胃肠道恶性肿瘤患者术前人体成分与术后低蛋白血症的相关性

姜涵; 佴永军; 戴春

doi:10.16689/j.cnki.cn11-9349/r.2026.03.011

PDF(1280 KB)

肿瘤代谢与营养电子杂志 ›› 2026, Vol. 13 ›› Issue (3) : 400-406. DOI: 10.16689/j.cnki.cn11-9349/r.2026.03.011

论著

胃肠道恶性肿瘤患者术前人体成分与术后低蛋白血症的相关性

¹姜涵, ²佴永军, ¹戴春

作者信息 +

Preoperative body composition and its correlation with postoperative hypoalbuminemia in gastrointestinal tumor patients

¹Jiang Han, ²Nai Yongjun, ¹Dai Chun

Author information +

文章历史 +

摘要

目的探讨胃肠道恶性肿瘤患者术前的人体成分相关指标对术后低蛋白血症的影响,为围手术期营养风险的评估与干预提供依据。方法回顾性收集南京市第一医院2023年12月至2025年7月接受胃肠道恶性肿瘤根治性手术治疗的245例肿瘤患者病历资料。术前通过生物电阻抗分析(BIA)获得人体成分数据。记录术前及术后的相关实验室指标水平。筛选胃肠道恶性肿瘤患者术后发生低蛋白血症的影响因素,采用受试者操作特征(ROC)曲线评估影响因素的预测能力,采用1000次重复抽样的自助法(Bootstrap)验证预测稳定性。结果 245例接受胃肠道肿瘤根治手术的患者中,183例(75%)在术后48 h发生低蛋白血症。多因素Logistic回归分析显示,骨骼肌质量指数(SMI)是术后发生低蛋白血症的影响因素(P<0.05)。SMI预测患者术后发生低蛋白血症的ROC曲线的曲线下面积(AUC)为 0.713(95%CI=0.635~0.790),Bootstrap验证AUC均值为0.712,提示预测模型稳定性良好。根据约登指数,SMI预测术后低蛋白血症的最佳截断点为 7.4 kg/m²(敏感度79.2%,特异度56.5%)。结论基于BIA测量的SMI对术后低蛋白血症具有一定预测价值,SMI<7.4 kg/m²可作为识别高危人群风险截点参考。

Abstract

Objective To investigate the correlation of preoperative body composition indicators on postoperative hypoproteinemia in patients with gastrointestinal cancer, so as to provide evidence for the assessment and intervention of nutritional risk during the perioperative period. Method A retrospective analysis was conducted on 245 patients who underwent radical surgery for gastrointestinal malignancies at Nanjing First Hospital between December 2023 and July 2025. Preoperative body composition data were obtained using bioelectrical impedance analysis (BIA). Relevant laboratory indicators were recorded both preoperatively and postoperatively. Factors influencing the occurrence of postoperative hypoproteinemia in patients with gastrointestinal malignancies were identified. The predictive ability of these factors was evaluated using the receiver operating characteristic (ROC) curve, and the stability of the prediction was validated using Bootstrap with 1000 resampling iterations. Result Among the 245 patients who underwent radical gastrointestinal surgery, 183 (75%) developed hypoproteinemia within 48 hours postoperatively. Multivariate logistic regression analysis indicated that the skeletal muscle mass index (SMI) was an independent influencing factor for postoperative hypoproteinemia (P<0.05). The area under the ROC curve (AUC) for SMI in predicting postoperative hypoproteinemia was 0.713 (95%CI=0.635-0.790), with a Bootstrap validation value of 0.712, demonstrating good stability of the predictive indicator. According to the Youden index, the optimal cutoff value of SMI for predicting postoperative hypoproteinemia was 7.4 kg/m² (sensitivity 79.2%, specificity 56.5%). Conclusion SMI measured by BIA has predictive value for postoperative hypoalbuminemia, and an SMI < 7.4 kg/m² may serve as a reference cut-off point for identifying high-risk individuals.

