腹部脂肪及骨骼肌CT测量在胃癌患者营养评估中的价值

The value of CT measurement of abdominal fat and skeletal muscle in nutritional assessment of patients with gastric cancer

目的探讨腹部脂肪及骨骼肌CT测量指标在胃癌患者营养评估中的价值。方法连续收集胃癌患者56例,记录临床营养评估指标、营养风险筛查2002(nutrition risk screening,NRS2002)评分及患者主观整体评估(patient-generated subjective global assessment,PG-SGA)评分。在患者术前腹部CT图像上测量脐平面及全腹内脏脂肪容积(visceral fat volume,VFV)、皮下脂肪容积(subcutaneous fat volume,SFV),计算内脏与皮下脂肪容积比(visceral-to-subcutaneous fat volume ratio,VSR)、内脏脂肪百分比(visceral fat percentage,VF%);测量腰3横突平面及腰3椎体水平骨骼肌容积(skeletal muscle volume,SMV),计算骨骼肌指数(skeletal muscle index,SMI)。分析CT测量指标与临床营养评分及定量指标的相关性。结果单次腹部脂肪及骨骼肌CT测量结果与NRS2002及PG-SGA评分无相关性。二维与三维测量的VFV、SFV呈正相关(r=0.906、0.921,P<0.001)。VFV、SFV与患者BMI呈正相关(P<0.001)。SMI、二维及三维SMV与右上臂肌围及握力呈正相关(P<0.001)。结论腹部脂肪及骨骼肌CT测量指标与临床营养评估定量指标具有相关性,对胃癌患者营养评估具有一定价值。

Objective To investigate the value of CT measurement of abdominal fat and skeletal muscle in the nutritional assessment of patients with gastric cancer.Methods Fifty-six patients with gastric cancer were consecutively collected,and clinical nutritional assessment indexes,nutritional risk screening 2002(NRS2002)scores and patient-generated subjective global assessment(PG-SGA)scores were recorded.Visceral fat volume(VFV)and subcutaneous fat volume(SFV)of the umbilical plane and whole abdomen were measured,respectively.Then visceral-to-subcutaneous fat volume ratio(VSR)and visceral fat percentage(VF%)were calculated.Skeletal muscle volume(SMV)of the third lumbar transverse plane and the third lumbar vertebra plane were measured,and skeletal muscle index(SMI)was calculated.The correlations of CT measurements with clinical nutrition scores and clinical quantitative indexes were analyzed.Results The single CT measurement results of abdominal fat and skeletal muscle had no correlation with NRS2002 and PG-SGA scores,while 2D and 3D measurements of VFV and SFV showed positive correlations(r=0.906,0.921,P<0.001).VFV and SFV were positively correlated with BMI(P<0.001).SMI,2D and 3D SMV were positively correlated with right upper arm muscle circumference and grip strength(P<0.001).Conclusion CT measurement indexes of abdominal fat and skeletal muscle are correlated with quantitative indexes of clinical nutritional assessment,which have certain value for nutritional assessment of gastric cancer patients.