Study On The Relationship Between Nutritional Status And Spleen And Kidney Deficiency Syndrome In Patients With Common Malignant Tumors

ObjectiveNRS 2002 and PG-SGA were performed in hospitalized patients with primary lung cancer,primary liver cancer,and colorectal cancer.The evaluation of TCM syndromes was carried out using the syndromes of spleen qi deficiency,kidney yang deficiency and kidney yin deficiency syndrome.Using statistical methods,the correlation between the nutritional status of patients with common malignant tumors and spleen and kidney deficiency syndrome was analyzed.MethodsThis study was a prospective,descriptive cross-sectional study.From January 2019 to February 2019,patients who met the inclusion criteria in the Cancer Center of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were serially sampled.125 new patients admitted to the hospital was investigated.The research tools used in this study include:Nutritional Risk Screening 2002(NRS 2002),Patient Subjective Overall Assessment(PG-SGA),Spleen Qi Deficiency Syndrome,Kidney Yang Deficiency Syndrome,and Kidney Yin Deficiency Syndrome.The data collected above, through Excel 2013 and SPSS 19.0 software,the reliability and validity of the syndrome of spleen and kidney deficiency syndrome,the correlation between NRS 2002 and spleen and kidney deficiency syndrome,the correlation between PG-SGA and spleen and kidney deficiency syndrome and NRS 2002 The correlation between PG-SGA,spleen-kid deficiency syndrome and measurement index wasstatistically analyzed.Results1.Evaluation of the spleen-kidney deficiency syndrome syndrome scale:Cronbach's a of the spleen-qi deficiency syndrome scale is 0.710,the half-fold reliability coefficient is 0.745,the KMO value is 0.699,Bartlett test?2=282.940(P<0.001),factor analysis Five common factors were extracted by the method,and the cumulative variance interpretation rate was 61.981%.The Cronbach's a of the syndrome of kidney yang deficiency was 0.453,the half-factor reliability coefficient was 0.391,the KMO value was 0.590,the Bartlett test ?2=59.186(P<0.05),and the three common factors were extracted by factor analysis.The cumulative variance was explained.The rate is 52.029%.The Cronbach's a of the kidney yin deficiency syndrome scale was 0.611,the half-fold reliability coefficient was 0.714,the KMO value was 0.604,the Bartlett test ?2=172.941(P<0.001),and the factor analysis method extracted 5 common factors,and the cumulative variance was explained.The rate is 61.857%.2.The correlation between NRS 2002 and spleen-kidney deficiency syndrome:The incidence of nutritional risk was 50.40%;the composition of NRS 2002 score?3 group and NRS 2002 score<3 group were statistically different()?2=32.964,P<0.001),the incidence of NRS 2002 score?3 group document and undocumented was lower(P<0.05),the incidence of three syndromes was higher(P<0.05),and the incidence of double syndrome was not statistically different(P>0.05).There was no statistical difference between the two groups(P>0.05).Using spleen qi deficiency,kidney yang deficiency,and kidney yin deficiency syndrome to carry out the diagnosis of NRS 2002,the combination of spleen qi deficiency and kidney yang deficiency had the highest Yoden index(0.49),the highest accuracy(74.40%),sensitivity was 79.37%,specificity was 69.35%,misdiagnosis rate was 30.65%,missed diagnosis rate was 20.63%,positive likelihood ratio was 2.59,negative likelihood ratio was 0.30.As for the evaluation of diagnosis consistency with NRS 2002,the Kappa value was 0.488,P<0.001.3.Correlation between PG-SGA and spleen-kidney deficiency syndrome:There were 11 cases in PG-SGA A group,and 114 cases in PG-SGA B+C group.The composition of syndromes in the two groups was statistically different(P<0.001),PG-SGA B+C group had lower incidence of documentary and undocumented(P<0.05),and the incidence of double and triple syndrome was higher(P<0.05).Compared with the three groups of PG-SGA score 2-3 group,score 4-8 group and score?9 group,the composition of the syndrome was statistically different(P<0.001),and the incidence of the three syndromes of the PG-SGA score?9 subgroup was higher(P<0.017).The undocumented incidence rate of the PG-SGA score 2-3 subgroup was higher(P<0.017).The spleen qi deficiency,kidney yang deficiency,and kidney yin deficiency syndrome were used to predict the results of PG-SGA,the criteria of patients diagnosed as spleen qi deficiency or kidney yin deficiency had the highest Yoden index(0.70),sensitivity was 78.95%,specificity was 90.91%,misdiagnosis rate was 9.09%,missed diagnosis rate was 21.05%,accuracy was 80.00%,positive likelihood ratio was 8.68,negative likelihood ratio was 2.40.As for the evaluation of diagnosis consistency with PG-SGA,the Kappa value was 0.359,P<0.001.Using the spleen qi deficiency score of patients diagnosed as spleen qi deficiency syndrome to predict PG-SGA