消化道肿瘤营养不良患者外周血炎症指标水平临床研究

Clinical study on malnutrition and the level of inflammatory indicators in peripheral blood of patients with digestive tract cancer

目的研究常见消化系统恶性肿瘤患者营养状况,分析其与临床分期等肿瘤特征因素及外周血炎症指标水平的相关性。方法收集中国科学技术大学附属第一医院(西区)安徽省肿瘤医院2019年1月至2020年12月食管癌、胃癌及结直肠癌共298例患者的临床资料,据PG‐SGA法评估患者营养状况,分为无或轻度营养不良、中度和重度营养不良三组,比较三组间相关临床特征、血液学和炎症指标等差异。结果298例患者中,无或轻度营养不良占34.2%,中度营养不良占26.5%,重度营养不良占39.3%。三组间年龄、性别、肿瘤分化程度及血脂水平无统计学差异(P>0.05);临床分期Ⅲ~Ⅳ期患者比Ⅰ~Ⅱ期更易发生中重度营养不良;重度营养不良组中,食管癌、胃癌和结直肠癌比例分别为41.0%、36.8%、22.2%,差异有显著性(P<0.05);重度营养不良患者体质指数、血红蛋白、淋巴细胞绝对值、血小板计数、总蛋白、前白蛋白水平更低,更易出现低蛋白血症、高血小板和D二聚体升高。结果还显示,外周血白细胞计数、C反应蛋白水平、白细胞介素-6水平、中性粒细胞和淋巴细胞比值升高比例随着营养不良程度增加而增加,以上三组患者分别为1.9%比7.6%比14.5%、29.4%比51.9%比61.5%、15.7%比27.8%比53.0%和35.3%比38.0%比70.9%,差异均有显著意义(P<0.05);重度营养不良PLR升高患者比例超过50%(P<0.05)。IL‐6、NLR、PLR区分无或轻度营养不良与中重度营养不良的最佳临界值分别为4.75、2.47、150.5。结论消化道肿瘤患者易发生中重度营养不良,而临床分期和炎症指标与营养状况有一定相关性,在临床应用中一定程度具有提示价值,指导早期干预。

Objective To investigate the nutritional status of patients with common digestive tract cancer and analyze the correlation between nutritional status and tumor characteristic factors and blood inflammatory indicators.Methods Clinical data of 298 patients with esophageal cancer,gastric cancer and colorectal cancer in our hospital from January 2019 to December 2020 were collected.According to the PG⁃SGA score,the patients were divided into three groups:no or mild malnutrition,moderate malnutrition and severe malnutrition,and the differences in related clinical characteristics,blood and inflammatory indicators among the three groups were compared.Results Among the 298 patients,no or mild malnutrition accounted for 34.2%,moderate malnutrition accounted for 26.5%and severe malnutrition accounted for 39.3%.There were no significant differences in age,gender,degree of tumor differentiation and blood lipid levels among the three groups(P>0.05).Patients in stageⅢ-Ⅳwere more likely to suffer from moderate or severe malnutrition than those in stageⅠ-Ⅱ.In the severe malnutrition group,the proportions of esophageal cancer,gastric cancer and colorectal cancer were 41.0%vs 36.8%vs 22.2%,respectively,P<0.05.Patients with severe malnutrition had lower levels of BMI,HB,LY,TP,and PAB.And they were more likely to have hypoproteinemia,high platelet count,and elevated D⁃dimer levels.The results also showed that the proportion of WBC,CRP,IL⁃6 and NLR in peripheral blood increased with the increase of malnutrition degree,which were 1.9%vs 7.6%vs 14.5%,29.4%vs 51.9%vs 61.5%,15.7%vs 27.8%vs 53.0%and 35.3%vs 38.0%vs 70.9%,respectively,with significant differences(P<0.05).The proportion of PLR increased in severe malnutrition group was more than 50%(P<0.05).The optimum cut⁃offs of IL⁃6,NLR and PLR were 4.75,2.47 and 150.5 for moderate or severe malnutrition.Conclusion Patients with digestive tract cancer are prone to moderate or severe malnutrition.The clinical stages and inflammatory indicators are correlated with nutritional status to a certain extent,and have suggestive value in clinical application to guide early intervention.