目的探讨恶性肿瘤患者相位角与营养风险和住院时间相关性。方法利用生物电阻抗分析对2017年10月至2018年9月在河北医科大学第一医院接受治疗的259例恶性肿瘤患者进行人体成分检测、应用营养风险筛查2002和患者主观整体营养评估进行营养风险筛查和评估、同时收集患者血清ALB指标和住院时间。结果正常相位角组患者的BMI、ICW、FFM、SMM、BCM、蛋白质等均高于低相位角组（P<0.05）；正常相位角组与低相位角组男性患者ICW、FFM、SMM、BCM、蛋白质等均高于女性患者（P<0.05）；相位角与营养风险筛查2002评分（r=－0.346，P<0.05）、患者主观整体营养评估（r=－0.393，P＜0.05）呈负相关，与血清ALB值呈正相关（r=0.363，P<0.05）；与正常相位角组患者相比，低相位角组营养风险更高，计算相关风险比发现，按营养风险筛查2002评价营养不良分组，发现存在营养风险（OR=3.7，95%CI=1.8～7.7），按PG-SGA评估分组，结果显示中度风险（OR=4.5，95％CI=2.1～9.4），重度风险（OR=12.6，95％CI=5.1～31.3），按血清ALB值分组，ALB<40g/L（OR=3.7，95％CI=2.1～6.4）（P<0.05）；与正常相位角组患者相比，低相位角组住院时间较长，住院时间≥14d（OR=1.9，95％CI=1.0～3.3）（P<0.05）。 结论低相位角与营养风险和住院时间密切相关。与正常相位角患者相比，低相位角患者存在营养风险高，住院时间延长。因此对肿瘤患者进行相位角测量有助于快速判断其是否存在营养风险，为及时进行营养干预的实施提供了客观依据，利于患者疾病控制与好转。
Abstract
ObjectiveTo explore the association between phase angle （PA） and nutritional risk and hospital length of stay in patients with malignant tumors. Methods We selected 259 patients with malignant tumors who were treated at the First Hospital of Hebei Medical University from October 2017 to September 2018 and used bioelectrical impedance analysis （BIA） for body composition testing to them. We chose nutritional risk screening 2002 （NRS 2002） for nutritional risk screening and patient-generated subjective global assessment （PG-SGA） for nutritional risk assessment to patients with malignant tumors, while collecting patients serum albumin （ALB） and hospitalization time. ResultsWe found that the BMI, ICW, FFM, SMM, BCM and protein of patients with malignant tumors in the normal PA group are higher than those in the low PA group （P<0.05）. The ICW, FFM, SMM, BCM and protein of male patients with malignant tumors in normal PA group and low PA group are higher than those in females （P<0.05）. The PA have an obviously negative correlation with NRS 2002 （r=－0.346，P<0.05） and PG-SGA （r=－0.393，P＜0.05）, meanwhile PA have a positive correlation with serum albumin （r=0.363，P<0.05） in evidence. Compared with the patients with malignant tumors in normal PA group, the patients in the low PA group are more likely to have nutritional risk. We calculate a serious of odds ratio （OR） and the results show that patients with malignant tumors who have nutritional risk （OR=3.7,95%CI=1.8~7.7） in the malnutrition group evaluated by NRS 2002 score, while moderate nutritional risk （OR=4.5, 95% CI=2.1~9.4） and severe nutritional risk （OR=12.6, 95% CI=5.1~31.3） by PG-SGA, grouped by serum albumin shows that serum albumin<40g/L （OR=3.7, 95% CI=2.1~6.4）. Compared with the normal PA group patients, the low PA group patients have a longer hospital stay, and the hospitalization time is greater than or equal to 14 days （OR=1.9, 95% CI=1.0~3.3） （P<0.05）. ConclusionLow PA is closely related to nutritional risk and hospital length of stay in patients with malignant tumors. Compared with normal PA patients, patients with low PA have higher nutritional risk and longer hospital length of stay. Therefore, to get PA of malignant tumor patients is helpful to quickly judge whether there is nutritional risk in them, which provides an objective basis for the implementation of nutritional intervention in time, and is conducive to disease control and improvement of patients.
关键词
相位角 /
营养风险筛查2002 /
患者主观整体营养评估 /
白蛋白 /
住院时间
Key words
Phase angle /
Nutritional risk screening 2002 /
Patient-generated subjective global assessment /
Albumin /
Hospitalization time
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参考文献
1.Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018；68（6）:394-424.
2.Prado CM, Cushen SJ, Orsso CE, et al. Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact. Proc Nutr Soc. 2016；75（2）:188-198.
3.Gibson DJ, Burden ST, Strauss BJ, et al. The role of computed tomography in evaluating body composition and the influence of reduced muscle mass on clinical outcome in abdominal malignancy:a systematic review. Eur J Clin Nutr. 2015；69（10）:1079-1086.
4.Murphy KT, Lynch GS. Editorial update on emerging drugs for cancer cachexia. Expert Opin Emerg Drugs. 2012；17（1）:5-9.
5.Inui A. Cancer anorexia-cachexia syndrome:current issues in research and management. CA Cancer J Clin. 2002；52（2）:72-91.
6.Andreoli A, Garaci F, Cafarelli FP, et al. Body composition in clinical practice. Eur J Radiol. 2016；85（8）:1461-1468.
7.Mcclave SA, Dibaise JK, Mullin GE, et al. ACG Clinical Guideline: nutrition therapy in the adult hospitalized patient. Am J Gastroenterol. 2016；111（3）:315-334.
