主观全面营养评估工具(SGNA)在住院神经损伤患儿中的应用

doi:10.12372/jcp.2024.23e0898

临床儿科杂志 ›› 2024, Vol. 42 ›› Issue (11): 962-967.doi: 10.12372/jcp.2024.23e0898

主观全面营养评估工具(SGNA)在住院神经损伤患儿中的应用

陈功勋¹, 朱登纳¹(), 王玉梅², 游杰³, 程志伟⁴, 张广宇¹, 李三松¹, 杨磊¹, 王明梅¹, 赵云霞¹, 王瑞霞¹

1.郑州大学第三附属医院康复医学科/河南省小儿脑损伤重点实验室/河南省儿科疾病临床医学研究中心，（河南郑州 450052）
2.郑州大学第三附属医院消化科，（河南郑州 450052）
3.郑州大学第三附属医院营养科，（河南郑州 450052）
4.郑州大学第三附属医院病案管理科（河南郑州 450052）

收稿日期:2023-09-11 出版日期:2024-11-15 发布日期:2024-11-08
通讯作者: 朱登纳 E-mail:zhudengna@126.com
基金资助:
河南省医学科技攻关省部共建项目(SBGJ2018047);河南省科技厅基于云服务的残疾儿童精准康复管理平台建设(232102310135)

Application of subjective global nutritional assessment tool (SGNA) in the nutritional assessment of hospitalized children with neurologically impairment

CHEN Gongxun¹, ZHU Dengna¹(), WANG Yumei², YOU Jie³, CHENG Zhiwei⁴, ZHANG Guangyu¹, LI Sansong¹, YANG Lei¹, WANG Mingmei¹, ZHAO Yunxia¹, WANG Ruixia¹

1. Department of Children's Rehabilitation/ Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center/ Institute of Neuroscience of Zhengzhou University, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
2. Department of Gastroenterology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
3. Department of Nutrition, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
4. Department of Medical Records Management, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China

Received:2023-09-11 Online:2024-11-15 Published:2024-11-08
Contact: ZHU Dengna E-mail:zhudengna@126.com

摘要/Abstract

摘要：

目的探讨主观全面营养评估工具(SGNA)评估结果与人体测量指标的相关性，以及其对住院神经损伤患儿进行营养评估的临床有效性。方法以2019年1月—10月住院的1 466例神经损伤患儿为研究对象，应用SGNA对其进行营养评估，使用WHO推荐的人体测量Z值评分法来验证SGNA对神经损伤患儿营养评估的有效性。结果以SGNA评估的中、重度养不良及营养不良总体发生率分别为15.14%、3.27%、18.41%。以身高别体重Z评分(WHZ)、年龄别体重Z评分(WAZ)、年龄别身高Z评分(HAZ)及综合Z值为标准评估的营养不良发生率分别为9.69%、12.48%、10.10%和21.56%。以WAZ作为参照标准，SGNA的灵敏度、特异度、约登指数分别为86.62%、88.90%、0.76。以综合Z值评分法作为参照标准，这些分别为57.28%、92.27%、0.50。SGNA与WHZ、综合Z值之间均具有中度一致性(Kappa=0.53、0.523，P均<0.001)。SGNA评估结果与WAZ和WHZ之间相关系数为-0.52、-0.45。结论 SGNA是有别于人体测量更为全面的营养评估方法，可以作为神经损伤患儿可靠的营养评估工具。

关键词: 神经损伤, 营养评估, 主观全面营养评估工具, 儿童

Abstract:

Objective This study aimed to investigate the correlation between the Subjective Global Nutritional Assessment Tool (SGNA) and anthropometric measurements, as well as to evaluate its clinical efficacy in assessing the nutritional status of hospitalized children with neurological impairments. Methods A retrospective analysis of 1466 pediatric patients with neurological impairments admitted to the Department of Children’s Rehabilitation were conducted from January 2019 to October 2019. Nutritional status was evaluated using the SGNA, and its effectiveness was corroborated against the World Health Organization's recommended anthropometric Z-score method. Results The prevalence of moderate and severe malnutrition, as well as overall malnutrition, as determined by SGNA, were 15.14%, 3.27%, and 18.41%, respectively. In comparison, the rates identified using weight-for-height Z-score (WHZ), weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and composite Z-score were 9.69%, 12.48%, 10.10%, and 21.56%, respectively. When using WAZ as the benchmark, the sensitivity, specificity, and Youden’s index for SGNA were 86.62%, 88.90%, and 0.76, respectively. With the composite Z-score as the reference, these values were 57.28%, 92.27%, and 0.50, respectively. A moderate level of agreement was observed between SGNA and both WHZ and the comprehensive Z-score (Kappa values of 0.53 and 0.523, both P<0.001). The SGNA assessment demonstrated significant correlations with both the WAZ and WHZ, with correlation coefficients of -0.52 and -0.45, respectively. Conclusion The SGNA emerges as a comprehensive nutritional assessment instrument that surpasses anthropometry in scope and can be reliably utilized for nutritional assessment in children with neurological impairments.

