Clinical value of nutritional risk screening tools in identifying sarcopenia in patients with gastric cancer
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摘要:目的
探讨患者主观整体营养状况评价量表(PG-SGA)与营养风险筛查2002(NRS 2002)识别胃癌患者肌减少症的临床价值。
方法选取136例胃癌患者进行回顾性研究，使用PG-SGA和NRS 2002评估其术前营养状况。根据CT扫描中第3腰椎水平的骨骼肌指数(L3-SMI)定义肌减少症，将患者分为肌减少症患者与非肌减少症患者，比较2组患者的基线特征。采用受试者工作特征(ROC)曲线评价PG-SGA和NRS 2002对肌减少症的识别能力。以存在肌减少症作为主要自变量，采用多因素Logistic回归分析评估与其具有独立相关性的协变量。
结果根据L3-SMI对肌减少症的定义, 43例(31.6%)胃癌患者被诊断为肌减少症。与非肌减少症患者相比，肌减少症患者的平均年龄更大，体质量指数(BMI)、L3-SMI、血红蛋白值、外周血淋巴细胞计数、血清白蛋白、总胆固醇以及甘油三酯水平均更低，差异有统计学意义(P < 0.05或P < 0.01)。肌减少症还与NRS 2002评分≥3分和PG-SGA定义的严重营养不良显著相关(P < 0.01)。ROC曲线显示, PG-SGA识别胃癌患者肌减少症的最佳临界值为5分，曲线下面积(AUC)为0.714 (95%CI: 0.621~0.807); NRS 2002评分≥3分识别肌减少症的AUC为0.658 (95%CI: 0.560~0.757)。多因素Logistic回归分析显示，当PG-SGA评分≥5分时，肌减少症的发生风险增加了约4.484倍(OR=4.484, 95%CI: 1.805~11.136, P=0.001)。与胃癌患者肌减少症独立相关的其他因素有年龄(OR=1.046, 95%CI: 1.007~1.087, P=0.019)、BMI (OR=0.734, 95%CI: 0.627~0.859, P < 0.001)和血红蛋白值(OR=0.805, 95%CI: 0.658~0.986, P=0.016)。
结论L3-SMI定义的肌减少症与NRS 2002、PG-SGA评分显著相关, PG-SGA或可作为识别肌减少症的有效工具。
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关键词:
- 胃癌 /
- 肌减少症 /
- 患者主观整体营养状况评价量表 /
- 营养风险筛查2002 /
- 营养不良
Abstract:ObjectiveTo investigate the clinical values of the Patient-Generated Subjective Global Assessment (PG-SGA) and the Nutritional Risk Screening 2002 (NRS 2002) in identifying sarcopenia in patients with gastric cancer.
MethodsA total of 136 patients with gastric cancer were selected for retrospective study, and their preoperative nutritional conditions were evaluated by PG-SGA and NRS 2002. Sarcopenia was defined according to the skeletal muscle index at the level of the third lumbar vertebrae (L3-SMI) on CT scans, the patients were divided into sarcopenia group and non-sarcopenia group, and the baseline characteristics were compared between the two groups. The identification abilities of PG-SGA and NRS 2002 for sarcopenia were evaluated by receiver operating characteristics (ROC) curve. Taking the presence of sarcopenia as the main independent variable, the multivariate Logistic regression analysis was used to evaluate the covariates with independent correlation.
ResultsAccording to the L3-SMI definition of sarcopenia, 43 patients (31.6%) with gastric cancer were diagnosed as sarcopenia. Compared with the non-sarcopenia patients, the average age of sarcopenia patients was significantly larger, the body mass index (BMI), L3-SMI, hemoglobin value, peripheral blood lymphocyte count, serum albumin, total cholesterol and triglyceride levels were significantly lower (P < 0.05 or P < 0.01). Sarcopenia was also significantly associated with NRS 2002 score≥3 and severe malnutrition defined by PG-SGA (P < 0.01). The ROC curve showed that the optimal cut-off score of PG-SGA in identifying sarcopenia in patients with gastric cancer was 5, and the area under the curve (AUC) was 0.714 (95%CI, 0.621 to 0.807); the AUC of NRS 2002 score≥3 for identifying sarcopenia was 0.658 (95%CI, 0.560 to 0.757). Multivariate Logistic regression analysis showed that when PG-SGA score≥5, the risk of sarcopenia increased by nearly 4.484 times (OR=4.484, 95%CI, 1.805 to 11.136, P=0.001). Other factors independently associated with sarcopenia in patients with gastric cancer were age (OR=1.046, 95%CI, 1.007 to 1.087, P=0.019), BMI (OR=0.734, 95%CI, 0.627 to 0.859, P < 0.001) and hemoglobin value (OR=0.805, 95%CI, 0.658 to 0.986, P=0.016).
ConclusionSarcopenia defined by L3-SMI is significantly correlated with NRS 2002 and PG-SGA scores, and the PG-SGA score may be used as an effective tool to identify sarcopenia.
