内脏脂肪含量对直肠癌术后早期严重并发症的预测价值

Predictive value of visceral adipose for early major complications after rectal cancer surgery

目的通过计算机断层扫描(CT)测量直肠癌患者内脏脂肪面积,探讨内脏脂肪含量对直肠癌根治术后早期严重并发症的预测价值。方法采用病例对照研究方法,回顾性收集2017年1月—2018年6月间于首都医科大学附属北京友谊医院接受直肠癌根治手术的135例患者的临床病理资料,其中男89例,女46例,年龄30~88岁,中位年龄63岁。根据术后30 d内是否发生严重并发症,将患者分为并发症组(n=16)和对照组(n=119),分析患者内脏脂肪含量与术后早期严重并发症发生的相关性。其中,正态分布的计量资料用均值±标准差(±s)表示,组间比较采用t检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Mann-Whitney U检验。计数资料以例(%)表示,组间比较采用χ^(2)检验或Fisher精确概率法。采用Logistic回归模型对影响直肠癌根治术后早期严重并发症发生的因素进行多因素分析,并通过受试者工作特征(ROC)曲线下面积(AUC)分析模型对直肠癌根治术后发生早期严重并发症的预测能力。结果单因素分析结果显示,并发症组与对照组患者在术中出血量[100(62,187)mL比50(40,100)mL,Z=-2.04,P=0.042]、手术时间(325(212,375)min比260(180,310)min,Z=-2.04,P=0.041)、术前血糖[4.67(4.44,5.09)mmol/L比5.20(4.80,5.72)mmol/L,Z=-3.33,P=0.001]及内脏脂肪面积/皮下脂肪面积(V/S)(1.23±0.54比0.96±0.40,t=-2.39,P=0.018)方面,差异均有统计学意义。多因素Logistic回归模型显示V/S比值(OR=3.978,95%CI:1.160~13.636,P=0.028)和术前血糖水平(OR=0.168,95%CI:0.055~0.512,P=0.002)是直肠癌根治术后发生早期严重并发症的独立危险因素。结论高内脏脂肪含量是直肠癌根治术后发生早期严重并发症的独立危险因素,V/S有望成为直肠癌根治术后早期严重并发症发生的预测指标。

Objective To investigate the predictive value of visceral adipose for early major complications after rectal cancer surgery by CT scan.Methods A retrospective case-control study method was used to recruit a total of 135 patients with rectal cancer who underwent radical resection at Beijing Friendship Hospital,Capital Medical University from January 2017 to June 2018.There were 89 males and 46 females,aged from 30 to 88 years,with a median age of 63 years.The patients were divided into complication group(n=16)and control group(n=119)according to whether serious complications occurred within 30 days after operation.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed by using independent sample t-test.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3))and analyzed by using the Mann-Whitney U test.Count data were expressed as constituent ratio,and analyzed using the chi-square test or Fisher exact test.Logistic regression model was used to analyze the factors affecting the occurrence of early severe complications after radical resection of rectal cancer.The area under the receiver operating characteristic(ROC)curve(AUC)was used to analyze the predictive ability of the model for early severe complications after radical resection of rectal cancer.Results Univariate analysis showed that there were significant differences in intraoperative blood loss[100(62,187)mL vs 50(40,100)mL,Z=-2.038,P=0.042],operation time[(325(212,375)min vs 260(180,310)min,Z=-2.04,P=0.041)],preoperative blood glucose[4.67(4.44,5.09)mmol/L vs 5.20(4.80,5.72)mmol/L,Z=-3.33,P=0.001]and visceral fat area/subcutaneous fat area(V/S)(1.23±0.54 vs 0.96±0.40,t=-2.39,P=0.018)between the complication group and the control group.Multivariate Logistic regression model showed that V/S ratio(OR=3.978,95%CI:1.160-13.636,P=0.028)and preoperative blood glucose level(OR=0.168,95%CI:0.055-0.512,P=0.002)were independent risk factors for early major complications after radical resection of rectal cancer.Conclusions Visceral fat and preoperative blood glucose level are independent risk factors for early major complications after radical resection of rectal cancer,V/S is expected to be a predictor of early major complications after radical resection of rectal cancer.