目的 探讨上臂围(MAC)和小腿围(CC)对结直肠癌(CRC)患者肌肉减少症的预测价值。 方法 本研究为横断面研 究,纳入 2022 年 4 月至 2023 年 8 月于西南医科大学附属医院胃肠外科首次诊断为 CRC 的 372 例患者,通过生物电阻抗法 (BIA)测定四肢骨骼肌质量(ASM)和四肢骨骼肌质量指数(ASMI),测定 MAC、CC、握力和 6 米步速等,按肌肉减少症分组比 较肌肉减少症患者与非肌肉减少症患者基线情况差异。 按照性别分组主要参考既往相似文献,男女性 MAC 和 CC 的大小差 异大,所以本研究按照性别分层分析得出不同性别的截止点,采用 ROC 曲线比较 MAC 和 CC 对 CRC 患者肌肉减少症的预测 价值并确定最佳截止点,计算 Kappa 值判断 MAC、CC 与肌肉减少症诊断标准的一致性。 结果 372 例 CRC 患者中,男性 233 例 (62. 6%),女性 139 例(37. 4%),肌肉减少症 81 例(21. 8%)。 ROC 曲线示,MAC 预测肌肉减少症的最佳截止点为男性 24. 9 cm(敏感度 81. 8%,特异度 73. 0%),女性 23. 7 cm(敏感度 80. 8%,特异度 72. 6%);CC 预测肌肉减少症的最佳截止点为男性 32. 4 cm(敏感度 74. 5%,特异度 80. 9%),女性 31. 0 cm(敏感度 88. 5%,特异度 66. 4%)。 男性患者的 MAC、CC 及两者联合预 测肌肉减少症的 AUC 值分别为 0. 824、0. 851、0. 864,女性患者分别为 0. 819、0. 801、0. 828,联合预测的价值更高。 与肌肉减少 症诊断标准进行一致性比较,男性 MAC 和 CC 的 Kappa 值分别为 0. 443、0. 493,女性 MAC 和 CC 的 Kappa 值分别为 0. 385、 0. 334。 结论 CRC 患者 MAC、CC 对肌肉减少症均具有较好的预测价值,且两者联合的预测效果更好。

Objective To investigate the predictive value of mid-upper arm circumference MAC and calf circumference CC for sarcopenia in patients with colorectal cancer CRC . Method This is a cross-sectional study that includes 372 patients who were diagnosed with CRC for the first time at the Department of Gastrointestinal Surgery Affiliated Hospital of Southwest Medical University from April 2022 to August 2023 with appendicular skeletal muscle mass ASM and appendicular skeletal muscle mass index ASMI measured by bioelectrical impedance analysis BIA and MAC CC hand grip strength and 6-Meter Walk test measured with comparison of basic conditions by grouping by sarcopenia. Grouped by gender ROC curves were used to compare the predictive value of MAC and CC for sarcopenia in patients with CRC and to determine the optimal cut-off value and Kappa values were calculated to determine the consistency of MAC and CC with the diagnostic criteria for sarcopenia. Result Among 372 CRC patients 233 62. 6% were male and 139 37. 4% were female and 81 21. 8% were diagnosed with sarcopenia. The ROC curves showed that the optimal cut-off values for MAC to predict sarcopenia were 24. 9 cm in males sensitivity 81. 8% specificity 73. 0% and 23. 7 cm in females sensitivity 80. 8% specificity 72. 6% and for CC to predict the best cut - off values for sarcopenia were 32. 4 cm sensitivity 74. 5% specificity 80. 9% in men and 31. 0 cm sensitivity 88. 5% specificity 66. 4% in women. The AUC values of MAC CC and the combination of the two for the prediction of sarcopenia were 0. 824 0. 851 0. 864 for male patients and 0. 819 0. 801 0. 828 for female patients respectively which showed a higher value of the combined one. Comparing with the diagnostic criteria of sarcopenia the Kappa values of MAC and CC were 0. 443 0. 493 for male and 0. 385 0. 334 for female respectively. Analysis by gender age history of smoking alcohol consumption clinical stage and body mass index BMI subgroups revealed that mPG-SGA showed strong consistency for good/ mild malnutrition moderate malnutrition and severe malnutrition among patients with BMI<18. 5 kg / m 2 Kappa=0. 762 P=0. 001 . All subgroups with the exception of BMI<18. 5 kg / m 2 showed almost perfect consistency for the three different nutritional stages Kappa>0. 9 P<0. 001 . Conclusion Both MAC and CC have good predictive value for sarcopenia in patients with CRC and the combination of them has a better predictive effect.