相位角在结直肠癌手术患者营养评估及预后预测中的应用

Application of phase angle in nutritional evaluation and prognosis prediction of colorectal cancer patients undergoing surgery

关键词:  结直肠癌  相位角  营养不良  预后

Key words:  colorectal cancer  phase angle  malnutrition  prognosis

摘要:

目的探讨生物电阻抗相位角（phase angle, PA）在结直肠癌（colorectal cancer, CRC）手术患者营养评估及预后预测的应用。方法选取同济大学附属第十人民医院胃肠外科241例CRC手术患者，入院时采用营养风险筛查2002（Nutrition Risk Screening 2002, NRS 2002）、患者主观整体评估量表(Patient Generated-Subjective Global Assessment, PG-SGA)、全球领导人发起的营养不良倡议（Global Leadership Initiative on Malnutrition, GLIM）行营养筛查与评估，完善人体成分测定，同时收集相关营养指标及预后指标，评价PA在营养评估及预后预测的应用。结果与正常PA组相比，低PA组体质量指数（body mass index, BMI）、骨骼肌质量指数（skeletal muscle mass index, SMI）、前白蛋白（serum prealbumin, PALB）、总蛋白（total protein, TP）、白蛋白（albumin, ALB）、血红蛋白（hemoglobin, HGB）、预后营养指数（prognostic nutritional index, PNI）呈下降趋势（P<0.05），而年龄、纤维蛋白原（fibrinogen, FBG）、中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio, NLR）、血小板/淋巴细胞比值（platelet-to-lymphoccyte ratio, PLR）呈上升趋势（P<0.05）。营养风险及营养不良的患者PA明显下降（P<0.05）。PA与NRS 2002、GLIM存在一致性（P<0.05）。PA与年龄、FBG、NLR、PLR、NRS 2002、PG-SGA、改良格拉斯哥预后评分（modified Glasgow Prognostic Score, mGPS）、GLIM呈负相关，与BMI、SMI、PALB、TP、ALB、HGB、PNI呈正相关（P<0.05）。多元线性回归分析显示年龄、SMI、PALB、HGB、PNI、mGPS及GLIM对CRC手术患者的PA影响差异有统计学意义（P<0.05）。结论PA与CRC手术患者营养状况及预后指标密切相关，有利于辅助识别营养不良及预测预后，为及时进行营养干预及改善预后提供依据。

Abstract:

ObjectiveTo explore the application of phase angle(PA) of bioelectrical impedance analysis(BIA) in nutritional evaluation and prognosis prediction of patients with colorectal cancer undergoing surgery. MethodsA total of 241 patients with colorectal cancer(CRC) undergoing surgery were included in the department of gastrointestinal surgery of Shanghai Tenth People’s Hospital, Tongji University. At admission, nutrition screening and assessment were performed using Nutrition Risk Screening 2002(NRS 2002), Patient-Generated Subjective Global Assessment(PG-SGA), Global Leadership Initiative on Malnutrition(GLIM). Body composition of patients was measured by BIA, while the relevant nutritional indexes and prognostic indexes were collected to evaluate the application of PA in nutritional evaluation and prognosis prediction. ResultsBody mass index(BMI), skeletal muscle mass index(SMI), serum prealbumin(PALB), total protein(TP), albumin(ALB), hemoglobin(HGB) and prognostic nutritional index(PNI) in the low PA group were lower than those in the normal PA group(P<0.05). Age, fibrinogen(FBG), neutrophil to lymphocyte ratio(NLR), platelet to lymphoccyte ratio(PLR) in the low PA group were increased(P<0.05). PA decreased significantly in patients with nutritional risk and malnutrition(P< 0.05). PA was consistent with NRS 2002 and GLIM(P<0.05). The PA values were negatively correlated with age, FBG, NLR, PLR, NRS 2002, PG-SGA, modified Glasgow prognostic score(mGPS) and GLIM(P<0.05), and were positively correlated with BMI, SMI, PALB, TP, ALB, HGB and PNI(P<0.05). Multiple linear regression analysis showed that age, SMI, PALB, HGB, PNI, mGPS and GLIM had significant effects on PA in patients with colorectal cancer undergoing surgery(P<0.05). ConclusionThe phase angle of bioelectrical impedance analysis is closely related to the nutritional status and prognosis of CRC patients, which may assist to identify the malnutrition and predict the prognosis of CRC patients undergoing surgery.