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| 脑瘫儿童营养不良评估工具的临床应用研究 |
| The clinical research on assessment tools for malnutrition in children with cerebral palsy |
| 投稿时间：2026-02-04 |
| DOI：10.3969/j.issn.1000-0399.2026.06.001 |
| 中文关键词: 脑性瘫痪 营养评估 主观全面营养评估 Z值 中上臂围 |
| 英文关键词: Cerebral palsy Nutritional assessment Subjective Global Nutrition Assessment Z-score Mid-upper arm circumference |
| 基金项目:出生人口健康教育部重点实验室联合安徽省妇幼保健协会2022年度母婴与健康研究项目(编号:JK202211) |
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| 中文摘要: |
| 目的 探讨主观全面营养评估（SGNA）、基于生长曲线的Z值评分及中上臂围测量在脑瘫儿童营养不良评估中的应用价值。方法 选取2025年8月至12月于安徽省儿童医院康复科就诊的58名脑瘫患儿为研究对象。分别采用SGNA进行营养分级（正常/中度不良/重度不良），计算体质量/年龄（WAZ）、身高/年龄（HAZ）、体质量/身高（WHZ）(5岁以下)、身体质量指数/年龄（BAZ），并测量中上臂围（MUAC）。采用加权Kappa系数评估SGNA与基于Z值定义营养不良之间的一致性。通过Spearman相关系数分析中上臂围（MUAC）与体质量/年龄（WAZ）、身高/年龄（HAZ）、身体质量指数/年龄（BAZ）的相关性。分别针对1～8岁（全队列）及1～5岁（亚组）两个年龄范围，以Z值诊断营养不良作为金标准，采用受试者工作特征曲线（ROC）分析中上臂围对Z值定义营养不良的诊断效能，并计算1～5岁亚组的MUAC最佳截断值。结果 SGNA及Z值定义营养不良中高度一致（Kappa值=0.659, 95%CI:0.501～0.818）。MUAC与BAZ具有相关性（i>rs=0.832,P<0.001）。ROC曲线分析显示，在两组年龄范围的研究者中，MUAC对Z值定义营养不良都具有良好的诊断效能，1～8岁患儿AUC为0.883（0.780～0.986）,1～5岁年龄亚组患儿AUC为0.959（0.912～1.000）,1～5岁年龄亚组患儿MUAC最佳截断值为15.25 cm，灵敏度与特异度分别为76.7%和100.0%。结论 在脑瘫儿童中，SGNA与生长Z值定义营养不良具有较高的一致性。中上臂围与生长Z值高度相关且对评估营养不良具有良好效能。 |
| 英文摘要: |
| Objective To explore the application value of Subjective Global Nutritional Assessment(SGNA), growth curvebased Zscores, and midupper arm circumference measurement in the assessment of malnutrition in children with cerebral palsy. Methods A total of 58 children with cerebral palsy from the Rehabilitation Department of Anhui Provincial Children's Hospital were included between August 2025 and December. SGNA was used to classify nutritional status(good/moderately poor/severely poor), calculate Z-scores for weight/age(WAZ), height/age(HAZ), weight/height(WHZ)(under 5), and body mass index/age(BAZ), and measure upper arm circumference(MUAC). The weighted Kappa coefficient was used to evaluate the consistency between SGNA and malnutrition defined by Z-scores. Spearman's correlation coefficient was used to analyze the association between MUAC and WAZ, HAZ, and BAZ. Using Zscoredefined malnutrition as the gold standard, receiver operating characteristic(ROC) curve was employed to analyze the diagnostic performance of midupper arm circumference(MUAC) for Zscoredefined malnutrition in two age groups: the full cohort(aged 1～8 years) and a subgroup(aged 1～5 years). The optimal MUAC cutoff value was calculated for the 1 to 5 year subgroup. Results SGNA demonstrated moderate to high agreement with Z-score-defined malnutrition.(Kappa: 0.659,95%CI: 0.501～0.818). MUAC was correlated with BAZ(rs= 0.832, P < 0.001). ROC curve analysis showed that MUAC had good diagnostic performance for Z-score-defined malnutrition in both groups. The AUC for children aged 1～8 years was 0.883(95% CI: 0.780～0.986), and for the 1～5 years subgroup it was 0.959(95% CI: 0.912～1.000). The optimal MUAC cutoff value for the 1～5 years subgroup was 15.25 cm, with a sensitivity of 76.7% and a specificity of 100%. Conclusion In children with cerebral palsy, SGNA demonstrates high consistency with growth Z-scores for defining malnutrition. Mid-upper arm circumference is strongly correlated with growth Z-scores and exhibits good efficacy for assessing malnutrition. |
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