SGA和GLIM评估肝衰竭患者营养状态一致性分析

doi:10.3969/j.issn.1672-5069.2025.02.017

摘要/Abstract

摘要： 目的分析主观全面营养评价(SGA)和全球领导人营养不良倡议(GLIM) 标准评估肝衰竭(LF)患者营养状态的一致性。方法 2020年～2023年北京佑安医院住院的LF患者110例,其中包括亚急性肝衰竭(SALF)患者26例、慢加急性肝衰竭(ACLF)患者43例和慢性肝衰竭(CLF)患者41例,采用营养风险筛查2002(NRS2002)、SGA和GLIM方法评估营养状态,采用Kappa一致性检验。结果入组患者NRS2002筛查存在营养风险比例51.8%,SGA评估营养不良发生率为60.9%,显著高于GLIM评估的50.0%(P＜0.05);在SALF组,营养不良组仅血清前白蛋白(PA)水平显著低于营养正常组(P＜0.05);在ACLF组,营养不良组BMI显著低于营养正常组,血清总胆红素(TBIL)水平显著高于营养正常组,SGA评估的营养不良组血清PA和凝血酶原时间活动度(PTA)显著低于营养正常组,GLIM评估的营养不良组28 d病死率显著高于营养正常组(P＜0.05);在CLF组,营养不良组血清TBIL水平显著高于营养正常组,SGA评估的营养不良组BMI、PA和PTA显著低于营养正常组,GLIM评估的营养不良组BMI、PA和血红蛋白(HGB)水平显著低于营养正常组(P＜0.05);SGA与GLIM两种方法评估结果的一致性良好(Kappa=0.615,P＜0.001)。结论 LF患者营养不良发生率较高,SGA与GLIM评估的一致性较好,适合对具有慢性肝病基础的ACLF和CLF患者进行营养评估,而对于SALF患者,建议应用NRS2002营养风险筛查。一旦出现阳性结果,应给予营养支持。

关键词: 肝衰竭, 营养不良, 主观全面营养评价, 全球领导人营养不良倡议, 诊断

Abstract: Objective The aim of this study was to compare subjective global assessment (SGA) and global leaders malnutrition initiative (GLIM) standards in the assessment of malnutrition in patients with liver failure (LF). Methods A total of 110 patients with LF were encountered in Beijing You'an hospital between 2020 and 2023, including subacute liver failure (SALF) in 26 cases, acute-on-chronic liver failure (ACLF) in 43 cases and chronic liver failure (CLF) in 41 cases; Malnutrition was screened by nutritional risk screening 2002 (NRS2002), SGA and GLIM, and the consistency was compared by Kappa test. Results The nutritional risk incidence rate of all patients assessed by NRS2002 was 51.8%, by SGA was 60.9%, which was higher than 50.0% assessed by GLIM (P＜0.05); serum prealbumin (PA) level in malnutrition group was significantly lower than in normal nutrition group in patients with SALF (P<0.05); in patients with ACLF, the body mass index (BMI) in malnutrition group was significantly lower than in normal group, while total serum bilirubin (TSB) level was significantly higher than in normal group (P＜0.05). serum PA and prothrombin time activity (PTA) in malnutrition group evaluated by SGA were significantly lower than in normal group, and 28 d fatality rate in malnutrition group by GLIM was significantly higher than in normal (P<0.05); in patients with CLF, TSB level in malnutrition group was significantly higher than in normal group, while BMI, PA and PTA in malnutrition group by SGA were significantly lower than in normal group; the BMI, PA and blood hemoglobin (HGB) levels in malnutrition group by GLIM were significantly lower than in normal group (P<0.05); Kappa test showed that SGA and GLIM had a good consistency in the evaluation of malnutrition in patients with LF (Kappa = 0.615,P＜0.001). Conclusion The incidence rates of nutritional risk and malnutrition are high in patients with LF, and majority of patients with malnutrition con be identified by SGA than GLIM. The evaluation results in ACLF and CLF are consistent by SGA than GLIM, we recommend NRS2002 for nutritional risk assessment in patients with SALF, and those with malnutrition should be carefully supported.

Key words: Liver failure, Malnutrition, Subjective global assessment, Global leadership initiative on malnutrition, Diagnosis

班凌伟, 杨勤兵, 华鑫. SGA和GLIM评估肝衰竭患者营养状态一致性分析[J]. 实用肝脏病杂志, 2025, 28(2): 226-229.

Ban Lingwei, Yang Qinbing, Hua Xin. Subjective global assessment and global leaders malnutrition initiative standards in the assessment of malnutrition in patients with liver failure[J]. Journal of Practical Hepatology, 2025, 28(2): 226-229.

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