肺癌患者并发肌肉减少症的危险因素分析及其列线图 预测模型的应用价值

Analysis of risk factors of sarcopenia in lung cancer patients and the application value of nomograph prediction model

目的探究肺癌患者并发肌肉减少症(简称肌少症)的危险因素并构建其列线图预测模型。方法选取2020年9月至2022年9月淮安市第二人民医院特需病房收治的肺癌患者96例为研究对象;记录患者临床资料及实验室指标;生物电阻抗测试法检测人体成分;根据AWGSOP制定的标准将患者分为并发肌少症(并发组,52例)及未并发肌少症(未并发组,44例);Logistic回归分析影响肺癌患者并发肌少症的因素;构建预测肺癌患者并发肌少症的列线图模型;预测肺癌患者并发肌少症列线图模型的区分度和一致性用受试者工作特征曲线(ROC曲线)、校准曲线来评估。结果本研究纳入96例肺癌患者,并发肌少症的患者共52例,肌少症发生率54.17%(52/96);长期吸烟史、营养风险筛查2002(NRS 2002)评分、体质指数(body mass index,BMI)、去脂体质量(fat-free body mass,FFM)、肌肉量(muscle mass,SLM)、四肢骨骼肌量(appendicular skeletal muscle mass,ASM)、体脂肪(body fat mass,BFM)在并发组与未并发组之间差异显著(P<0.05);多因素Logistic回归分析结果显示,长期吸烟史、NRS 2002评分及BMI是肺癌患者并发肌少症的影响因素(P<0.05);列线图模型显示,长期吸烟史增加21.8分的权重,NRS 2002评分每增加1分增加25分的权重,BMI每降低2 kg/m 2增加12.5分的权重;H-L拟合度检验显示,χ^(2)=3.891、P=0.867,校准曲线斜率趋近1,ROC曲线下面积为0.917,敏感性、特异性分别为92.31%、75.00%。结论长期吸烟史、NRS 2002评分及低水平BMI均是肺癌患者发生肌少症的影响因素,本研究构建的列线图模型用于个体化预测肺癌患者发生肌少症具有较高的临床价值。

Objective To explore the risk factors of sarcopenia in patients with lung cancer and construct its nomograph prediction model.Method From September 2020 to September 202296 patients with lung cancer admitted to Huai'an Second People's Hospital special needs ward were regarded as the study subjects the clinical data and laboratory indicators of patients were recorded bioelectrical impedance test was applied to detect human body composition according to the criteria established by AWGSOP the patients were grouped into two groups myopenia group 52 cases in the concurrent group and no myopenia group 44 cases in the non-concurrent group logistic regression analysis was applied to analyze the factors affecting sarcopenia in patients with lung cancer a nomograph model was constructed for predicting sarcopenia in patients with lung cancer the differentiation and consistency of the nomograph model for predicting sarcopenia in patients with lung cancer were evaluated with ROC and calibration curve.Result A total of 96 patients with lung cancer were included in this study and there were 52 patients with sarcopenia the incidence of sarcopenia was 54.17%52/96 long-term smoking history NRS 2002 score body mass index BMI fat-free body mass FFM muscle mass SLM appendicular skeletal muscle mass ASM body fat BFM were obviously different between the concurrent group and the non-concurrent group P<0.05 multivariate Logistic regression analysis showed that long-term smoking history NRS2002 score and BMI were the factors affecting sarcopenia in lung cancer patients P<0.05 the nomograph model shows that the weight of long-term smoking history was increased by 21.8 points the weight of NRS2002 score was increased by 25 points for every 1 point increase and the weight of BMI was increased by 12.5 points for every 2 kg/m 2 decrease H-L fit test showed thatχ^(2)=3.891 P=0.867 the slope of the calibration curve approached 1 the area under the ROC curve was 0.917 and the sensitivity and specificity were 92.31%and 75.00%respectively.Conclusion Long-term smoking history NRS2002 score and low level BMI are all the factors that influence the occurrence of sarcopenia in lung cancer patients.The nomograph model constructed in this study has high clinical value in the individualized prediction of sarcopenia in lung cancer patients.