胃肠道恶性肿瘤患者术前营养不良相关因素研究

Study on the related factors of malnutrition in patients with gastrointestinal malignant tumor

目的研究胃肠道恶性肿瘤患者术前营养状况以及营养不良发生的相关因素。方法选取2016年8月至2017年11月在武汉同济医院胃肠外科住院拟行手术治疗的胃肠道恶性肿瘤患者202例,入院后采用主观综合营养评估(subjective global assessment,SGA)法评估营养状况,记录入院时体重指数(body mass index,BMI)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NRL)、营养指标(血红蛋白、白蛋白、前白蛋白)、血清肿瘤标志物(CA199、CA724、CEA)和肿瘤部位、TNM分期、分化程度。采用多元回归分析营养不良的相关因素。结果 202例患者中,SGA法评定营养不良发生率为46%。多因素回归分析显示,在矫正年龄、性别、NRL、CA199、CA724、TNM分期和肿瘤分化程度等因素后,肿瘤部位和CEA是营养不良的独立相关因素。与远端胃、左半结肠、乙状结肠和直肠的恶性肿瘤患者相比,近端胃和右半结肠恶性肿瘤患者的营养不良发生风险增高(OR=2.51,95%CI 1.25~5.03,P=0.009);与CEA<10ng/ml的患者相比,CEA≥10ng/ml的患者营养不良发生风险增高(OR=12.50,95%CI 2.66~58.63,P=0.001)。结论肿瘤部位和CEA水平是胃肠道恶性肿瘤患者营养状态的独立相关因素,对于肿瘤位于近端胃和右半结肠以及CEA≥10ng/ml的消化道肿瘤患者,其营养状况应引起临床医护人员更多的关注。

Objective To study the nutritional status of patients with gastrointestinal malignant tumor and analyze the related factors. Method 202 patients with gastrointestinal malignant tumor who admitted to gastrointestinal surgery department of Wuhan Tongji Hospital for surgery treatment from August 2016 to November 2017 were selected. Patients＇ nutritional status at admission was assessed according to subjective Global Assessment（SGA）. Body mass index（BMI）, blood nutrition markers（hemoglobin, serum albumin and pre-albumin）, neutrophil lymphocyte ratio（NRL）, and serum tumor markers（CA199, CA72 and CEA） were collected at admission. Tumor site, postoperative TNM stage and tumor differentiation degree were also recorded. Multivariate logistic regression analysis was used. Result Of these 202 patients, 46% was indicated malnutrition by SGA. Multivariate logistic regression analysis showed that tumor site and CEA were independent risk factors for malnutrition after adjusting for other confounding factors such as age, sex, NRL, CA199、CA724、TNM stage and tumor differentiation degree. Compared with malignant tumors located in the distal stomach, left half colon, sigmoid colon and the rectum, the risk of malnutrition was higher in malignant tumors located in the proximal stomach and the right half colon（OR=2.51,95% CI 1.25-5.03, P=0.009）. Compared with patients with CEA〈10 ng/ml, the risk of malnutrition was higher in patients with CEA≥10 ng/ml（OR=12.50, 95% CI 2.66-58.63, P=0.001）. Conclusion Tumor site and CEA were independent risk factors for malnutrition, and clinicians and nurses should pay more attention to the nutritional status of patients with gastrointestinal malignant tumors located in the proximal stomach and the right half colon and with CEA≥10 ng/ml.