第三腰椎旁肌肉指数对晚期非小细胞肺癌营养不良风险的预测价值

The predictive value of L,skeletal muscle index(SMI)for sarcopenia in advanced non-small cell lung cancer patients

目的分析第三腰椎旁肌肉指数(L_(3)-SMI)与晚期非小细胞肺癌(NSCLC)营养状态之间的关系,以进一步明确L_(3)-SMI是否可以作为评估NSCLC营养不良的有效预测参数。方法选择2016年1月至2020年12月间于阜宁县人民医院行放、化疗的100例Ⅲ~Ⅳ期NSCLC为研究对象,并根据患者主观整体评估(PG-SGA)将所有患者分为重度营养不良组与非重度营养不良组。采用单、多因素Logistic回归分析确定各评价参数与重度营养不良的相关性,并通过受试者操作特征(ROC)曲线比较不同评价参数对NSCLC重度营养不良的预测价值。结果PG-SGA量表发现严重营养不良在进展期或晚期NSCLC中的发生率高达48.0%。与非重度营养不良组相比,重度营养不良组年龄更大[(65.4±10.0)岁比(61.2±6.9)岁,t=2.482,P=0.015)],控制营养状态评分更高[3(1,5)分比2(1,4)分,t=2.238,P=0.027],而体质指数[(21.1±3.2)kg/m^(2)比(25.2±3.8)kg/m^(2),t=-5.840,P<0.001)]、血清白蛋白水平[(33.8±4.7)g/L比(36.4±3.9)g/L,t=-2.970,P=0.004)]、预后营养指数[(41.5±5.3)比(44.7±5.0),t=-3.122,P=0.002)]及L_(3)-SMI更低[(36.0±8.9)比(53.1±12.3),t=-8.103,P<0.001)]。多因素Logistic回归分析证实血清低白蛋白水平(OR=0.791,95%CI=0.678~0.922,P=0.003)和低L_(3)-SMI(OR=0.826,95%CI=0.765~0.892,P<0.001)是严重营养不良的危险因素。ROC曲线展示L_(3)-SMI对NSCLC的营养状态具有良好预测效能(AUC值:0.888,95%CI=0.822~0.955),优于其他血液学参数。结论L_(3)-SMI与PG-SGA具有高度一致性,是一项筛查晚期NSCLC营养不良风险的有效指标。

Objective This study aimed to analyze the correlation between the third lumbar skeletal muscle index(L-SMI)and nutritional status,and to elarifty whether L_(3)-SMI could be used as an ffective predictor of malnutrition for advanced non-small cell lung cancer(NSCLC)patients.Method A total of 100 clinical stage I-N NSCLC patients who received radiotherapy and/or chemotherapy in Funing People's Hospital from Jan 2016 to Dec 2020 were enolled in this analysis,and all patients were divided into severe malnutrition and non-severe malnutrition groups based on the patient-generated subjective global asessment(PG--SCA).The.correlations between different assment parameters and severe malnutrition risk were determined using the univariate and multivariate Logistie regression analysis,and the receiver operation characteristics(ROC)curves were ploted to conmpare these predietive values for severe malnutrition risk in adwanced NSCLC patients.Result Using the PC--SGA scale,we found that frequency of severe malnutrition in advanced NSCLC patients could be as high as 48.0%,Compared with the non-severe malnutrition group,patients with severe malnutrition were older[(65.4±10.0)18(61.2±6.9)years old,t=2.482,P=0.015)]and had a higher soore of Cortolling nutritional status[3(1,5)us2(1,4),t=2.238,P=0.027],lower body mass index[(21.1±3.2)kg/m^(2)us(25.2±3.8)kg/m^(2),t=-5.840,P<0.001),senum albumin level[(33.8±4.7)ts(36.4±3.9)g/L_(3)t=-2.970,P=0.004],the prognostic nutritional index[(41.5+5.3)ts(44.7+5.0),t=-3.122,P=0.002)and L_(3)-SMI[(36.0±8.9)8(53.1±12.3),t=-8.103,P<0.001].The mulivariate Logistie regression analysis demonstrated that low serum albumin level(OR=0.791,95%CI=0.678-0.922,P=0.003)and L_(3)-SMI(OR=0.826,95%C1=0.765-0.892,P<0.001)were independently crrelated with severe malnutrition risk in advanced NSCLC patients.In addition,ROC curves showed that L_(3)-SMI had an exellent predictive perfomance,with an AUC value of0.888(95%C1=0.822-0.955),which was higher than other hematological paraneters.Condusion L-SMI was signifcanly correlated with PG--SGA scale,and it was an useful tool of nutrition risk screening for advanced NSCLC patients.