肺癌住院患者癌症相关肌肉异常现患率调查及其相关影响因素分析  

Prevalence and risk factors of cancer related muscle disorder in lung cancer patients

作　　者：张玉[1] 王师佳 刘潇衍[3] 杜扬 于康[1] Zhang Yu;Wang Shijia;Liu Xiaoyan;Du Yang;Yu Kang(Department of Clinical Nutrition,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Clinical Nutrition,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Respiratory and Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院、北京协和医院临床营养科,北京100730 [2]苏州大学附属第二医院临床营养科,苏州215004 [3]中国医学科学院北京协和医学院、北京协和医院呼吸与危重症医学科,北京100730

出　　处：《中华健康管理学杂志》2024年第5期370-377,共8页Chinese Journal of Health Management

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-B-055)。

摘　　要：目的调查肺癌住院患者癌症相关肌肉异常(CRMD)现患率,并分析其影响因素。方法本研究为一项横断面研究。从2023年3—8月在北京协和医院呼吸内科非重复住院的共347例肺癌患者中,纳入符合纳入排除标准且无数据缺失的259例患者为研究对象进行分析。利用生物电阻抗分析对患者进行肌肉质量测定,采用食物频率法收集膳食信息,通过查阅病历获得患者的疾病信息和实验室检验结果。根据AWGS 2019标准并参考其推荐的界值将患者分为5组:(1)可能肌肉衰减症(possible sarcopenia,PS)组(71例);(2)肌肉衰减症(sarcopenia,S)组(35例);(3)严重肌肉衰减症(severe sarcopenia,SS)组(37例);(4)低肌肉质量(low muscle mass,LMM)组(24例);(5)无肌肉异常(non-muscle disorder,non-MD)组(92例)。采用方差分析、Kruskal-Wallis检验和χ^(2)检验比较各组的基线资料、能量和宏量营养素摄入和实验室检查指标差异,并采用有序logistic回归分析进行多因素分析识别肺癌患者CRMD的影响因素。结果259例患者中CRMD的现患率为64.5%,PS的现患率为27.4%,S的现患率为13.5%,SS的现患率为14.3%,LMM的现患率为5.4%。植物蛋白(OR=0.969,95%CI:0.942~0.996)摄入和规律运动(OR=0.485,95%CI:0.269~0.869)是肺癌住院患者CRMD的保护因素,而年龄(OR=1.056,95%CI:1.013~1.101)、近6个月体重下降≥5%(OR=4.546,95%CI:1.363~15.563)和合并糖尿病(OR=2.342,95%CI:1.137~4.866)则是其危险因素。结论肺癌住院患者CRMD的发生率较高,患者的年龄、膳食摄入、体重变化、运动以及合并症情况与之密切相关。Objective To Investigate the prevalence of cancer related muscle disorder(CRMD)in hospitalized lung cancer patients,and to identify the possible risk factors.Methods This study was a cross-sectional study.The study enrolled 259 patients without missing data who met the inclusion and exclusion criteria from 347 lung cancer patients who were non-repeated hospitalized in the Department of Respiratory and Critical Care Medicine of Peking Union Medical College Hospital from March 2023 to August 2023.Bioimpedance analysis was used to measure muscle mass in patients,and dietary information was collected using the food frequency questionnaire.Disease information and laboratory test results were obtained by consulting Hospital Information System.According to AWGS 2019,patients were divided into five groups:possible sarcopenia(PS),sarcopenia(S),severe sarcopenia(SS),low muscle mass(LMM),and non-muscle disorder(non-MD).The analysis of variance,Kruskal-Wallis test,and χ^(2) test were used to compare differences in baseline data,energy and macronutrient intake,and laboratory test indicators among different groups,and ordered logistic regression analysis was applied for multivariate analysis to identify the influencing factors of CRMD in lung cancer patients.Results This study included 259 hospitalized lung cancer patients who met the inclusion and exclusion criteria.The prevalence of CRMD among 259 patients was 64.5%,PS was 27.4%,S was 13.5%,SS was 14.3%,and LMM was 5.4%.plant protein intake(OR=0.969,95%CI:0.942-0.996)and regular exercise(OR=0.485,95%CI:0.269-0.869)were found to be protective factors for CRMD in hospitalized lung cancer patients,while age(OR=1.056,95%CI:1.013-1.101),weight loss of more than 5%in the last six months(OR=4.546,95%CI:1.363-15.563),and diabetes(OR=2.342,95%CI:1.137-4.866)were identified as risk factors.Conclusion The prevalence of CRMD in hospitalized lung cancer patients is relatively high,and is closely related to age,weight changes,exercise,comorbidities,and dietary intake.

关 键 词：肺肿瘤 癌症相关肌肉异常 植物蛋白质类 体重减轻 疾病影响状态调查 

分 类 号：R734.2[医药卫生—肿瘤]