内脏脂肪指数对胃癌患者根治术后补充性肠外营养期间血糖与短期并发症的影响

Effect of visceral adipose tissue index on blood glucose and short-term complications during supplementary parenteral nutrition in patients with gastric cancer after radical operation

目的 探讨内脏脂肪指数(VATI)与非糖尿病胃癌患者根治术后补充性肠外营养(SPN)期间血糖、短期并发症的关系。方法 回顾性分析2018年1月-2021年4月在兰州大学第一医院肿瘤外科接受胃癌根治术及SPN的218例患者的临床病理资料,将术前计算机断层扫描在第三腰椎层面的内脏脂肪面积除以身高的平方得到VATI,再根据X-tile软件计算出的VATI的最佳截断值将患者分为VATI-L组(27例)、VATI-M组(150例)和VATI-H组(41例)。比较不同组VATI在术后血糖状态、并发症发生率及1年、3年总生存率方面的差异,评估VATI与术后高血糖、短期并发症发生的关系,COX回归分析影响患者总生存期的危险因素。结果 与VATI-L组和VATI-M组相比,VATI-H组患者术后高血糖发生率更高(分别为33.3%、46.0%、68.3%,P=0.010),并发症发生率更高(分别为18.5%、13.3%、39.0%,P=0.001),且术后SPN期间的血糖平均值及最高值更高,血糖控制率更差(P<0.05);多因素Logistic回归分析发现VATI-H组的胃癌患者发生术后高血糖、并发症的风险更高(P<0.05);多因素COX回归分析表明,新辅助化疗史、更低的VATI、开腹手术、pTNM分期为Ⅱ~Ⅲ期、组织学分级差及综合并发症指数是影响患者总生存期的危险因素(P<0.05)。结论 VATI影响非糖尿病胃癌根治术后患者SPN期间高血糖发生,可作为胃癌根治术后患者预后的评估指标。

Objective To explore the relationship between visceral adipose tissue index(VATI) and blood glucose and short-term complications during supplementary parenteral nutrition(SPN) after radical resection of gastric cancer. Methods The clinical and pathological data of 218 patients who underwent radical gastrectomy and SPN in the Department of Oncology, the First Hospital of Lanzhou University from January 2018to April 2021 were analyzed retrospectively. The VATI was obtained by dividing the visceral fat area of preoperative computed tomography at the third lumbar vertebrae level by the square of height. Then, the patients were divided into a VATI-L group(27 cases), VATI-M group(150 cases) and VATI-H group(41 cases)according to the optimal truncation value of VATI calculated by X-tile software. The differences of VATI in postoperative blood glucose status, complication rate and 1-year and 3-year overall survival rate were compared between the groups, and the relationship between VATI and postoperative hyperglycemia and short-term complications was evaluated. COX regression analysis was used to analyze the risk factors affecting the overall survival time. Results Compared with the VATI-L and VATI-M group, the incidence of postoperative hyperglycemia in the VATI-H group was higher(33.3%, 46.0%, 68.3%, respectively, P = 0.010), and the incidence of complications higher(18.5%, 13.3%, 39.0%, respectively, P = 0.001). The average and maximum value of blood glucose during SPN was higher, and the blood glucose control rate worse(P < 0.05).Multivariate Logistic regression analysis showed that gastric cancer patients in the VATI-H group had a higher risk of postoperative hyperglycemia and complications(P< 0.05), while multivariate COX regression analysis showed that history of neoadjuvant chemotherapy, lower VATI, laparotomy, pTNM stage Ⅱ~Ⅲ, histological grade difference and comprehensive complication index were risk factors for the overall survival time(P <0.05). Conclusion VATI affects the occurrence of hyperglycemia during SPN in non-diabetic patients with gastric cancer, and can be used as an index in evaluating the prognosis of patients after radical resection of gastric cancer.