目的 评价使用全球营养不良领导倡议(GLIM)标准对接受手术治疗的食管癌患者营养不良诊断与术后短期结局 预测的临床价值。 方法 纳入 2019 年 1 月至 2022 年 1 月于江苏省如皋市人民医院心胸外科确诊并接受食管癌根治性切除的 158 例患者。 通过营养风险筛查 2002(NRS 2002)和 GLIM 标准对患者进行营养风险筛查与营养不良诊断。 基于 GLIM 标准 将患者划分为营养不良组与营养良好组,比较两组患者的短期术后结果。 通过单、多因素 Logistic 回归分析确定食管癌术后 并发症(Clavien-Dindo 分级≥Ⅱ级)的预测因素。 结果 使用 NRS 2002 筛查出有营养风险患者 75 例(47. 5%),而 GLIM 标准 定义的营养不良发生率为 34. 2%(54 / 158)。 11. 4%(18 / 158)的患者在术前出现了非自主性体重丢失,10. 8%(17 / 158)有体 质指数(BMI)减低,而 16. 5%(26 / 158)符合肌肉质量减少的诊断标准。 与营养良好组患者相比,更多的营养不良患者接受了 术前新辅助放、化疗(χ 2 = 4. 209,P = 0. 040),且其术前的血清白蛋白[(36. 7±5. 1)g / L 比(38. 6±3. 7)g / L,t = 2. 691,P = 0. 008]、BMI [(21. 0±3. 4)kg / m 2 比(23. 1±2. 5)kg / m 2 ,t = 4. 195,P<0. 001]和第三腰椎旁肌肉指数[(40. 8±9. 4)cm 2 / m 2 比(46. 7±7. 3)cm 2 / m 2 ,t = 4. 252,P<0. 001]均显著降低。 此外,营养不良患者的住院时间显著延长(t = -2. 152,P = 0. 033),术后总体并发症( χ 2 = 3. 842, P= 0. 044)和 Clavien-Dindo≥Ⅱ级并发症(χ 2 = 5. 026,P= 0. 025)发生率明显增高,特别是吻合口漏(χ 2 = 4. 478,P= 0. 034)与肺 内感染(χ 2 = 9. 459,P= 0. 002)。 单、多因素 Logistic 回归分析表明术前低蛋白血症(OR = 3. 784,95%CI = 1. 294 ~ 11. 070,P = 0. 015)和 GLIM 定义的营养不良(OR= 2. 834,95%CI = 1. 142~ 7. 029,P = 0. 025)是食管癌术后并发症的独立风险因素。 结论 GLIM 不仅是评估食管癌患者术前营养状况的有效方法,还可预测术后并发症风险,有望作为优化食管癌患者临床管理的有 用工具。

Objective This study aimed to evaluate the clinical value of Global Leadership Initiative on Malnutrition GLIM criteria for the the diagnosis of malnutrition and prediction of short-term clinical outcomes in esophageal cancer who underwent curative esophagectomy. Method This study included 158 esophageal cancer patients who were diagnosed and treated with curative esophagectomy in Rugao People's Hospital of from January 2019 to January 2022. Nutritional Risk Screening 2002 NRS 2002 and GLIM criteria were used for nutritional risk assessment and the diagnosis of malnutrition. All patients were divided into malnutrition and non - malnutrition group according to the GLIM criteria and the short-term surgical outcomes between the two groups were compared. In addition the univariate and multivariate Logistic regression analysis was conducted to determine the predictors of postoperative complications Clavien-Dindo grade≥grade Ⅱ for esophageal cancer patients. Result The preoperative nutritional risk was detected in 75 patients 47. 5% using NRS 2002 and the prevalence of malnutrition defined by GLIM criteria was 34. 2% 54 / 158 . Overall 11. 4% 18 / 158 of esophageal cancer patients had unintentional weight loss 10. 8% 17 / 158 had a low body mass index BMI and 16. 5% 26 / 158 were diagnosed with sarcopenia. Compared with the non-malnutrition group GLIM-defined malnutrition group had a higher proportion of preoperative neoadjuvant chemotherapy χ 2 = 4. 209 P= 0. 040 lower level of serum albumin 36. 7±5. 1 g / L vs 38. 6±3. 7 g / L t = 2. 691 P = 0. 008 lower BMI 21. 0± 3. 4 kg / m 2 vs 23. 1± 2. 5 kg / m 2 t = 4. 195 P< 0. 001 and skeletal muscle index at the third lumbar 40. 8±9. 4 cm 2 / m 2 vs 46. 7±7. 3 cm 2 / m 2 t = 4. 252 P<0. 001 . Moreover the length of hospital stays was longer t = -2. 152 P= 0. 033 the rates of postoperative complications χ 2 = 3. 842 P = 0. 044 and ClavienDindo≥ grade Ⅱ χ 2 = 5. 026 P = 0. 025 were higher especially for anastomotic leakage χ 2 = 4. 478 P = 0. 034 and pneumonia χ 2 = 9. 459 P = 0. 002 in malnutrition group than in non - malnutrition group. Univariate and multivariate logistic regression analysis demonstrated that preoperative hypoalbuminemia OR = 3. 784 95%CI = 1. 294-11. 070 P = 0. 015 and GLIMdefined malnutrition OR= 2. 834 95%CI = 1. 142-7. 029 P= 0. 025 were independent risk factors of postoperative complications for esophageal cancer patients who underwent curative esophagectomy. Conclusion GLIM is an useful tool to evaluate the preoperative nutritional status and predict the risk of postoperative complications and it could help surgeons to optimize the clinical management of esophageal cancer patients