基于随机森林模型的肺癌患者肌肉减少症的危险因素分析

Analysis of risk factors for sarcopenia in lung cancer patients with random forest model

目的调查肺癌患者肌肉减少症(简称肌少症)发生的现状,并分析其危险因素,为临床识别肺癌肌少症高危人群提供参考。方法采用方便抽样法选取2022年9月至2023年7月广州医科大学附属第一医院收治的420例肺癌患者作为调查对象。依据2019年亚洲肌少症小组的诊断标准,使用四肢骨骼肌指数、握力、5次起坐试验时间等多项指标进行联合诊断,将研究对象分为肌少症组与非肌少症组。采用随机森林算法对可能影响肌少症发生的自变量进行重要性排序和袋外误差数据分类错误分析,并将筛选出的变量纳入多因素Logistic回归分析。结果420例肺癌患者样本中,97例(23.10%)合并肌少症,其中47例(11.19%)为严重肌少症。多因素Logistic回归分析结果显示,小腿围(OR=0.533)是肺癌患者发生肌少症的保护因素,年龄≥65岁(OR=3.789)、SARC-F评分高(OR=1.857)、吸烟史(OR=4.407)则是独立危险因素(P<0.05)。结论肺癌患者普遍存在较高的肌少症患病率。对于年龄≥65岁、小腿围较小、SARC-F评分较高和有吸烟史的患者,其发生肌少症的风险更大。建议医护人员应加强对这些高危人群的关注,及早实施干预措施,以降低肺癌患者肌少症的发生率。

Objective To investigate the current situation of the ocurrence of saropenia in lung cancer patients and analyze its risk factors,so as to provide reference for elinical ientifcation of the high-risk group of sarcopenia in lung cancer.Method A total of 420 lung cancer patients were conveniently selected from the First Afiliated Hospital of Guangzhou Medical University between September 2022 and July 2023.Based on the diagnostic criteria of the Asian sarcopenia working group in 2019,the study subjects were divided into sarcopenia and non-sarcopenia groups by using several indexes for joint diagnosis,such as skeletal muscle index,grip strength,and5 times sit-up test time.The random forest algorithm was applied to rank the importance of potential independent variables influencing sarcopenia,while considering classification errors with out-of-bag data.The selected variables were subsequently incorporated into a mulifactorial logistie regression analysis.Result Out of the 420 lung cancer patients,97(23.10%)exhibited coexisting sarcopenia,with 47(11.19%)classified as severe cases.The results of binary logistic regression showed that calf circunference(OR=0.533)was a protective factor for the development of saropenia in lung cancer patients,while age≥65 years(OR=3.789),high SARC-F score(OR=1.857),and history of smoking(OR=4.407)were independent risk factors(P<0.05).Conclusion A high prevalence of sarcopenia is prevalent in lung cancer patients.The risk of saropenia was greater for patients≥65 years of age,smaller calf circumference,higher SARC-F scores,and a history of smoking.It is recommended that healthcare professionals should pay more attention to these high-risk groups and implement eardy interventions to reduce the incidence of sarcopenia in lung cancer patients.