目的评价胃癌患者术前营养状况，分析人体测量、血生化、炎症因子等客观指标与其相关性。 方法采用连续入组法，以2017年6月至2018年2月在江西省肿瘤医院腹部肿瘤外科一病区住院的单纯性胃癌患者150例为研究对象，入院24h采用患者主观整体评估法评估其营养状况，检测血常规、血生化及炎症因子，测量身高、体重、体质指数、优势手握力及卡氏功能状态评分，进行Pearson相关及Logistic逐步回归分析患者主观整体评估的相关因素。结果150例单纯性胃癌患者入院时营养良好（0~1分）29例（19.33%），可疑或轻度营养不良（2~3分）39例（26.00%），中度营养不良（4~8分）60例（40.00%），重度营养不良（≥9分）22例（14.67%）；营养不良组（≥2分）患者的身高、体重、体质指数、血红蛋白、白蛋白、甘油三酯及优势手握力显著低于营养良好组（0~1分），而年龄、白介素-2和肿瘤坏死因子-α显著高于营养良好组（P<0.05）；Pearson相关性分析显示患者主观整体评估评分与年龄（r=0.242）、白介素-2（r=0.284）、肿瘤坏死因子-α（r=0.230）可能存在正相关（P<0.05），与体质指数（r=－0.310）、卡氏功能状态评分（r=－0.463）、血红蛋白（r=－0.233）、白蛋白（r=－0.267）、优势手握力（r=－0.490）可能存在负相关（P<0.05）；Logistic回归分析显示年龄（OR=1.122）、白介素-2（OR=1.010）、肿瘤坏死因子-α（OR=1.139）、优势手握力（OR=0.832）是术前胃癌患者发生营养不良的独立危险因素。 结论单纯性胃癌患者术前营养不良发生比例较高，其营养状况可采用患者主观整体评估结合人体测量、炎症因子等客观指标进行监测和评估。
Abstract
ObjectiveTo assess the nutritional status and analyze the correlation among objective indicators of anthropometric, blood biochemistry and inflammatory factors. Methods 150 patients with simple gastric cancer hospitalized in the first department of abdomen surgy of Jianxi tumor hospital from June 2017 to February 2018 were consecutively enrolled in this study. The nutritional status was assessed by patient-generated subjective global assessment （PG-SGA）in their first 24 hours in hospital. The blood routine, blood biochemistry and inflammatory factors were detected. The height, weight, BMI, dominant handgrip strength and Karnofsky performance status （KPS） were measured. Pearson correlation and multivariate stepwise logistic regression analyses were used to analyze the related factors of nutritional status. ResultsFor the 150 patients with gastric cancer, there were 29 patients （19.33%） with well-nourished （0~1 point）, 39 patients （26.00%） with suspected or mild malnutrition （2~3 points）, 60 patients （40.00%） with moderate malnutrition （4~8 points） and 22 patients （14.67%） with severe malnutrition （≥9 points）. The height, weight, BMI, Hb, ALB, TG and dominant handgrip strength of patients in the malnutrition group （≥2 points） were significantly lower than those in the well-nourished group （0~1 point）, while the age, interleukin 2 （IL-2） and TNF-α levels were significantly higher than those in the well-nourished group （P<0.05）. Pearsons correlation analyses showed that PG-SGA score was positively correlated with age （r=0.242）, IL-2 （r=0.284）,TNF-α （r=0.230） and negative correlated with BMI （r=-0.310）, KPS （r=-0.463）, Hb （r=-0.233）, ALB （r=-0.267） and dominant handgrip strength （r=-0.490） （P<0.05）. Logistic stepwise regression analysis showed that age （OR=1.122）, IL-2 （OR=1.010）, TNF-α level （OR=1.139） and dominant handgrip strength （OR=0.832） were independent risk factors for malnutrition in gastric cancer patients before surgery. ConclusionThe incidence of preoperative malnutrition in patients with simple gastric cancer is relatively high, and their nutritional status can be monitored and evaluated by PG-SGA combined with objective indicators such as anthropometric measurements and inflammatory factors.
关键词
胃癌 /
患者主观整体评估 /
营养状况 /
营养不良 /
炎症因子
Key words
Gastric cancer /
Patient-generated subjective global assessment /
Nutritional status /
Malnutrition /
Inflammatory factors
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