score?9,the AUC was 0.798(95%CI,0.693-0.902),P<0.001,and the spleen qi deficiency score was 7.5 points.The Yoden index has the largest value(0.427),sensitivity of 74.50%,and specificity of 68.20%.Using the yang-deficiency score of patients with kidney yang deficiency syndrome to predict PG-SGA score?9,the AUC was 0.646(95%CI,0.538-0.755),P<0.05,and the cutoff value of spleen qi deficiency was 5.5.The Yoden index has the largest value(0.275),sensitivity of 59.30%,and specificity of 68.20%.Using the kidney yin deficiency score of patients with kidney yin deficiency syndrome to predict the PG-SGA score?9,the AUC was 0.586(95%CI,0.444-0.728),P>0.05,and the spleen qi deficiency score was 11.5 points.The Yoden index has the largest value(0.231),sensitivity of 27.90%,and specificity of 95.20%.Spearman correlation coefficient of spleen-qi deficiency syndrome score and PG-SGA total score=0.544(P<0.001),Spearman correlation coefficient of syndrome of kidney-yang deficiency syndrome and PG-SGA total score=0.304(P<0.05),kidney The Spearman correlation coefficient of yin deficiency syndrome score and PG-SGA total score=0.209(P>0.05).4.Correlation between NRS 2002,PG-SGA,spleen-kidney deficiency syndrome and measurement indicators:Grouping positive and negative judgment results of NRS 2002,PG-SGA,spleen qi deficiency syndrome,kidney yang deficiency syndrome,and kidney yin deficiency syndrome,the age,gender,KPS score,BMI,serum albumin,total protein,globulin,prealbumin,inorganic phosphorus,magnesium ion,total calcium,sodium,potassium,serum iron,transferrin,urea,Creatinine,eGFR,triglycerides,total cholesterol,hemoglobin,leukocytes,neutrophils,lymphocytes,platelets,D-dimer,fibrinogen levels of each group were compared.Among them,the NRS 2002 positive group had lower BMI,serum albumin,prealbumin,sodium,serum iron,transferrin,and hemoglobin levels(P<0.05),higher total white blood cell count,platelet count,and fibrinogen level than the NRS 2002 negativie group(P<0.05),and the other indicators were not statistically different(P>0.05).The levels of BMI,prealbumin,sodium,serum iron and hemoglobin were lower in PG-SGA B+C group than in A group(P<0.05),while globulin and fibrinogen levels were higher(P<0.05).And the remaining indicators were not statistically different(P>0.05).KPS score,serum albumin,prealbumin,transferrin,serum iron,hemoglobin levels were lower in spleen qi deficiency group than in non-qi deficiency group(P<0.05),while globulin,white blood cell count,neutrophils,D-dimer and fibrinogen were higher(P<0.05).And the other indexes were not statistically different(P>0.05).The level of fibrinogen was higher in the kidney yang deficiency group than in the non-kidney yang deficiency group(P<0.05),and the other indexes were not statistically different(P>0.05).KPS score,BMI,prealbumin and serum iron levels were lower in the kidney yin deficiency group than in the non-kidney yin deficiency group(P<0.05),while neutrophil count and fibrinogen level were higher(P<0.05).And the remaining indicators were not statistically different(P>0.05).Gonclusions1.Inpatients with cancer,who were judged to have nutritional risk by NRS 2002 screening,were inclined to have multiple syndromes of spleen deficiency,kidney yang deficiency and kidney yin deficiency.The most effective diagnostic criteria to predict the diagnosis of NRS 2002 was to have both spleen qi deficiency syndrome and kidney yang deficiency syndrome.The severity of spleen qi deficiency and kidney yang deficiency was positively correlated with the NRS 2002 risk score.2.The higher the score of PG-SGA in hospitalized patients with common malignant tumors,the greater the probability that patients will have a combined syndrome of spleen-kidney deficiency.When the spleen qi deficiency syndrome or kidney yin deficiency syndrome is used as the diagnostic condition,the comprehensive diagnosis of PG-SGA grade A and B+C grade is the most effective.The severity of spleen qi deficiency,kidney yang deficiency and kidney yin deficiency syndrome was positively correlated with the degree of malnutrition assessed by PG-SGA.The spleen qi deficiency syndrome score>7.5 points,kidney yang deficiency score>4.5 points and kidney yin deficiency score>6.5 points could be used as the criteria for the prediction of severe malnutrition.3.Inpatients with common malignant tumors,who had spleen qi deficiency,had lower KPS score,serum albumin,prealbumin,transferrin,serum iron,hemoglobin than those had non-spleen qi deficiency,while the globulin,white blood cell count,neutrophil count,D-The level of dimer and fibrinogen of them were higher.The level of fibrinogen in kidney yang deficiency was higher than that in non-kidney yang deficiency.The KPS score,BMI,prealbumin,serum iron of patients with kidney yin deficiency was lower than that in non-kidney yang deficiency,while neutrophil counts and fibrinogen levels were higher.