8.Wirth R, Volkert D, Rsler A, et al. Bioelectric impedance phase angle is associated with hospital mortality of geriatric patients. Arch Gerontol Geriatr. 2010；51（3）:290-294.
9.丛明华, 邹宝华, 宋晨鑫, 等. 生物电阻抗分析技术在肿瘤患者人体成分分析中应用研究. 肿瘤代谢与营养电子杂志. 2018；5（4）:90-93.
10.Ringaitiene D, Gineityte D, Vicka V, et al. Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients. Clin Nutr. 2016；35（6）:1328-1332.
11.Norman K, Wirth R, Neubauer M, et al. The bioimpedance phase angle predicts low muscle strength, impaired quality of life, and increased mortality in old patients with cancer. J Am Med Dir Assoc. 2015；16（2）:173.e17-e22.
12.Gupta D, Lis CG, Dahlk SL, et al. Bioelectrical impedance phase angle as a prognostic indicator in advanced pancreatic cancer. Br J Nutr. 2004；92（6）:957-962.
13.Gupta D, Lammersfeld CA, Burrows JL, et al. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer. Am J Clin Nutr. 2004；80（6）:1634-1638.
14.Gupta D, Lammersfeld CA, Vashi PG, et al. Bioelectrical impedance phase angle as a prognostic indicator in breast cancer. BMC Cancer. 2008；8:249.
15.Gupta D, Lammersfeld CA, Vashi PG, et al. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in stage IIIB and IV non-small cell lung cancer. BMC Cancer. 2009；9:37.
16.Kyle UG, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clin Nutr. 2013；32（2）:294-299.
17.Cederholm T, Jensen GL. To create a consensus on malnutrition diagnostic criteria: a report from the global leadership initiative on malnutrition （GLIM） meeting at the ESPEN congress 2016. Clin Nutr. 2017；36（1）:7-10.
18.Sardinha LB. Physiology of exercise and phase angle: another look at BIA. Eur J Clin Nutr. 2018；72（9）:1323-1327.
19.Zouridakis A, Simos YV, Verginadis II, et al. Correlation of bioelectrical impedance analysis phase angle with changes in oxidative stress on end-stage renal disease patients, before, during, and after dialysis. Ren Fail. 2016；38（5）:738-743.
20.OLone EL, Visser A, Finney H, et al. Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients:independent predictor of patient survival. Nephrol Dial Transplant. 2014；29（7）:1430-1437.
21.Hui D, Bansal S, Morgado M, et al. Phase angle for prognostication of survival in patients with advanced cancer: preliminary findings. Cancer. 2014；120（14）:2207-2214.
22.Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol. 2002；86（6）:509-516.
23.Wilhelm-Leen ER, Hall YN, Horwitz RI, et al. Phase angle, frailty and mortality in older adults. J Gen Intern Med. 2014；29（1）:147-154.
24.Varan HD, Bolayir B, Kara O, et al. Phase angle assessment by bioelectrical impedance analysis and its predictive value for malnutrition risk in hospitalized geriatric patients. Aging Clin Exp Res. 2016；28（6）:1121-1126.
25.Bosy-Westphal A, Danielzik S, Drhfer RP, et al. Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. JPEN J Parenter Enteral Nutr. 2006；30（4）:309-316.
26.Torres A, Oliveria K, Oliveira-Junior A, et al. Biological determinants of phase angle among Brazilian elite athletes. Proc Nutr Soc. 2008；67（OCE8）:E332.
27.Lee SY, Lee YJ, Yang JH, et al. The association between phase angle of bioelectrical impedance analysis and survival time in advanced cancer patients: preliminary study. Korean J Fam Med. 2014；35（5）:251-256.
28.应丽美, 陈芳芳, 陈艺丹, 等. 国内肿瘤患者的营养风险及营养不良研究现状分析. 肿瘤代谢与营养电子杂志. 2017；4（2）:226-231.
29.丛明华. 肿瘤患者的营养教育（详见光盘）. 肿瘤代谢与营养电子杂志. 2018；5（3）:79.
30.Bozzetti F, Mariani L, Vullo SL, et al. The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer. 2012；20（8）:1919-1928.
31.Berker D, Koparal S, Isik S, et al. Compatibility of different methods for the measurement of visceral fat in different body mass index strata. Diagn Interv Radiol. 2010；16（2）:99-105.
32.易海维, 马东波, 宋悦, 等. 肺癌患者营养不良状况的调查和分析. 肿瘤代谢与营养电子杂志. 2017；4（4）:453-457.
33.Mueller C, Compher C, Ellen DM. A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr. 2011；35（1）:16-24.
34.Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003；22（4）:415-421.
35.刘琳,刘广寅,贾虹,等. 人体成分分析在体重管理单纯肥胖患者中的应用效果. 中国当代医药. 2017；24（18）:31-33.
36.Ottery FD. Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin Oncol.1994；21（6）:770-778.
37.中国抗癌协会. PG-SGA肿瘤病人营养状况评估操作手册. 北京:人民卫生出版社,2013.
38.梁晓坤, 蒋朱明, 于康. 常用营养风险筛查工具的评价与比较. 中华临床营养杂志. 2008；16（6）:361-366.
39.Wang ZK, Yang YS, Stefka AT, et al. Review article: fungal microbiota and digestive diseases. Aliment Pharmacol Ther. 2014；39（8）:751-766.
40.Black CS, Goltz DE, Ryan SP, et al. The role of malnutrition in ninety-day outcomes after total joint arthroplasty. J Arthroplasty. 2019；34（11）:2584-2600.
基金
河北省重点研发计划项目健康医疗与生物医药专项（182777127D）
河北医科大学创新性实验计划项目（USIP2019260）
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