数据标准化处理在急性淋巴细胞白血病儿童营养状况分析与营养不良风险筛查中的应用

摘要

目的 对急性淋巴细胞白血病(ALL)住院儿童进行营养状况评估和营养不良风险筛查,为后续治疗提供营养支持,减少可能发生的营养不良风险,提高治疗效果;数据标准化以实现跨年龄间身高、体重的统计分析.方法 选用2014年8月至2016年9月在北京儿童医院确诊的592例ALL患儿,将实测身高、体重等直接反映儿童营养状况的数据进行标准化处理;儿童营养不良风险筛查使用STAMP筛查工具完成,以Z值法的3个评分指标,HAZ＜-2、WAZ＜-2和WHZ＜-2评估营养状况;以L-asp治疗前后的体重变化和血红蛋白、清蛋白的变化考察营养干预的作用和效果.结果 以Z值法评分得出患ALL儿童治疗前生长迟缓的占0.34％,低体重的占2.36％,消瘦的占0.17％,与营养不良(3％)的健康儿童相比,营养状况无明显差异;ALL儿童通过STAMP营养不良风险筛查发现高营养不良风险患儿(分值≥4)占比9.71％,与体重指数有较强的相关性,体重系数＜0.80(有50％患营养不良)或＞1.30(有20％患营养不良)的患儿患营养不良风险的几率较高,且高营养不良风险群体的体重系数(0.852)明显低于低风险患儿(分值≤3)的群体(1.051);STAMP≤3分的患儿身高与STAMP≥4分的患儿身高、STAMP≤3分的患儿体重与STAMP≥4分的患儿体重比较差异均具有统计学意义(P均＜0.05);L-asp治疗前后,STAMP≤3分和STAMP≥4分的的患儿的体重变化差异无统计学意义(P＞0.05);治疗前后STAMP≤3分和STAMP≥4分的患儿,血红蛋白值变化差异有统计学意义[(87.46±19.27) g/L比(95.12±13.51) g/L,t=4.985,P=0.001;(101.55±21.97) g/L比(95.05±11.22) g/L,t=4.031,P=0.001];治疗前后STAMP≤3分患儿清蛋白比较差异无统计学意义[(40.63±4.149) g/L比(41.20±5.266) g/L,t=1.284,P=0.20];治疗前后STAMP≥4分患儿清蛋白比较差异无统计学意义[(40.96±8.429) g/L比(42.17±3.574) g/L,t=2.013,P=0.05].结论 ALL儿童无明显的营养不良特征,约10％的患儿有营养不良风险,需在治疗期间进行特殊饮食指导;营养干预在L-asp治疗过程中起到明显效果,标准化数据在统计分析中更便于使用,结果更精准,可以作为儿童身高、体重等指标跨年龄间统计的辅助手段.%Objective To evaluate the nutrional status and malnutrition risks of hospitalized children with acute lymphoblastic leukemia (ALL),provide nutrition support for subsequent treatment,lower nutritional risks and improve therapeutic effects;to complete the statistical analysis of height and weight across age through data normalization.Methods A total of 592 children diagnosed ALL from August 2014 to September 2016 at Beijing Children's Hospital were enrolled,and the directly measured height and weight which reflected the nutritional status of children were collected and normalized.Nutritional risk screening was completed by STAMP screening tool and the nutritional status was evaluated by three Z scores HAZ＜-2,WAZ＜-2 and WHZ＜-2.The effects of nutrition intervention were investigated by weight,hemoglobin and albumin changes between before and after L-asp treatment.Results The Z score test showed that there was no significant difference between the nutritional status of pretreatment ALL patients (0.34％ growth retardation,2.36％ lower body weight,0.17％ emaciation) and normal healthy children (3％ malnutrition);after comparing the STAMP nutritional risk assessment and t test results for children with ALL,it was found that the proportion of children with high malnutrition risk (score≥4) was 9.71％,which had a strong correlation with body mass index;the children with body mass index less than 0.80 (50％ children having malnutrition) or greater than 1.30 (20％ children having malnutrition) had a higher risk of malnutrition,and the body mass indexof the high-risk group (0.852 kg/m2) were significantly lower than that of the low risk group (1.051 kg/m2,score ≤ 3);there were significant differences in height and weight between children with STAMP ≤ 3 and STAMP ≥ 4 (all P ＜0.05) Nutritional interventions made no significant weight change during treatment;For children with STAMP ≤3 and STAMP ≥4 in L-asp treatment,the hemoglobin value changed from (87.46± 19.27) g/L to (95.12±13.51) g/L and (101.55±21.97) g/L to (95.05±11.22) g/L respectively (all P=0.001);The albumin of children with STAMP≤3 changed from (40.63±4.149) g/L to (41.20±5.266) g/L in treatment and that of children with STAMP ≥4 changed from (40.96±8.429) g/L to (42.17±3.574) g/L in treatment (P=0.20,0.05).Conclusion There are no obvious indications of malnutrition in children with ALL,but nearly 10 ％ of them have malnutrition risks.Special dietary guidance is needed during the treatment.Nutrition intervention is effective in the treatment of L-asp.Normalized data is more convenient to use in statistical analysis with more accurate results,which can be used as a supplementary method for cross-age group statistical analysis of children's height,weight and other parameters.