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营养风险筛查工具识别胃癌患者肌减少症的临床价值

Clinical value of nutritional risk screening tools in identifying sarcopenia in patients with gastric cancer

    摘要
  • 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。

     

    Abstract:
    Objective To 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.
    Methods A 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.
    Results According 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).
    Conclusion Sarcopenia 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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