探讨全球领导人营养不良倡议(GLIM)标准下胃肠道恶性肿瘤患者营养不良发生情况,并比较其与患者主观整体 评估(PG-SGA)在营养不良诊断中的一致性,以期为 GLIM 标准的临床应用提供依据。 方法 选取 2021 年 10 月至 2022 年 7 月 安徽医科大学第一附属医院普外科收治的 220 例胃肠道恶性肿瘤患者,运用 GLIM 标准及 PG-SGA 量表对患者进行营养评 估,采用生物电阻抗技术测量患者的人体组成成分,通过 Kappa 一致性检验分析 GLIM 标准与 PG-SGA 量表评估结果的一致 性。 结果 GLIM 诊断出营养不良患者 112 例(50. 9%),其中中度营养不良 85 例,重度营养不良 27 例。 营养不良的严重程度 在不同年龄、体重、体质指数、右上臂围、右小腿围、手握力、体脂、体脂百分比、去脂体重、去脂体质指数、肌肉含量以及骨骼肌 方面具有显著差异(P<0. 05)。 PG-SGA 诊断出营养不良患者 158 例(71. 8%),其中 85 例为中度营养不良,73 例为重度营养 不良。 GLIM 标准和 PG-SGA 量表在诊断营养不良时表现出中等程度的一致性(Kappa = 0. 548,P<0. 001),其受试者操作特征 曲线下面积为 0. 821(95%CI = 0. 745~ 0. 877);但在区分不同严重程度的营养不良患者时,二者一致性水平相对较低(Kappa = 0. 344,P<0. 001)。 结论 GLIM 标准与 PG-SGA 在诊断营养不良时一致性尚可,而在区分中度和重度营养不良时一致性较 差,但这并不影响 GLIM 标准的临床适用性。

Objective To investigate the occurrence of malnutrition in patients with gastrointestinal malignancy according to the Global Leadership Initiative on Malnutrition criteria GLIM and compare the consistency of GLIM and patient-generated subjective global assessment PG- SGA in the diagnosis of malnutrition. Method A total of 220 patients with gastrointestinal malignancies admitted to the First Affiliated Hospital of Anhui Medical University were selected from October 2021 to July 2022 for nutritional assessment using the GLIM criteria and PG-SGA. Patients' body composition was measured by bioelectrical impedance technology and Kappa consistency test was used to analyze the consistency of GLIM and PG-SGA evaluation results. Result 112 patients 50. 9% were diagnosed as malnutrition by GLIM including 85 moderate and 27 severe malnutrition. The severity of malnutrition was significantly different in age weight body mass index right upper arm circumference right calf circumference hand grip strength fat mass fat mass percentage fat free mass fat free mass index muscle and skeletal muscle P < 0. 05 . One hundred and 58 patients 71. 8% were diagnosed as malnutrition by PG-SGA including 85 moderate and 73 severe malnutrition. GLIM and PG-SGA had good consistency in the diagnosis of malnutrition Kappa = 0. 548 P < 0. 001 and the area under the ROC curve was 0. 821 95% CI = 0. 745-0. 877 . When distinguishing patients with different degrees of malnutrition the level of consistency was relatively low Kappa = 0. 344 P<0. 001 . Conclusion GLIM criteria and PG-SGA have a good consistency in the diagnosis of malnutrition but a relatively poor consistency in the classification of the severity of malnutrition. However this does not affect the clinical applicability of GLIM criteria.