肺癌患者并发肌肉减少症的危险因素分析及其与临床预后的相关性探讨  

Analysis of Risk Factors of Lung Cancer Patients Combined with Sarcopenia and Their Correlation with Clinical Prognosis

作　　者：李周华 季爽[1,2] 胡先纬 尤青海[1] 费广鹤[1,2] LI Zhouhua;JI Shuang;HU Xianwei;YOU Qinghai;FEI Guanghe(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Key Laboratory of Respiratory Diseases Research and Medical Transformation of Anhui Province,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院呼吸与危重症医学科,安徽省合肥市230022 [2]呼吸道疾病研究与医学转化安徽省重点实验室,安徽省合肥市230022

出　　处：《中国全科医学》2021年第26期3310-3315,3322,共7页Chinese General Practice

基　　金：国家自然科学基金面上项目(81870036);自主创新政策“借转补”项目(J2018Y04)。

摘　　要：背景肺癌患者常并发肌肉减少症,但对于肌肉减少症与生活质量及情绪状况之间的关系尚未明确。目的调查肌肉减少症在肺癌患者中的发生率,并分析其危险因素及其对患者情绪状况、生命质量等临床预后的影响,为肺癌患者临床预后的整体改善提供依据。方法招募2019年12月-2020年7月在安徽医科大学第一附属医院呼吸与危重症医学科就诊的肺癌患者87例为研究对象,收集患者年龄、性别、受教育程度、吸烟情况、肿瘤病理类型、体力状况(PS)评分、患病时长、治疗情况、合并症情况、体质指数(BMI),测量患者血红蛋白、乳酸脱氢酶、前白蛋白、白蛋白水平。采用人体成分分析仪测量四肢肌肉量并计算骨骼肌质量指数(SMI),根据亚洲老年肌肉减少症工作组(AWGSOP)诊断标准将患者分为肌肉减少症组(46例)、无肌肉减少症组(41例),采用营养风险筛查2002量表(NRS2002)评价患者的营养不良风险,采用生命质量核心量表(QLQ-C30)评价患者的生命质量,采用医院焦虑抑郁量表(HADS)评价患者的情绪状况。采用二元Logistic回归分析探索肺癌并发肌肉减少症的影响因素,采用Pearson相关分析探讨肌肉减少症与生命质量和情绪状况的相关性。结果肺癌患者合并肌肉减少症的发生率为52.9%(46/87)。肌肉减少症组患者年龄、长期吸烟比例、Charlson合并症指数、NRS2002评分、有营养不良风险比例高于无肌肉减少症组,BMI、四肢肌肉量、SMI低于无肌肉减少症组(P<0.05)。二元Logistic回归分析结果显示,长期吸烟史〔OR=5.515,95%CI(1.234,24.646)〕、患病时长〔OR=1.132,95%CI(1.007,1.272)〕、BMI〔OR=0.676,95%CI(0.519,0.880)〕、NRS2002评分〔OR=1.773,95%CI(1.012,3.108)〕均是肺癌并发肌肉减少症的影响因素。肌肉减少症患者焦虑量表、抑郁量表、疲倦、疼痛、气促及食欲丧失得分高于无肌肉减少症组患者(P<0.05),QLQ-C30总分,躯体Background Patients with lung cancer often suffer from sarcopenia,but the relationship between sarcopenia and quality of life,emotional status is unclear.Objective To investigate the incidence of sarcopenia in lung cancer patients,analyze its risk factors and their impact on the clinical prognosis including emotional status,quality of life,etc,so as to provide evidence for the overall improvement of the clinical prognosis of lung cancer patients.Methods 87 patients with lung cancer who attended the Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Anhui Medical University from December 2019 to July 2020 were recruited,and their age,gender,education level,smoking status,tumor pathological type,PS score,length of illness,treatment status,comorbidities,body mass index(BMI)were collected,their hemoglobin,lactate dehydrogenase,prealbumin,albumin were measured.The body composition analyzer was used to measure the muscle mass of the limbs and calculate skeletal muscle mass index(SMI),and the patients were divided into sarcopenia group(46 cases)and no sarcopenia group(41 cases)according to the diagnostic criteria of the Asia Working Group on Sarcopenia in Older People(AWGSOP).The Nutritional Risk Screening 2002(NRS2002)was used to evaluate the patients'malnutrition risk,the Quality-of-Life Questionnaire-Core 30(QLQ-C30)was used to evaluate the quality of life of the patients,and the Hospital Anxiety and Depression Scale(HADS)was used to evaluate the emotional state of the patients.Binary logistic regression analysis was used to explore the influencing factors of lung cancer combined with sarcopenia,and Pearson correlation analysis was used to explore the correlation between sarcopenia and quality of life,emotional status.Results The prevalence of sarcopenia in lung cancer patients was 52.9%.Age,proportion of long-term smoking,Charlson comorbidity index,NRS2002 score,and risk of malnutrition in the sarcopenia group were higher than the non-sarcopenia group,while BMI,limb muscle mass,and

关 键 词：肺肿瘤 肌肉减少症 营养风险 生命质量 情绪状况 焦虑 抑郁 相关性分析 

分 类 号：R734.2[医药卫生—肿瘤]