瘦体重对血液系统恶性肿瘤患者预后的影响分析

Impact of lean body mass on prognosis in patients with hematological malignancies

目的探讨不同瘦体重对血液系统恶性肿瘤(白血病、恶性淋巴瘤、多发性骨髓瘤)患者生存预后的影响。方法在单中心纳入2014年1月至2018年2月陆军军医大学大坪医院血液系统恶性肿瘤患者312例(白血病93例,恶性淋巴瘤174例,多发性骨髓瘤45例),入院后48 h内进行患者主观整体评估(PG-SGA)、血液学指标检查、体格测量及人体成分分析(biodynamics BIA450)。根据人体成分分析中瘦体重百分位切点值男性(P15)=35.7 kg,女性(P15)=28.7 kg进行分组,男性≤35.7 kg者纳入低瘦体重组,女性≤28.7 kg者纳入低瘦体重组。分析两组患者一般信息、生化指标、体格测量指标差异,并与生存结果进行相关性分析。结果312例患者中的瘦体重正常者262例,归为正常瘦体重组,低瘦体重者50例归入低瘦体重组。白血病患者中,白蛋白、淋巴细胞计数在正常瘦体重组与低瘦体重组之间的分布存在显著差异(P<0.05)。并且,在多发性骨髓瘤患者以及恶性淋巴瘤患者中,体格测量指标(BMI、MAC、TSF、MAMC以及CC)与低瘦体重组之间表现出统计学关联(P<0.05)。由Kaplan-Meier生存曲线以及Log-rank检验可知,低瘦体重组生存率低于正常瘦体重组(P<0.001);Cox回归分析表示低瘦体重是血液系统恶性肿瘤的危险因素(总:HR=2.361,95%CI=1.455~3.834;恶性淋巴瘤:HR=2.331,95%CI=1.213~4.477;多发性骨髓瘤:HR=6.348,95%CI=1.579~25.520)。结论血液系统恶性肿瘤患者瘦体重明显影响患者预后生存情况,建议加强个体化营养干预以改善低瘦体重,促进患者预后改善。

Objective To investigate the effect of lean body mass on the survival and prognosis of patients with hematological malignancies including leukemia lymphoma and multiple myeloma.Method 312 patients with hematological malignancies from January 2014 to February 2020 were enrolled in a single center.Subjective global assessment PG-SGA and body composition analysis BiodynamicsBIA450 were performed within 48 hours after admission.Male lean body mass P15=35.7 kg female lean body mass P15=28.7 kg for grouping males≤35.7 kg were included in low lean body mass reorganization females≤28.7 kg were included in low lean body mass reorganization.The basic conditions of the research subjects were compared and the biochemical indicators anthropometric indicators and survival conditions were compared between the two groups.Result Among 312 patients 262 patients with normal lean body weight were classified as normal lean body group and other 50 patients with low lean body weight were classified as low lean body group.In leukemia patients the albumin and lymphocyte of normal lean body mass group were significantly higher than those of low body mass group P<0.05.In addition in patients with multiple myeloma and malignant lymphoma there was a statistical correlation between body measurements BMI MAC TSF MAMC and CC and lean body mass group P<0.05.Kaplan-Meier survival curve and Log-rank test showed that the survival rate of low lean body group was lower than that of normal lean body group P<0.001 Cox regression analysis showed that low lean weight was a risk factor for hematological malignancies total HR=2.36195%CI=1.455-3.834 malignant lymphoma HR=2.33195%CI=1.213-4.477 multiple myeloma HR=6.34895%CI=1.579-25.520.Conclusion Lean body mass in patients with hematological malignancies significantly affects the prognosis and survival of patients.It is recommended to strengthen individualized nutritional intervention to improve low lean body mass and improve the prognosis of patients.