred and seventy-three patients with liver cirrhosis in the Second People''s Hospital of Yibin were randomly selected from January 2020 to December 2021. NRS 2002 and RFH-NPT were used to screen the nutritional risk of patients,GLIM standard was used to diagnose malnutrition, and the consistency of diagnostic results among each method and its correlation withsarcopenia were analyzed.Results The NRS 2002 and RFH-NPT scores of patients with liver cirrhosis were (3.43 ± 0.53) and (1.48 ±0.36) with the incidence of nutritional risk at 78.6% and 85.6%, respectively.The higher age and Child-pugh grade, the higher inci dence of nutritional risk (P<0.05). The positive rate of malnutrition diagnosed by GLIM standard was 72.8%, and the incidence of sarcopenia was 53.2%.There was significant difference in the incidence of malnutrition in different age groups and Child-pugh grades (P< 0.05). The consistency of RFH-NPT and NRS 2002 nutritional risk screening and the consistency of RFH-NPT and GLIM standard for the diagnosis of malnutrition was general with kappa value at 0.61 and 0.45, respectively. RFH-NPT score was negatively correlated with skeletal muscle mass index (SMI) with correlation coefficient r at 0.51 (P<0.01). Paired chi-square test showed that the contingen cy coefficients between GLIM standard diagnosis of malnutrition, NRS 2002 and RFH-NPT screening nutritional risk and sarcopenia were 0.50, 0.29 and 0.20, respectively (P<0.01). Conclusion The incidence of nutritional risk, malnutrition and sarcopenia is highamong patients with liver cirrhosis. There is a certain correlation between nutritional risk and malnutrition assessed by NRS 2002,RFH-NPT, GLIM and sarcopenia.