导出引用

姜涵, 佴永军, 戴春. 胃肠道恶性肿瘤患者术前人体成分与术后低蛋白血症的相关性[J]. 肿瘤代谢与营养电子杂志. 2026, 13(3): 400-406 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.03.011

Jiang Han, Nai Yongjun, Dai Chun. Preoperative body composition and its correlation with postoperative hypoalbuminemia in gastrointestinal tumor patients[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(3): 400-406 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.03.011

参考文献

[1] JIANG D, WU Y, LIU L, et al. Burden of gastrointestinal tumors in asian countries, 1990-2021: an analysis for the global burden of disease study 2021[J]. Clin Epidemiol,2024,16:587-601.
[2] LI B, HAN K, ZHAO M, et al. Cohort profile: the national early gastrointestinal cancer cohort (NEGCC) study in China[J]. Surg Endosc,2026,40(3):2153-2164.
[3] CHEN L, LU Y, QIAN J, et al. Clinical characteristics and prognosis of non-metastatic multiple gastrointestinal stromal tumors: a population-based study[J]. Discov Oncol,2025,16(1):643.
[4] 汤小青, 朱勇, 李健, 等. 结直肠癌患者术后发生低蛋白血症的影响因素分析及预测模型的构建[J]. 结直肠肛门外科,2025,31(3):229-236.
[5] 杨涛, 刘清泉, 高向楠. 胃癌患者术后低蛋白血症发生的影响因素及其Logistic回归方程的构建及其预测价值[J]. 实用癌症杂志,2024,39(9):1551-1554,1559.
[6] 万学红, 卢雪峰. 诊断学[M]. 10版. 北京: 人民卫生出版社, 2024.
[7] 石汉平, 陈伟. 临床营养学[M]. 北京: 人民卫生出版社, 2024.
[8] LIMA L M V, GUIMARAES P C, MONTENEGRO D O, et al. Prevalence of postoperative complications in oncologic gastro-esophageal surgeries: a cross-sectional study[J]. Acta Cir Bras, 2024, 39: e394424.
[9] SOETERS P B, WOLFE R R, SHENKIN A. Hypoalbuminemia: pathogenesis and clinical significance[J]. JPEN J Parenter Enteral Nutr,2019,43(2):181-193.
[10] ALMADA-CORREIA I, NEVES P M, MAKITIE A, et al. Body composition evaluation in head and neck cancer patients: a review[J]. Front Oncol,2019,9:1112.
[11] 陈镇燕, 朱丽. 胃肠道恶性肿瘤患者的人体成分分析[J]. 肿瘤防治研究,2019,46(10):911-915.
[12] BRANCO M G, MATEUS C, CAPELAS M L, et al. Bioelectrical impedance analysis (BIA) for the assessment of body composition in oncology: a scoping review[J]. Nutrients,2023,15(22):4792.
[13] 金鹏. 2024版CACA胃癌整合诊治指南(精简版)[J]. 中国肿瘤临床,2024,51(13):650-657.
[14] 中国抗癌协会, 中国抗癌协会大肠癌专业委员会. 中国恶性肿瘤整合诊治指南-直肠癌(2024 版)[J/CD]. 中华结直肠疾病电子杂志,2025,14(1):1-19.
[15] 中国抗癌协会, 中国抗癌协会大肠癌专业委员会. 中国恶性肿瘤整合诊治指南-结肠癌(2024版)[J/CD]. 中华结直肠疾病电子杂志,2025,14(2):97-113.
[16] GATTA A, VERARDO A, BOLOGNESI M. Hypoalbuminemia[J]. Intern Emerg Med, 2012, 3: S193-S199.
[17] 张静静, 金旭婷, 李若寒, 等. ICU住院期间平均血清白蛋白水平和患者预后的相关性分析——一项多中心回顾性队列研究[J]. 中国急救医学,2022,42(6):476-480.
[18] ISSANGYA C E, MSUYA D, CHILONGA K, et al. Perioperative serum albumin as a predictor of adverse outcomes in abdominal surgery: prospective cohort hospital based study in Northern Tanzania[J]. BMC Surg,2020,20(1):155.
[19] WARD L C, BRANTLOV S. Bioimpedance basics and phase angle fundamentals[J]. Rev Endocr Metab Disord,2023,24(3):381-391.
[20] DA SILVA B R, ORSSO C E, GONZALEZ M C, et al. Phase angle and cellular health: inflammation and oxidative damage[J]. Rev Endocr Metab Disord,2023,24(3):543-562.
[21] 陈伟. 医学营养管理在ERAS中的作用正日益受到重视[J]. 中华医学信息导报,2021,36(7):8.
[22] NUIJTEN M A H, EIJSVOGELS T M H, MONPELLIER V M, et al. The magnitude and progress of lean body mass, fat-free mass, and skeletal muscle mass loss following bariatric surgery: a systematic review and meta-analysis[J]. Obes Rev, 2022, 23(1): e13370.
[23] HAN K, WANG S, JIA W, et al. Serum albumin and activities of daily living in Chinese centenarians: a cross-sectional study[J]. BMC Geriatr,2020,20(1):228.
