定量CT分析结直肠癌患者治疗前后身体组分的变化及其危险因素

To analyze the changes of body composition and risk factors of colorectal cancer patients before and after treatment based on quantitative CT

目的探讨结直肠癌(CRC)患者治疗前后身体组分的变化及其危险因素。方法回顾性分析2018年1月至2021年12月在医院收治的221例经过根治性手术和术后静脉化疗的CRC患者,其中男性124例,女性97例,对其治疗前后全腹CT扫描图像进行分析。使用定量CT(QCT)分别测量治疗前后腰椎骨密度(BMD)、腹部皮下脂肪面积(SFA)、腹部内脏脂肪面积(VFA)、椎后肌群肌肉面积(MA),并计算出腹部总脂肪面积(TFA)。结果治疗后SFA高于治疗前,腰椎BMD、椎后肌群MA低于治疗前(P<0.05),治疗后TFA、VFA较治疗前差异无统计学意义(P>0.05)。≥60岁患者治疗后VFA及腰椎BMD低于治疗前(P<0.05)。<60岁患者治疗前后各身体组分差异无统计学意义(P>0.05)。男性患者治疗后TFA及SFA高于治疗前,腰椎BMD及椎后肌群MA低于治疗前(P<0.05)。女性患者治疗后TFA及VFA低于治疗前(P<0.05)。男性、开腹及结肠癌是腰椎BMD下降的独立危险因素(P<0.05)。男性、直肠癌、治疗前低腰椎BMD、T分期大是椎后肌群MA下降的独立危险因素(P<0.05)。结论CRC患者根治性手术及术后化疗会对其身体组分产生影响;男性、开腹及结肠癌是腰椎BMD下降的独立危险因素;男性、直肠癌、治疗前低腰椎BMD、T分期大是椎后肌群MA下降的独立危险因素。

Objective To investigate the changes of body composition and risk factors in patients with colorectal cancer(CRC)before and after treatment.Methods Data of 221 patients attacked by colorectal cancer who underwent radical surgery and postoperative intravenous chemotherapy in hospital from January 2018 to December 2021 were retrospectively analyzed.There were 124 males and 97 females.The CT images of the whole abdomen before and after treatment were analyzed.Quantitative CT(QCT)was used to measure lumbar bone mineral density(BMD),abdominal subcutaneous fat area(SFA),abdominal visceral fat area(VFA)and posterior vertebral muscle group muscle area(MA)before and after trement,and the abdominal total fat area(TFA)was calculated.Results The SFA after treatment was higher than that before treatment,and the BMD of the lumbar spine and the MA of the posterior vertebral muscle group were lower than before treatment(P<0.05).There was no statistical difference in TFA and VFA after treatment compared to before treatment(P>0.05).VFA and lumbar spine BMD were lower in patients≥60 years of age after treatment than before treatment(P<0.05).There was no statistical difference in each body component before and after treatment in patients<60 years of age(P>0.05).Male patients had higher TFA and SFA after treatment than before treatment,and lower lumbar spine BMD and posterior vertebral muscle group MA than before treatment(P<0.05).In female patients,TFA and VFA were lower after treatment than before treatment(P<0.05).Male,laparotomy and colon cancer were independent risk factors for lumbar spine BMD decline(P<0.05).Male,rectal cancer,low lumbar spine BMD before treatment and high T-staging were independent risk factors for MA decline in posterior vertebral muscle group(P<0.05).Conclusion CRC patients undergoing radical surgery and postoperative chemotherapy will affect their body composition.Male,open surgery and colon cancer are independent risk factors for lumbar spine BMD decline.Male,rectal cancer,low lumbar spine BMD before treatment and high T-staging were independent risk factors for MA decline in posterior vertebral muscle group.