肌肉减少症指标对70岁及以上食管癌患者术后肺炎的预测价值  

The predictive value of sarcopenia index for postoperative pneumonia in≥70 years old patients of esophageal cancer

作　　者：陆鹏 尤振兵[2] 张明志 徐克平[2] 蒋超 刘金涛 田文泽[2] Lu Peng;You Zhenbing;Zhang Mingzhi;Xu Keping;Jiang Chao;Liu Jintao;Tian Wenze(Department of Geriatric Medicine,The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Huaian 223300,China;Department of Thoracic Surgery,The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Huaian 223300,China;Department of Medical Oncology,The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Huaian 223300,China;Department of Medical Image,The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Huaian 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院老年科,淮安223300 [2]南京医科大学附属淮安第一医院胸外科,淮安223300 [3]南京医科大学附属淮安第一医院肿瘤内科,淮安223300 [4]南京医科大学附属淮安第一医院医学影像科,淮安223300

出　　处：《中华老年医学杂志》2024年第1期45-49,共5页Chinese Journal of Geriatrics

基　　金：淮安市自然科学研究计划(HAB202201);江苏省医学重点学科建设单位(JWDS202233);国家自然科学青年基金(82102969)。

摘　　要：目的探讨术前肌肉减少症常用指标在预测70岁及以上食管癌患者术后肺炎发生中的临床应用价值。方法回顾性分析2020年1月至2021年12月在我院行胸腹腔镜下食管癌根治术的398例≥70岁老年食管鳞癌患者的临床资料,分析临床病理相关指标以及肌肉减少症常用测量指标与术后肺炎发生的相关性。结果≥70岁食管鳞癌患者中术后发生肺炎的比例为27.9%(111/398);肺炎组患者术前测量的体质指数(BMI)及呼气峰值流量(PEF)指标均明显低于非肺炎组(t=2.799、2.674,均P<0.05);Logistic多因素分析显示,低PEF、低腰大肌指数(PMI)和低腰大肌密度(PMD)是≥70岁食管癌患者术后出现肺炎的主要危险因素(Waldχ^(2)=7.577、6.091、6.845,均P<0.05);低PEF、低PMI和低PMD的≥70岁食管癌患者术后发生肺炎的风险分别是高PEF、高PMI和高PMD患者的1.969倍(95%CI:1.215~3.185,P=0.006)、1.912倍(95%CI:1.143~3.205,P=0.014)和1.832倍(95%CI:1.164~2.882,P=0.009)。结论低PEF、低PMI及低PMD是≥70岁食管癌患者术后发生肺炎的主要危险因素;术前PEF、PMI和PMD等肌肉减少症常用的测量指标可以作为术后肺炎发生的早期筛查指标。ObjectiveTo investigate the clinical application value of commonly used preoperative indicators of sarcopenia in predicting postoperative pneumonia in patients aged 70 years and above with esophageal cancer.MethodsA retrospective analysis was conducted on the clinical data of 398 elderly patients(≥70 years old)with esophageal squamous cell carcinoma who underwent thoracic laparoscopic radical resection of esophageal cancer in our hospital from January 2020 to December 2021.The study aimed to investigate the correlation between clinical pathological indicators and commonly used measurement indicators of sarcopenia and postoperative pneumonia.Statistical analysis was performed to analyze the data.ResultsThe study found that the proportion of postoperative pneumonia in esophageal squamous cell carcinoma patients aged 70 years and above was 27.9%(111 out of 398).The pneumonia group had significantly lower preoperative BMI and peak expiratory flow(PEF)measurements compared to the non-pneumonia group,with statistically significant differences(t=2.799,2.674,both P<0.05).Logistic multivariate analysis revealed that low PEF,low psoas major muscle index(PMI),and low psoas muscle density(PMD)were the primary risk factors for postoperative pneumonia in esophageal cancer patients aged 70 years and above(Waldχ^(2)values were 7.577,6.091,6.845,all P<0.05).The risk of postoperative pneumonia in esophageal cancer patients aged 70 years and above with low PEF,low PMI,and low PMD was found to be 1.969 times higher(95%CI:1.215-3.185,P=0.006),1.912 times higher(95%CI:1.143-3.205,P=0.014),and 1.832 times higher(95%CI:1.164-2.882,P=0.009)respectively,compared to patients with high PEF,high PMI,and high PMD.ConclusionsLow PEF,low PMI,and low PMD are significant risk factors for postoperative pneumonia in esophageal cancer patients aged 70 years and older.Preoperative PEF,PMI,and PMD,which are commonly utilized measurement indicators for sarcopenia,can be utilized as early screening indicators for postoperative pneumonia.

关 键 词：食管肿瘤 肌疾病 肺炎 预测 

分 类 号：R735.1[医药卫生—肿瘤] R685[医药卫生—临床医学]