应用判别分析法建立肝硬化患者营养风险筛查模型

摘要

目的 尝试应用判别分析法建立肝硬化患者营养风险筛查模型.方法 收集2015年8月-2016年3月上海中医药大学附属曙光医院收治的273例肝硬化患者的临床资料.测量并记录肝硬化患者的身高、体质量、上臂围、三头肌皮褶厚度、肩胛下皮褶厚度和手握力,并在此基础上计算BMI和上臂肌围;检测肝功能、肾功能、维生素等实验室指标;完成营养风险筛查2002和营养风险通用筛查工具量表填写,并根据自定的肝硬化患者营养风险筛查路径进行营养风险分级;根据中医四诊观察量表,采集患者症状及体征.计量资料多组间比较采用方差分析,进一步两组间比较采用LSD-t检验;模型建立采用距离判别分析;模型检验采用交叉验证.结果 采用肝硬化患者营养风险的筛查路径对调查对象进行筛查后,无风险组共49例(17.95％),可能有风险组49例(17.95％),有风险组175例(64.10％).进一步应用距离判别函数分析,初步建立了用于肝硬化营养风险筛查模型:D1=-11.885+ 0.310×BMI+0.150×MAC+ 0.005×P-Alb-0.001×Vit B12+0.103×Vit D-0.89×腹水-0.404×乏力-0.560×胁肋痛+0.035×五心烦热(注:若存在腹水、乏力、胁肋痛和五心烦热,则该指标的数值为1,否则为0).经交叉验证后,误判概率为10％.结论 建立的筛查模型可为肝硬化患者临床营养风险筛查提供参考.%Objective To establish a nutritional risk screening model for patients with liver cirrhosis using discriminant analysis.Methods The clinical data of 273 patients with liver cirrhosis who were admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2015 to March 2016 were collected.Body height,body weight,upper arm circumference,triceps skinfold thickness,subscapular skinfold thickness,and hand grip strength were measured and recorded,and then body mass index (BMI) and upper arm muscle circumference were calculated.Laboratory markers including liver function parameters,renal function parameters,and vitamins were measured.The patients were asked to complete Nutritional Risk Screening 2002 and Malnutrition Universal Screcning Tool (MUST),and a selfdeveloped nutritional risk screening pathway was used for nutritional risk classification.Observation scales of the four diagnostic methods in traditional Chinese medicine were used to collect patients' symptoms and signs.Continuous data were expressed as mean ± SD ((x) ± s);an analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups.Discriminant analysis was used for model establishment,and cross validation was used for model verification.Resuits The nutritional risk screening pathway for patients with liver cirrhosis was used for the screening of respondents,and there were 49 patients (17.95％) in non-risk group,49 (17.95％) in possible-risk group,and 175 (64.10％) in risk group.The distance criterion function was used to establish the nutritional risk screening model for patients with liver cirrhosis:D1 =-11.885 + 0.310 × BMI + 0.150 ×MAC + 0.005 x P-Alb-0.001 x Vit B12 + 0.103 x Vit D-0.89 x ascites-0.404 x weakness-0.560 × hypochondriac pain + 0.035 x dysphoria with feverish sensation (note:if a patient has ascites,weakness,hypochondriac pain,or dysphoria with feverish sensation,this index equals 1,and otherwise it equals 0).Cross validation showed that the probability of misclassification of the this model was 10％.Conclusion The established screening model may provide a reference for chnical nutritional risk screening in patients with liver cirrhosis.