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表 1 肌减少症与非肌减少症患者的一般资料比较(x±s)[n(%)]
一般资料 分类 全组(n=136) 肌减少症 χ2/t P 无(n=93) 有(n=43) 年龄/岁 61.0±12.0 59.5±11.7 64.1±12.2 -2.095 0.038 性别 女 51(37.5) 34(36.6) 17(39.5) 0.111 0.739 男 85(62.5) 59(63.4) 26(60.5) BMI/(kg/m2) 22.8±3.4 23.6±3.2 21.1±3.1 4.196 < 0.001 吸烟史 50(36.8) 35(37.8) 15(34.9) 0.096 0.757 心血管系统疾病 32(23.5) 22(23.7) 10(23.3) 0.003 0.959 糖尿病 17(12.5) 13(14.0) 4(9.3) 0.588 0.321 ECOG评分(≥1分) 93(71.0) 61(67.8) 32(78.0) 1.443 0.230 肿瘤位置 胃上1/3 27(19.7) 19(20.2) 8(18.6) 1.022 0.796 胃中1/3 24(17.5) 16(17.0) 8(18.6) 胃下1/3 68(50.4) 48(52.1) 20(46.5) 累及≥2/3胃 17(12.4) 10(10.6) 7(16.3) 切除范围 胃大部切除 100(73.5) 67(72.0) 33(76.7) 0.334 0.563 全胃切除 36(26.5) 26(28.0) 10(23.3) 手术方式 开腹 56(41.2) 38(40.9) 18(41.9) 0.012 0.912 腹腔镜 80(58.8) 55(59.1) 25(58.1) 分化类型 高分化 44(32.4) 29(31.2) 15(34.9) 1.065 0.587 中分化 56(41.2) 41(44.1) 15(34.9) 低分化 36(26.5) 23(24.7) 13(30.2) TNM分期 Ⅰ期 39(28.7) 27(29.0) 12(27.9) 1.333 0.514 Ⅱ期 52(38.2) 38(40.9) 14(32.6) Ⅲ期 45(33.1) 28(30.1) 17(39.5) 血红蛋白/(g/dL) 11.80±2.10 12.10±1.80 11.20±2.60 2.526 0.013 白细胞计数/(×109/L) 6.65±3.14 6.53±3.12 6.90±3.19 -0.637 0.525 淋巴细胞计数/(×109/L) 1.56±0.64 1.64±0.66 1.38±0.58 2.182 0.031 血小板计数/(×109/L) 260.40±80.50 262.80±79.90 255.30±82.30 0.506 0.614 血清白蛋白/(g/L) 37.80±3.90 38.40±3.70 36.30±4.10 2.984 0.003 C反应蛋白/(mg/L) 7.60±5.08 7.43±4.99 7.98±5.29 -0.584 0.560 血清总胆固醇/(mmol/L) 4.11±1.14 4.26±1.16 3.79±1.20 2.155 0.033 甘油三酯/(mmol/L) 1.01±0.48 1.09±0.45 0.86±0.49 2.118 0.031 L3-SMI/(cm2/m2) 45.0±7.4 47.5±6.7 39.7±5.6 6.661 < 0.001 NRS 2002量表评分 < 3分 52(38.2) 43(46.2) 9(20.9) 7.974 0.005 ≥3分 84(61.8) 50(53.8) 34(79.1) PG-SGA分级 A级 33(24.3) 31(33.3) 2(4.7) 19.121 < 0.001 B级 90(66.2) 58(62.4) 32(74.4) C级 13(9.6) 4(4.3) 9(20.9) BMI: 体质量指数; ECOG: 东部肿瘤合作组; L3-SMI: 第3腰椎水平的骨骼肌指数; NRS2002: 营养风险筛查2002; PG-SGA: 患者主观整体营养状况评价量表。 
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表 2 胃癌患者肌减少症的相关因素分析
变量 单因素分析 多因素分析 OR(95%CI) P OR(95%CI) P 年龄 1.035(1.001~1.070) 0.041 1.046(1.007~1.087) 0.019 BMI 0.764(0.664~0.879) < 0.001 0.734(0.627~0.859) < 0.001 血红蛋白 0.804(0.673~0.960) 0.016 0.805(0.658~0.986) 0.016 淋巴细胞计数 0.969(0.909~0.994) 0.034 1.000(0.999~1.001) 0.490 血清白蛋白 0.241(0.089~0.652) 0.005 0.455(0.136~1.516) 0.200 血清总胆固醇 0.701(0.504~0.977) 0.036 0.937(0.613~1.430) 0.762 甘油三酯 0.295(0.089~0.979) 0.046 0.546(0.149~1.996) 0.360 NRS 2002评分(≥3分∶ < 3分) 2.928(1.385~6.191) 0.005 1.239(0.422~3.636) 0.696 PG-SGA评分(≥5分∶ < 5分) 4.393(1.896~10.778) 0.001 4.484(1.805~11.136) 0.001
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