主观全面营养评估量表在脑性瘫痪住院患儿中的临床有效性验证

Clinical effectiveness of Subjective Global Nutritional Assessment in hospitalized children with cerebral palsy

摘要:

目的 了解脑性瘫痪（简称脑瘫）患儿的营养状况，验证主观全面营养评估（SGNA）量表在脑瘫住院患儿营养评估中的临床有效性。方法 选取2019年4~10月住院的1~5岁脑瘫患儿208例为研究对象，回顾性收集其SGNA量表评估结果，并以世界卫生组织推荐的Z评分法作为参照标准，验证SGNA量表评估脑瘫患儿营养状况的临床有效性。结果 SGNA量表和Z评分法对脑瘫患儿的营养不良检出率分别为42.3%、39.4%，差异无统计学意义（P > 0.05）。SGNA量表的应用在不同评估者间呈高度一致性（κ=0.621，P < 0.001）。以Z评分法作为参照标准，SGNA量表的灵敏度、特异度、阳性预测值、阴性预测值分别为80.5%、82.5%、75.0%、86.7%，两种评估方法呈高度一致性（κ=0.622，P < 0.001）。SGNA量表与年龄别体重Z评分、年龄别身高Z评分均呈中度一致性（分别κ=0.495、0.478，P < 0.001），与身高别体重Z评分一致性低（κ=0.197，P < 0.05）。结论 脑瘫患儿营养不良发生率较高；SGNA量表可以作为评估脑瘫患儿营养状况的工具。

Abstract:

Objective To investigate the nutritional status of children with cerebral palsy (CP) and the clinical effectiveness of Subjective Global Nutritional Assessment (SGNA) in nutritional assessment of hospitalized children with CP. Methods A total of 208 children with CP, aged 1-5 years, who were hospitalized from April to October 2019 were enrolled as subjects. SGNA was used to investigate nutritional status, and the Z-score method recommended by the World Health Organization was used as a reference standard to validate the clinical effectiveness of SGNA. Results The detection rate of malnutrition in children with CP was 42.3% by SGNA and 39.4% by the Z-score method (P > 0.05). The application of SGNA showed high consistency between different evaluators (κ=0.621, P < 0.001). With the Z-score method as the reference standard, SGNA had a sensitivity of 80.5%, a specificity of 82.5%, a positive predictive value of 75.0%, and a negative predictive value of 86.7%, and high consistency was observed between the two evaluation methods (κ=0.622, P < 0.001). SGNA was moderately consistent with weight-for-age Z-score and height-for-age Z-score (κ=0.495 and 0.478 respectively, P < 0.001) and was poorly consistent with weight-for-height Z-score (κ=0.197, P < 0.05). Conclusions There is a relatively high incidence rate of malnutrition in children with CP. SGNA can be used as a tool to assess the nutritional status of children with CP.