[1]杨谨成,王黎明,李彩云,等.肿瘤医院肝胆外科住院病人营养现状调查及模型预测[J].肠外与肠内营养杂志,2022,(06):321-330.[doi:10.16151/j.1007-810x.2022.06.001]
 YANG Jin-cheng,WANG Li-ming,LI Cai-yun,et al.Survey of inpatients' nutrition and model prediction in hepatobiliary surgery of cancer hospital[J].PARENTERAL & ENTERAL NUTRITION,2022,(06):321-330.[doi:10.16151/j.1007-810x.2022.06.001]
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肿瘤医院肝胆外科住院病人营养现状调查及模型预测
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2022年06期
页码:
321-330
栏目:
论著
出版日期:
2022-11-10

文章信息/Info

Title:
Survey of inpatients' nutrition and model prediction in hepatobiliary surgery of cancer hospital
作者:
杨谨成 王黎明 李彩云 吴健雄 陈莲珍
国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院, 北京 100021
Author(s):
YANG Jin-cheng WANG Li-ming LI Cai-yun WU Jian-xiong CHEN Lian-zhen
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
关键词:
肿瘤 营养 世界营养日 肝胆外科 模型预测
Keywords:
Tumor Nutrition NutritionDay Hepatobiliary surgery Model prediction
分类号:
R952,R735.7
DOI:
10.16151/j.1007-810x.2022.06.001
文献标志码:
A
摘要:
目的:为更好地了解本院肝胆外科肿瘤病人的营养现状和营养管理情况,以及针对恶性肿瘤住院病 人实施的营养评估及干预情况,开展营养日问卷调查,建立预测模型,为临床合理决策提供理论实践基础。 方 法:根据世界营养日调查要求并取得本院伦理委员会审批后,对本院2016至2020年在营养日当日肝胆外科住院病 人进行问卷调查,调查内容除营养项目通用问卷外还包括针对肿瘤病人的专科问卷。通过R语言软件建立机器学习模型对营养风险进行预测。 结果:本研究纳入男性病人103人,女性病人61人;问卷回访率97.6%;其平均年龄 为(57.3 ± 11.8)岁;平均BMI为(24.3 ± 3.3)kg/m2。约25%病人MST评分大于2分,存在有营养风险。主要病人治疗目标为“积极治疗”,肿瘤分期为“局部浸润”和“局部扩散”,营养支持方案为“无特殊配餐”,有一定比例的肠内营养和肠外营养,5年来肠内营养方式有所加强。在30日随访中,73.2%的结果为“出院回家”。支持向量机模型预测结果远好于Logistic回归和判别分析模型。 结论:对本院肿瘤病人的营养干预还未有效实施。医生、护士、药师 和营养师营养相关理念和知识需要加强培训,对病人合理膳食和营养教育需要加强指导;对数据预测可选择支持 向量机法,有助于提高肿瘤治疗效果,改善病人生活质量。
Abstract:
Objective: In order to better understand nutritional status and management on hepatobiliary surgery patients in our hospital, as well as the nutritional evaluation and intervention for inpatients with malignant tumors, a nutrition day questionnaire survey and a prediction model was carried out, to provide a theoretical and practical basis for clinical rational decision-making. Methods: According to the nutritionDay Worldwide requirements and the approval of the ethics committee of our hospital, a questionnaire survey was conducted on the inpatients of hepatobiliary surgery department in our hospital on the nutrition days between 2016 and 2020. In addition to the general nutrition questionnaire items, the survey also included the special questionnaire for tumor patients. Machine learning models were used to predict nutrition risk using R language software. Results: This study included 103 male patients and 61 female patients with a return visit rate of 97.6%, an average age of (57.3 ± 11.8) years, and an average BMI of (24.3 ± 3.3) kg/m2. About 25% patients with MST score greater than 2 are at nutritional risk. The main treatment goals of patients are "Curative ", tumor stage is "Localized ", nutrition treatment is " No special diet". There was a certain proportion of enteral nutrition and parenteral nutrition. Enteral nutrition has been strengthened in the past five years. The proportion of patients who were "Discharged home" on the 30th day follow-up was 73.2%. Predictive evaluation from support vector machine (SVM) was far better than that from Logistic regression and discriminant analysis models. Conclusions: The nutrition intervention for tumor patient in our hospital has not been effectively implemented. The trainings for doctors and nurses on nutritional concepts and knowledge, as well as the guidance of patients' reasonable diet and nutrition education need to be strengthened. SVM could be selected for prediction, which is helpful to improve tumor treatment and patients’ quality of life.

参考文献/References:


