目的 研究原发性肝癌患者的营养状况,比较患者主观整体评估(PG-SGA) 和改良版患者主观整体评估(mPGSGA)评估营养不良的能力。 方法 纳入 2022 年 4 月至 2023 年 9 月于西南医科大学附属医院首诊为原发性肝癌的 249 例患 者,采用 PG-SGA 和 mPG-SGA 评估患者营养状况,通过 Spearman 相关分析比较不同营养指标与两种量表评估结果的相关 性,绘制受试者操作特征(ROC)曲线评价 mPG-SGA 的准确性,计算 Kappa 系数评价两种量表的一致性。 结果 249 例原发性 肝癌患者中,PG-SGA 和 mPG-SGA 分别诊断出中、重度营养不良患者 196 例(78. 71%)、189 例(75. 90%)。 以 PG-SGA 为标 准,对于营养良好/ 轻度营养不良、中度营养不良及重度营养不良 3 种不同营养状态,mPG-SGA 均表现出较好的准确性,AUC 值分别为 0. 982、0. 938、0. 977(P<0. 001),并具有强一致性(Kappa = 0. 951, P<0. 001)。 通过性别、年龄、吸烟史、饮酒史、临床 分期、体质指数(BMI)分层分析发现,BMI<18. 5 kg / m 2的患者中,mPG-SGA 对营养良好/ 轻度营养不良、中度营养不良及重度 营养不良 3 种不同营养状态表现出较强的一致性(Kappa = 0. 762, P = 0. 001),除外 BMI<18. 5 kg / m 2 的其余临床特征分层分 析中,mPG-SGA 对 3 种不同营养状态均表现出强一致性(Kappa>0. 9, P<0. 001)。 结论 原发性肝癌患者营养不良发生率 高,mPG-SGA 与 PG-SGA 具有良好的准确性及一致性,是一种更简便、适用于评估原发性肝癌患者营养不良的工具。

Objective To evaluate the nutritional status of patients with primary liver cancer and to compare the ability of PG-SGA and mPG-SGA to assess malnutrition. Method Clinical data of 249 patients diagnosed with primary liver cancer for the first time at Affiliated Hospital of Southwest Medical University between April 2022 and September 2023 were collected. PG-SGA and mPG-SGA were used to assess the nutritional status of patients. Spearman correlation analysis was used to compare the correlation between different nutritional indicators and two scales. The ROC curve was used to evaluate the accuracy of mPG-SGA. The Kappa coefficients were used to evaluate the concordance between two scales. Result Among 249 patients with primary liver cancer 196 78. 71% and 189 75. 90% were diagnosed with moderate to severe malnutrition using PG - SGA and mPG - SGA respectively. Using PG-SGA as a criterion mPG-SGA showed good accuracy for good / mild malnutrition moderate malnutrition and severe malnutrition with AUC values of 0. 982 0. 938 and 0. 977 respectively P < 0. 001 . It also showed almost perfect consistency with PG-SGA Kappa = 0. 951 P<0. 001 . Analysis by gender age history of smoking alcohol consumption clinical stage and body mass index BMI subgroups revealed that mPG-SGA showed strong consistency for good / mild malnutrition moderate malnutrition and severe malnutrition among patients with BMI < 18. 5 kg / m 2 Kappa = 0. 762 P = 0. 001 . All subgroups with the exception of BMI<18. 5 kg / m 2 showed almost perfect consistency for the three different nutritional stages Kappa>0. 9 P<0. 001 . Conclusion Malnutrition is prevalent in patients with primary liver cancer. mPG-SGA has been shown to have good accuracy and concordance with PG-SGA. It is a simpler tool for assessing malnutrition in patients with primary live cancer.