肌少症与胃癌患者外周血炎性和营养指标及预后关系的回顾性研究

Associations between sarcopenia and peripheral inflammatory,nutritional factors,and prognosis in patients with gastric cancer

目的探究肌少症与胃癌患者外周血中炎性和营养指标的关系及肌少症对胃癌患者预后的影响。方法收集2016年7月至2020年12月于四川大学华西医院胃肠外科就诊的174例胃癌患者。根据CT图像计算患者第三腰椎层面骨骼肌指数(男性<52.4 cm^(2)/m^(2)和女性<38.5 cm^(2)/m^(2)),分为肌少症和非肌少症患者。对两组患者的主要临床病理指标进行对比和预后分析。结果本研究共纳入174例胃癌患者,其中73例(41.95%)被诊断为肌少症。与非肌少症患者相比,肌少症患者年龄更大且BMI更低,男性肌少症患者的比例更高。此外,肌少症患者术后肺部感染的发生率高于非肌少症患者,且住院时间更长。两组患者在2型糖尿病患病率、外周血C反应蛋白水平,白介素-6水平、白蛋白水平、前白蛋白和血红蛋白水平上差异均有统计学意义。多因素分析和生存分析表明非肌少症患者总体生存期更长。结论胃癌伴肌少症患者具有炎性因子水平更高,营养状况更差及总体生存期更短的特点。因此,临床应注意早期识别胃癌伴肌少症患者,及时给予营养支持。

Objective To investigate the relevance among sarcopenia,peripheral inflammatory,and nutritional factors,as well as the impact of sarcopenia on the prognosis of gastric cancer.Methods A total of 174 patients with gastric cancer in Department of Gastrointestinal Surgery in West China Hospital of Sichuan University from July 2016 to December 2020 were retrospectively included.The skeletal muscle index(SMI)of the third lumbar vertebra level was calculated using CT images,and male patients with SMI<52.4 cm^(2)/m^(2)and female patients with SMI<38.5 cm^(2)/m^(2)were considered sarcopenia.The key clinicopathological features of patients were collected for prognostic analysis.Results Among the 174 patients with gastric cancer,73 patients(41.95%)were diagnosed with sarcopenia.Compared with those of non-sarcopenia,the patients who were diagnosed with sarcopenia showed a significantly elder age and lower body mass index(BMI).In addition,males demonstrated a significantly higher rate of sarcopenia.Further,patients with sarcopenia showed a significant increasing in the incidence of postoperative pulmonary infections and length of hospitalization than patients without sarcopenia.The two groups showed significant differences in type 2 diabetes,peripheral C-reaction protein(CRP),interleukin-6(IL-6),albumin,prealbumin,and hemoglobin.Overall,the multivariate analysis and KaplanMeier survival curves indicated that sarcopenic patients had a significantly lower survival rate than the non-sarcopenia patients.Conclusion Sarcopenia is closely related to higher levels of inflammation,malnutrition,and poor prognosis in patients with gastric cancer.Therefore,we should diagnose sarcopenia patients as early as possible,and give nutritional support to the patients.