5种肌肉减少症筛查工具在胃癌患者术前营养评定中的应用比较

doi:10.3761/j.issn.0254-1769.2021.09.003

摘要/Abstract

摘要：

目的比较5种不同肌肉减少症筛查工具在胃癌患者术前营养评定中的应用效果。方法便利选取2020年5月—10月江苏省某三级甲等医院收治的拟行胃癌手术的患者270例,分别应用肌肉减少症五条目问卷、改良版肌肉减少症五条目（Strength,Assis tance with walking,Rise from a Chair,Climb Stairs,Falls and Calf Circumference,SARC-CalF）问卷、Ishii评分、迷你肌肉减少症风险评估-7条目问卷和迷你肌肉减少症风险评估-5条目问卷对其进行评估,并基于2019年亚洲肌肉减少症工作组（Asian Working Group for Sarcopenia,AWGS 2019）提出的诊断标准,采用SPSS 20.0和MedCalc 19.0.4软件计算灵敏度、特异度和预测值,绘制受试者操作特征曲线,计算曲线下面积,并通过计算Youden指数,确定各筛查工具的最佳截断值。结果依据AWGS 2019提出的诊断标准,胃癌患者术前肌肉减少症的发生率为8.76%,使用5种评估工具得出存在肌肉减少症风险的发生率为3.42%~73.76%。上述5种筛查工具在胃癌患者术前肌肉减少症筛查中的灵敏度为26.09%~95.65%,特异度为28.33%~98.75%,受试者操作特征曲线下面积为0.696~0.901。其中,SARC-CalF问卷的受试者操作特征曲线下面积相对更高（0.901）,且其灵敏度（82.61%）和特异度（92.08%）也较好,此时对应的最佳截断值为10分。结论 5种肌肉减少症筛查工具均具有一定的临床实用性和准确性,使用SARC-CalF问卷对胃癌患者术前进行肌肉减少症筛查更具灵敏度、特异度和准确性。

关键词: 胃肿瘤, 肌肉减少症, 筛查, 诊断性试验, 护理评估, 外科护理学

Abstract:

Objective To compare the performance of 5 screening tools for sarcopenia in preoperative patients with gastric tumor. Methods We conducted a survey among a convenience sample of 270 patients who would undergo gastric tumor surgery in a tertiary class A hospital from May to October in 2020. The Questionnaire of Strength,Assistance with Walking,Rise from a Chair,Climb Stairs and Falls（SARC-F）,Questionnaire of Strength,Assistance with Walking,Rise from a Chair,Climb Stairs,Falls and Calf Circumference（SARC-CalF）,Ishii Score Chart,Mini Sarcopenia Risk Assessment Based on 7 Items（MSRA-7） Questionnaire and Mini Sarcopenia Risk Assessment Based on 5 Items（MSRA-5） Questionnaire were used in preoperative patients. Based on the diagnostic standard for sarcopenia proposed by Asian Working Group for Sarcopenia in 2019（AWGS 2019）,we used SPSS 20.0 and MedCalc 19.0.4 software to calculate the sensitivity,specificity and predicted value. Receiver operating characteristic curve（ROC） was also drawn to calculate the area under curve（AUC）. Additionally,the optimal cut-off value of each screening tool was determined by calculating Youden index. Results In preoperative patients with gastric tumor,the incidence of sarcopenia was 8.76% and the prevalence of the risk of sarcopenia was 3.42%~73.76%. Additionally,the sensitivity and specificity of the above 5 screening tools in preoperative patients with gastric tumor were 26.09%~95.65% and 28.33%~ 98.75%,respectively,and AUC of the 5 tools ranged from 0.696 to 0.901. Among them,the AUC of SARC-CalF questionnaire was relatively higher（0.901）,and its sensitivity（82.61%）and specificity（92.08%） were also good with the optimal cut-off value being 10 points. Conclusion The above 5 screening tools for sarcopenia all had certain clinical practicability and accuracy,and the SARC-CalF questionnaire had better sensitivity,specificity and accuracy for screening sarcopenia in preoperative patients with gastric tumor.

Key words: Stomach Neoplasms, Sarcopenia, Screen, Diagnostic Test, Nursing Assessment, Surgical Nursing

陆金玲, 许勤, 陈丽, 丁玲玉, 花红霞, 徐欣怡. 5种肌肉减少症筛查工具在胃癌患者术前营养评定中的应用比较[J]. 中华护理杂志, 2021, 56(9): 1299-1304.

LU Jinling, XU Qin, CHEN Li, DING Lingyu, HUA Hongxia, XU Xinyi. Comparison of the performance of 5 screening tools for sarcopenia in preoperative patients with gastric tumor[J]. Chinese Journal of Nursing, 2021, 56(9): 1299-1304.

图/表 3

表1 2019年亚洲肌肉减少症工作组诊断标准下5种肌肉减少症筛查工具的准确性分析（n=270）

Table 1 Accuracy analysis of five screening tools for sarcopenia based on AWGS 2019（n=270）

图1 2019年亚洲肌肉减少症工作组诊断标准下五种肌肉减少症筛查工具的受试者操作特征曲线

Figure 1 ROC of comparisons of five screening tools for sarcopenia based on AWGS 2019

表2 2019年亚洲肌肉减少症工作组诊断标准下5种肌肉减少症筛查工具的最佳截断值分析

Table 2 Analysis of the optimal cut-off value of five screening tools for sarcopenia based on AWGS 2019

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