[24] IDASIAK-PIECHOCKA I, LEWANDOWSKI D, SWIGUT W, et al. Effect of hypoalbuminemia on drug pharmacokinetics[J]. Front Pharmacol,2025,16:1546465.
[25] MAEYAMA L, FAS S, SCHUTTRUMPF J, et al. Comparative analysis of purity of human albumin preparations for clinical use[J]. Anal Chim Acta,2024,1332:343364.
[26] CHAN W L, YUN H B, CHEUNG E E, et al. Association of sarcopenia with severe chemotherapy toxicities and survival in patients with advanced gastric cancer[J]. Oncologist, 2024, 29(10): e1272-e1279.
[27] DALY L E, NI BHUACHALLA E B, POWER D G, et al. Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer[J]. J Cachexia Sarcopenia Muscle,2018,9(2):315-325.
[28] HE W Z, JIANG C, LIU L L, et al. Association of body composition with survival and inflammatory responses in patients with non-metastatic nasopharyngeal cancer[J]. Oral Oncol,2020,108:104771.
[29] MEZA-VALDERRAMA D, MARCO E, DAVALOS-YEROVI V, et al. Sarcopenia, malnutrition, and cachexia: adapting definitions and terminology of nutritional disorders in older people with cancer[J]. Nutrients,2021,13(3):761.
[30] HUANG Y, HUANG Z, HOU W, et al. Cachexia index as a biomarker for cancer cachexia and quality of life in patients with gastric cancer[J]. BMC Cancer,2025,25(1):1293.
[31] ZHAO H, DONG Q, CHEN C, et al. Perioperative body composition changes and their clinical implications in patients with gastric cancer undergoing radical gastric cancer surgery: a prospective cohort study[J]. J Gastrointest Surg,2025,29(1):101877.
[32] XU T, LI Z, LI H, et al. Dynamic changes in the body composition during chemotherapy for gastrointestinal tumors in the context of active nutrition intervention[J]. Front Oncol,2022,12:965848.
[33] GARCIA Y, LARREA N, MARTIN J, et al. Evaluation of clinical outcomes after an intervention in malnourished hospitalized patients[J]. Clin Nutr,2025,54:42-52.
[34] YUAN W, AO P, WU F, et al. Twelve-week combined arginine and fish oil supplementation is associated with reduced sarcopenia severity: a randomized, double-blind, placebo-controlled study[J]. Front Nutr,2026,13:1763219.
[35] HONAGA K, MORI N, AKIMOTO T, et al. Investigation of the Effect of nutritional supplementation with whey protein and vitamin D on muscle mass and muscle quality in subacute post-stroke rehabilitation patients: a randomized, single-blinded, placebo-controlled trial[J]. Nutrients,2022,14(3):685.
[36] MAGALHAES P M, CRUZ S P D, CARNEIRO O A, et al. Vitamin D inadequacy and its relation to body fat and muscle mass in adult women of childbearing age[J]. Nutrients,2024,16(9):1267.
[37] BEAR D E, LANGAN A, DIMIDI E, et al. beta-Hydroxy-beta-methylbutyrate and its impact on skeletal muscle mass and physical function in clinical practice: a systematic review and meta-analysis[J]. Am J Clin Nutr,2019,109(4):1119-1132.
[38] LI Y, LI J, CHEN X, et al. What specific exercise training is most effective exercise training method for patients on maintenance hemodialysis with sarcopenia: a network meta-analysis[J]. Front Nutr,2024,11:1484662.
[39] 蒲琳, 印义琼, 文曰, 等. 肌少症与胃癌患者外周血炎性和营养指标及预后关系的回顾性研究[J]. 中国循证医学杂志,2023,23(1):2-6.
[40] VELHO S, MOCO S, FERREIRA A, et al. Dietary patterns and their relationships to sarcopenia in portuguese patients with gastrointestinal cancer: an exploratory study[J]. Nutrition,2019,63-64:193-199.