大腸直腸癌病患營養篩檢工具之比較

Comparison of Nutritional Screening Tools for Patients with Colorectal Cancer

住院病患常發生營養不良的情形，尤其是腸胃外科及腫瘤科的病人，其比率甚至高達50～60%，因此建議病人入院後應及早作營養篩檢。但相關篩檢工具多是依照西方白人的飲食習慣及體型結構發展而來，並不適用於東方亞裔族群。本研究目的為探討不同營養篩選及評估工具，包括：病人主觀性整體評估表（Patient-Generated-Subjective Global Assessment，PG-SGA）長式簡易營養評估量表台灣修訂版（Mini Nutritional Assessment-Long Form Taiwan revision，MNA-LFT1）、萬用營養不良篩檢工具台灣修訂版（Malnutrition Universal Screening Tool Taiwan revision，MUST-T1）與營養危險因子篩檢方法（Nutritional Risk Screening，NRS-2002）等四種，比較其營養不良篩檢能力之差異。共收案200名大腸直腸癌病患，於入院後進行多項資料收集。結果發現：當以PG-SGA為標準時，MUST-T1與其評估結果之吻合度為0.545；MNA-LF-T1為0.545；NRS-2002為0.613（皆＜0.001）。各工具與生化檢驗值、體位測量值及住院天數的相關性測量結果良好；以PG-SGA為標準，計算接收者操作特徵曲線（Receiver Operating Characteristic curve，ROC curve）時，其曲線下的面積仍以NRS-2002最佳（0.908）。本研究結果顯示，當以PG-SGA為標準時，NRS-2002比其他工具更適合用於評估大腸直腸癌病人的營養不良風險。

Hospitalized patients usually suffer from malnutrition, especially those of the departments of gastrointestinal surgery and oncology, with prevalences which are as high as 50% 60%. Thus, nutritional screening assessments of admitted patients should be performed as early as possible. However, most screening tools were developed based on the dietary habits and body constitution of Western Caucasian people, which might not be appropriate for East Asian populations. The aim of study was to investigate power differences among the following nutritional screening and assessments tools, including the Patient-Generated-Subjective Global Assessment(PG-SGA), Mini Nutritional Assessment- Long Form Taiwan revision(MNA-LF-T1), Malnutrition Universal Screening Tool Taiwan revision(MUST-T1), and Nutritional Risk Screening(NRS-2002). This study included 200 colorectal cancer patients, and their information on several aspects was collected after admission. We found that the respective kappa coefficients of agreement of the MUST-T1, MNA-LF-T1, and NRS-2002 were 0.545, 0.545, and 0.613, when using the PG-SGA as the reference method( < 0.001 for all tools). All tools showed statistically significant relationships with biochemical data, anthropometric measurements, and length of hospital stay. In addition, when comparing the PG-SGA with other tools using the receiver operating characteristic(ROC)curve, the NRS-2002 was the best(0.908)in terms of the area under the ROC curve. The results of this study showed that the NRS-2002 had a better screening capability for malnutrition risk for colorectal patients, compared to the other tools on the basis of the PG-SGA.