[1] Zheng RS, Zhang SW, Zeng HM, et al , Cancer incidence and mortality in China, 2016. Journal of the National Cancer Center,2022, 2(1): 1-9.
[2] Lee YM, Ryoo E, Hong J, et al. Nationwide "Pediatric Nutrition Day" survey on the nutritional status of hospitalized children in South Korea. Nutr Res Pract, 2021, 15(2): 213-224.
[3] 黄小明, 雷 艳, 肖华旭等. GLIM标准"一步法"和"两步法"评估住院肿瘤病人营养不良的一致性研究 . 肠外与肠内营养,2022, 29(1): 1-6.
[4] 李子建, 姚玉昕, 李海龙, 等. 住院患者肿瘤相关营养不良现况分析:一项横断面调查研究 . 中国临床医生杂志, 2016, 44(6):19-23.
[5] 国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版). 临床肝胆病杂志, 2022, 38(2): 288-303.
[6] Llovet JM, Montal R, Sia D, et al. Molecular therapies and precision medicine for hepatocellular carcinoma. Nat Rev Clin Oncol, 2018, 15(10): 599-616.
[7] Moreau R, Clària J, Aguilar F, et al. Blood metabolomics uncovers inflammation-associated mitochondrial dysfunction as a potential mechanism underlying ACLF. J Hepatol, 2020, 72(4):688-701.
[8] Zaccherini G, Aguilar F, Caraceni P, et al. Assessing the role of amino acids in systemic inflammation and organ failure in patients with ACLF. J Hepatol, 2021, 74(5): 1117-1131.
[9] 王 瑛, 袁鹤立, 赵 利, 等. 伴营养不良风险的原发性肝癌患者临床特征及预后因素分析 . 中西医结合肝病杂志, 2022, 32(6): 494-498.
[10] Huang TH, Hsieh CC, Kuo LM, et al. Malnutrition associated with an increased risk of postoperative complications following hepatectomy in patients with hepatocellular carcinoma. HPB(Oxford), 2019, 21(9): 1150-1155.
[11] Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int, 2018, 17(1): 17-21.
[12] Ma BQ, Chen SY, Jiang ZB, et al. Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice. World J Gastroenterol, 2020, 26(46): 7405-7415.
[13] 翁 敏, 代正燕, 甘志明, 等. 消化系统恶性肿瘤住院病人营养状况与生活质量的相关性分析. 肠外与肠内营养, 2021, 28(6):347-351.
[14] 陈莲珍, 王雨潇, 杨谨成, 等 . 我国 2006-2015 年肠外营养处方中维生素使用的文献分析. 中国药房, 2017, 28(17): 2326-2330.
[15] Schindler K, Pichard C, Sulz I, et al , nutritionDay: 10 years of growth. Clin Nutr, 2017, 36(5): 1207-1214.
[16] Huang S, Cai N, Pacheco PP, et al. Applications of Support Vector Machine (SVM) Learning in Cancer Genomics. Cancer Genomics Proteomics, 2018, 15(1): 41-51.
[17] Zhao M, Hoti K, Wang H, et al. Assessment of medication self administration using artificial intelligence. Nat Med, 2021, 27(4):727-735.
[18] Yang J, Li N, Lin W, et al. Machine Learning for Predicting Hyperglycemic Cases Induced by PD-1/PD-L1 Inhibitors. J Healthc Eng, 2022: 6278854.
[19] Ferguson M, Capra S, Bauer J, et al. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition, 1999, 15(6): 458-464.
[20] Sauer AC, Goates S, Malone A, et al. Prevalence of Malnutrition Risk and the Impact of Nutrition Risk on Hospital Outcomes: Results From nutritionDay in the U. S. JPEN J Parenter Enteral Nutr, 2019, 43(7): 918-926.
[21] 孙海峰, 章 黎, 万松林, 等. 肿瘤住院病人营养治疗现状多中心调查报告. 中国实用外科杂志, 2018, 38(6): 654-658.
[22] Torbahn G, Sulz I, Gro?hauser F, et al. Predictors of incident malnutrition-a nutritionDay analysis in 11, 923 nursing home residents. Eur J Clin Nutr, 2021, 76(3): 382-388.
[23] 易佳盛, 张吉翔, 王 静, 等. 肝癌患者营养不良的原因及其营养治疗. 肿瘤代谢与营养电子杂志, 2015, 2(3): 73-76.
[24] Rimassa L, Danesi R, Pressiani T, et al. Management of adverse events associated with tyrosine kinase inhibitors: Improving outcomes for patients with hepatocellular carcinoma. Cancer Treat Rev, 2019, 77: 20-28.
[25] 何 芳, 王蕾蕾, 孟雪杉, 等. 肿瘤患者营养状况及对临床结局的影响. 肿瘤代谢与营养电子杂志, 2016. 3(3): 166-169.
[26] 蒋咏梅, 施咏梅, 张培红, 等. 普外科住院病人营养状况及营养干预的现状调查. 外科理论与实践, 2017, 22(4): 347-351.
[27] 陈莲珍, 费小非, 李 璐, 等. 肠内营养制剂产品配方评价. 临床药物治疗杂志, 2019, 17(4): 43-46, 64.
[28] 匡荣康, 王成龙, 强光辉, 等. 营养状态对结直肠癌病人手术部位感染的影响及相关因素分析. 肠外与肠内营养, 2021, 28(2):84-87.
[29] Ostrowska J, Jeznach-Steinhagen A. Fight against malnutrition(FAM): Selected results of 2006-2012 nutrition day survey in Poland. Rocz Panstw Zakl Hig, 2016, 67(3): 291-300.
[30] 杨谨成, 王会凌, 费小非, 等.“新医改”背景下对医院药剂科改革的思考. 中国药业, 2019, 28(2): 93-95.
[31] Yang JC, Ge WD, Yang WJ. Developing Career as a Hospital Cancer Pharmacist in China. Farmacja Polska, 2021, 77(2): 79-83.
[32] 杨谨成, 林伟龙, 邓 明, 等. 肿瘤诊治质控标准化在真实世界研究中的作用. 中国卫生产业, 2021, 18(25): 70-73.

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备注/Memo

备注/Memo:
作者简介 :杨谨成,副主任药师,药学博士,主要从事癌症诊治质控研究。E-mail:Yangjc@cicams.ac.cn 共同第一作者:王黎明,主任医师,医学博士,主要从事肝胆肿瘤外科和肿瘤营养研究。E-mail:stewen_wang@sina.com 通讯作者 :陈莲珍,E-mail:yjkclz@163.com 共同通讯作者 :吴健雄,E-mail:dr_wujianxiong@sina.com
更新日期/Last Update: 1900-01-01