Key words: neurologically impaired, nutritional assessment, subjective global nutritional assessment tool, child

陈功勋, 朱登纳, 王玉梅, 游杰, 程志伟, 张广宇, 李三松, 杨磊, 王明梅, 赵云霞, 王瑞霞. 主观全面营养评估工具(SGNA)在住院神经损伤患儿中的应用[J]. 临床儿科杂志, 2024, 42(11): 962-967.

CHEN Gongxun, ZHU Dengna, WANG Yumei, YOU Jie, CHENG Zhiwei, ZHANG Guangyu, LI Sansong, YANG Lei, WANG Mingmei, ZHAO Yunxia, WANG Ruixia. Application of subjective global nutritional assessment tool (SGNA) in the nutritional assessment of hospitalized children with neurologically impairment[J]. Journal of Clinical Pediatrics, 2024, 42(11): 962-967.

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参考文献 28

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项目	男(n=947)	女(n=519)	统计量	P
年龄[M(P₂₅~P₇₅)]/岁	1.62（0.90~2.56）	1.46（0.87~2.20）	Z=2.39	0.020
WAZ($\bar{x} \pm s$)	-0.12±1.64	-0.18±1.48	t=0.68	0.494
WHZ($\bar{x} \pm s$)	0.02±1.86	0.06±1.67	t=0.38	0.704
HAZ($\bar{x} \pm s$)	-0.31±1.91	-0.30±1.68	t=0.13	0.894

方法	标准	结果[n(%)]
WAZ	Z>-2	1 324(90.31)
	-3≤Z<-2	85(5.80)
	Z <-3	57(3.89)
HAZ	Z>-2	1 283(87.52)
	-3<Z≤-2	107(7.30)
	Z <-3	76(5.18)
WHZ	Z>-2	1 318(87.57)
	-3≤Z <-2	98(6.68)
	Z <-3	50(3.41)
综合Z值法	Z>-2	1 150(78.44)
	-3<Z≤-2	181(12.53)
	Z <-3	135(9.21)
SGNA	营养良好	1 196(81.58)
	中度营养不良	222(15.14)
	重度营养不良	48(3.27)

指标	WAZ	HAZ	WHZ	综合Z评分法
灵敏度/%	86.62(79.65~91.55)	49.18(41.76~56.63)	76.35(68.53~82.77)	57.28(51.61~62.76)
特异度/%	88.90(87.05~90.51)	85.97(83.92~87.80)	88.08(86.19~89.76)	92.27(90.52~93.71)
PPV/%	45.56(39.54~51.70)	33.33(27.80~39.35)	41.85(35.94~48.00)	67.04(61.03~72.55)
NPV/%	98.41(97.48~99.01)	92.22(90.52~93.65)	97.07(95.91~97.92)	88.71(86.75~90.42)
约登指数	0.76	0.35	0.64	0.50

人体测量Z值	SGNA评估结果			F值	P
人体测量Z值	营养良好	中度营养不良	重度营养不良	F值	P
WAZ	0.24±1.36	-1.50±1.25	-3.39±1.01	180.08	<0.001
HAZ	-0.10±1.66	-0.90±2.02	-2.72±2.67	304.29	<0.001
WHZ	0.41±1.64	-1.34±1.42	-2.54±3.06	65.79	<0.001

主观全面营养评估工具(SGNA)在住院神经损伤患儿中的应用

Application of subjective global nutritional assessment tool (SGNA) in the nutritional assessment of hospitalized children with neurologically impairment

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SGNA	WAZ		WHZ		HAZ		综合Z值
SGNA	＋	-	+	-	＋	-	＋	-
＋	123	147	113	157	90	180	181	89
-	19	1 177	35	1 161	93	1 103	135	1 061
Kappa值	0.54(95%CI：0.45~0.60)		0.47(95%CI：0.41~0.54)		0.29(95%CI：0.23~0.36)		0.52(95%CI：0.47~0.58)
P	<0.001		<0.001		<0.001		<0.001

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