骨骼肌质量指数对胃肠道恶性肿瘤患者术后并发症及再入院率的影响

Effects of skeletal muscle mass index on postoperative complications and readmission rate in patients with gastrointestinal malignancy

目的 探讨骨骼肌质量指数(skeletal muscle mass index, SMI)对胃肠道恶性肿瘤患者术后并发症及再入院率的影响。方法 收集2020年7月-2021年3月上海交通大学医学院附属同仁医院胃肠外科接受外科手术的94例胃肠道恶性肿瘤患者资料,采用人体成分测定仪测定患者术前四肢骨骼肌量,根据SMI分成两组。SMI正常组:男性≥7 kg/m^(2)、女性≥5.7 kg/m^(2);降低组:男性<7 kg/m^(2)、女性<5.7 kg/m^(2)。比较两组患者术前体质量指数(body mass index, BMI)、前白蛋白水平、营养风险筛查2002、内科合并症以及术后1个月内总并发症、住院时间、住院费用之间的差异。结果 94例患者中有33例存在SMI降低。术前SMI正常组的BMI和肌肉量均高于SMI降低组,营养风险筛查评分显著低于SMI降低组,差异有统计学意义(P<0.001);SMI正常组前白蛋白均高于SMI降低组,差异有统计学意义(P<0.05)。术后SMI正常组的并发症发生率低于SMI降低组,差异有统计学意义(P<0.05)。多因素Logistic回归分析表明,SMI降低是患者术后发生并发症的独立危险因素(OR=0.716,95%CI 1.159~19.200,P<0.05)。结论 骨骼肌减少在胃肠道恶性肿瘤患者中发生率较高,术前已存在骨骼肌质量指数降低的患者术后并发症发生率更高。

Objective To investigate the effect of skeletal muscle mass index(SMI) on postoperative complications and readmission rate of patients with gastrointestinal malignancy. Methods From July 2020 to March 2021, 94 patients with gastrointestinal cancer underwent surgery in Gastrointestinal Surgery Department of Tongren Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. The skeletal muscle mass of limbs was measured by body composition instrument before operation, and patients were divided into two groups according to SMI: normal group(male≥7 kg/m^(2), female ≥5.7 kg/m^(2))and reduction group(male<7 kg/m^(2), female<5.7 kg/m^(2)). The preoperative body mass index(BMI), prealbumin, nutritional risk screening 2002 score, medical complications, total complications, length of hospital stay and hospitalization cost in 1 month after surgery were compared between the two groups. Results Among 94 patients 33 had reduced SMI. Compared to preoperative SMI reduced group, patients with normal SMI had higher BMI and muscle mass, higher prealbumin level(P<0.001 or P<0.05);and had lower nutritional risk screening score and lower incidence of postoperative complications(all P<0.05). Multivariate Logistic regression analysis showed that reduced SMI was an independent risk factor for postoperative complications(OR=0.716, 95%CI 1.159-19.200, P<0.05). Conclusion Patients with gastrointestinal cancer have a higher prevalence of sarcopenia, and patients with reduced SMI have a higher incidence of postoperative complications.