目的 研究主观全面营养评估(SGNA)和儿童生长发育Z评分临床应用于脑瘫儿童营养不良状况评估的一致性,为SGNA的临床应用推广提供有效参考。方法 对于2021年1—7月就诊于安徽省儿童医院康复科的76例脑瘫儿童,分别进行SGNA评估和儿童生长发育Z评分测量,评估其营养不良状况,并使用加权Kappa系数分析SGNA与Z评分在评估脑瘫儿童营养等级时的一致性。Z评分营养等级划分考虑两种不同标准:传统Z评分营养等级,包括营养正常(Z>-2),中度营养不良(-3<Z≤-2),重度营养不良(Z≤-3)三个等级;2014年美国肠内肠外营养学会(ASPEN)共识声明Z评分营养等级,包括四个等级,新增轻度营养不良等级(-2<Z≤-1),本研究中将轻度、中度营养不良合并为同一等级,以便与SGNA进行营养等级一致性分析。结果 将SGNA与Z评分均按营养正常、中度营养不良、重度营养不良分为3类分析,按传统Z评分营养等级划分(Z>-2为营养正常),加权Kappa系数κ=0.491(95%CI:0.336~0.645),一致性中等;按ASPEN共识声明划分(Z>-1为营养正常),其加权Kappa系数κ=0.709(95%CI:0.569~0.850),一致性较强。结论 对于脑瘫儿童的营养不良状况分级,SGNA与Z评分的一致性受Z评分营养等级划分标准影响明显,相比传统Z评分营养等级划分, ASPEN共识声明提出的Z评分营养等级划分与SGNA营养等级具有更高一致性。
Abstract
Objective To study the consistency between the results of Subjective Global Nutritional Assessment (SGNA) and Z-score method for children when assessing the malnutrition of children with cerebral palsy (CP), so as to provide helpful reference for more general clinical applications of SGNA. Methods Totally 76 children with CP treated in the Department of Pediatric Rehabilitation of Anhui Children′s Hospital from January to July 2021 were enrolled in this study, and were assessed with SGNA and Z-score method simultaneously to evaluate their nutritional status. Weighted-Kappa coefficient was used to analyze their consistency on evaluating different nutritional levels for children with CP. There were two kinds of nutritional level division for the Z-score method. The traditional Z-score nutritional levels included three levels:well nourished (Z>—2), moderately malnourished (-3＜Z ≤-2) and severely malnourished(Z≤-3). Nutritional levels presented by consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) included four levels, among which slightly malnourished (-2＜Z ≤-1) was added, and this new level was merged with moderately malnourished as one level to compare with the three SGNA nutritional levels in this study. Results According to traditional Z-score levels (Z >-2 as well nourished), the weighted-Kappa coefficient of the two methods was 0.491 (95%CI: 0.336 - 0.645), and the consistency was moderate. According to ASPEN nutritional levels (Z >-1 as well nourished), the weighted-Kappa coefficient of the two methods was 0.709 (95%CI: 0.569 - 0.850), and the consistency was relatively strong. Conclusions For CP children′s nutritional status evaluation, the consistency between SGNA nutritional levels and Z-score levels is obviously affected by different divisions of Z-score levels. Compared with the traditional Z-score nutritional levels, higher consistency is observed between ASPEN Z-score nutritional levels and SGNA nutritional levels.
关键词
脑瘫 /
营养不良 /
主观全面营养评估 /
儿童生长发育Z评分
Key words
cerebral palsy /
malnutrition /
Subjective Global Nutritional Assessment /
child growth Z-score
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参考文献
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基金
安徽省科技厅重点研究与开发计划项目A类(1804h08020254);安徽省儿童医院中青年面上项目(2019etyy002)
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