目的 调查老年胃癌患者术后营养不良情况,分析术后营养不良情况与预后的关系。方法 回顾性分析病例资料选自武汉大学中南医院2019年5月至2020年5月收治的120例老年胃癌患者,根据患者术后营养情况分为营养不良组和营养正常组,比较两组预后营养预后指数(PNI),并通过单因素和多因素Logistic回归分析老年胃癌患者术后营养不良的危险因素,并通过Kaplan-Meier法绘制生存曲线进行预后分析。结果 120例老年胃癌患者中术后出现营养不良者有85例,术后营养不良发生率为70.83%。经单因素分析,营养不良组和营养正常组患者在肿瘤分化程度、肿瘤直径、肿瘤浸润深度、总胆固醇水平、PNI值以及有无辅助化疗、贫血、淋巴结转移、低蛋白血症上有显著差异(P<0.05);经多因素Logistic回归分析发现,肿瘤低分化、淋巴结转移、肿瘤浸润深度T3+T4a、PNI值低、低蛋白血症是老年胃癌患者术后发生营养不良的独立危险因素;营养不良组患者5年总生存(OS)率为38.82%,营养正常组患者5年OS率为54.29%,营养不良组相较营养正常组5年OS率明显更低(χ2=4.266,P=0.039)。结论 老年胃癌患者术后营养不良发生率高,且术后营养不良者5年OS率降低,多预后不良,临床需重视对老年胃癌患者术后营养不良高危者的营养治疗。
Abstract
Objective To investigate the postoperative malnutrition status in elderly patients with gastric cancer, and to analyze the relationship between postoperative malnutrition status and prognosis. Method A retrospective analysis was conducted on case data of 120 elderly patients with gastric cancer admitted to the hospital from May 2019 to May 2020, and the patients were divided into group A and group B according to the postoperative nutritional status. Patients with malnutrition were included in group A, and patients with normal nutritional status were included in group B. The prognostic nutritional index (PNI) was compared between the two groups, and the risk factors affecting postoperative malnutrition in elderly patients with gastric cancer were analyzed by univariate and multivariate Logistic regression analyses, and the survival curve was drawn by Kaplan-Meier method for prognosis analysis. Result Among 120 elderly patients with gastric cancer, 85 cases had postoperative malnutrition, with the incidence rate of postoperative malnutrition of 70.83%. Univariate analysis showed that there were significant differences in tumor differentiation degree, tumor diameter, depth of tumor invasion, total cholesterol, PNI, presence or absence of adjuvant chemotherapy, anemia, lymph node metastasis and hypoproteinemia between group A and group B (P<0.05). After multivariate Logistic regression analysis, it was found that low tumor differentiation, lymph node metastasis, tumor invasion depth T3+T4a, low PNI and hypoproteinemia were independent risk factors for postoperative malnutrition in elderly patients with gastric cancer. The 5-year overall survival rate of patients in group A was 38.82% and that in group B was 54.29%. The 5-year overall survival rate in group A was significantly lower than that in group B (χ2=4.266, P=0.039). Conclusion The incidence rate of postoperative malnutrition is high in elderly patients with gastric cancer. The 5-year overall survival rate of patients with postoperative malnutrition is reduced, and the prognosis is poor. It is necessary to pay clinical attention to nutritional support therapy for high-risk population with postoperative malnutrition among elderly patients with gastric cancer.
关键词
老年 /
胃癌患者 /
预后营养指数 /
术后营养不良情况 /
预后 /
预后营养预后指数 /
总生存率 /
低蛋白血症
Key words
Elderly /
Patients with gastric cancer /
Prognostic nutrition index /
Postoperative malnutrition status /
Prognosis /
Overall survival rate /
Hypoproteinemia
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