结直肠癌病人肌肉减少症风险预测模型的构建及验证  

Construction and validation of a risk prediction model for sarcopenia in colorectal cancer patients

作　　者：张雪静 顾启红 程梦瑶 邵炎 刘诗语 杨健[1] 童莉莉 ZHANG Xue-jing;GU Qi-hong;CHENG Meng-yao;SHAO Yan;LIU Shi-yu;YANG Jian;TONG Li-li(Department of General Surgery,First Affiliated Hospital of Suzhou University,Suzhou 215006,Jiangsu China)

机构地区：[1]苏州大学附属第一医院普通外科,江苏苏州215006

出　　处：《肠外与肠内营养》2024年第6期346-352,共7页Parenteral & Enteral Nutrition

基　　金：国家自然科学基金(81902385);苏州市2023年度第十一批科技发展计划(sky2023156)。

摘　　要：目的:探讨肌少症在结直肠癌术后病人中的发生现状及其影响因素,构建肌少症预测模型并完成验证。方法:前瞻性选取苏州大学附属第一医院于2022年01月至2023年12月时间段内收治的450例结直肠癌病人作为本研究的研究对象,统计并分析发生肌少症现状及影响因素,利用Logistic回归分析构建肌少症风险预测模型,使用列线图展示模型并完成验证。结果:共有315例结直肠癌纳入病人建模组中,年龄37~89岁,平均(67.09±9.06)岁,女性144例,占比45.71%,男性171例,占比54.29%。纳入的315例结直肠癌病人中,有72人发生肌少症,发生率为22.86%。单因素分析结果显示,肿瘤分期、既往吸烟史、饮酒史、合并糖尿病、营养状况、体育锻炼成为结直肠癌病人肌少症的独立危险因素(P<0.05)。多因素分析结果:肿瘤分期、吸烟史、饮酒史、合并糖尿病成为结直肠癌病人肌肉减少症的危险因素(P<0.05),营养状况及体育锻炼成为结直肠癌病人肌肉减少症的保护性因素(P<0.05)。验证组AUC为0.880,95%CI(0.823,0.933),约登指数0.613,灵敏度为87.4%,特异度为73.9%。Hosmer-Lemeshow检验结果:χ^(2)=4.664,P=0.795。结论:本研究构建了结直肠癌病人肌少症发生的风险预测模型,肿瘤分期、吸烟史、饮酒史、合并糖尿病、营养状况、体育锻炼成为结直肠癌病人肌少症影响因素。结直肠癌病人肌少症预测模型有一定的预测能力,可为临床识别结直肠癌肌少症病人提供依据。Objective:To investigate the incidence of sarcopenia in postoperative colorectal cancer patients and its influencing factors,to construct a prediction model for sarcopenia and to complete the validation.Methods:A total of 450 colorectal cancer patients admitted between January 2022 and December 2023 were prospectively enrolled in this study.The incidence and influencing factors of sarcopenia were analyzed statistically.A risk prediction model for sarcopenia was constructed using logistic regression,displayed and validated with a nomogram.Results:In this study,a total of 315 colorectal cancer patients were included in the modeling group,ranging in age from 37 to 89 years old,with an average age of(67.09±9.06)years old.Among these,144 were females(45.71%)and 171 were males(54.29%).Sarcopenia was present in 72 patients(22.86%).Univariate analysis identified tumor stage,smoking history,drinking history,combined diabetes,nutritional status and physical exercise as independent risk factors for sarcopenia in colorectal cancer patients(P<0.05).Logistic regression analysis confirmed that Tumor stage,smoking history,drinking history and diabetes mellitus were risk factors for sarcopenia in colorectal cancer patients(P<0.05),while nutritional status and physical exercise were protective factors for sarcopenia in colorectal cancer patients(P<0.05).In the verification group,the area under the curve(AUC)was 0.880(95%CI:0.823,0.933),Yoden index was 0.613,and sensitivity and specificity were 87.4%and 73.9%,respectively.Hosmer-Lemeshow goodness of fit test indicatedχ^(2)=4.664,P=0.795.Conclusion:This study established a risk prediction model for sarcopenia in colorectal cancer patients.Tumor stage,smoking history,drinking history,diabetes mellitus,nutritional status and physical exercise were influencing factors for sarcopenia in colorectal cancer patients.The predictive model can assist clinical nurses in identifying high-risk patients and implementing timely interventions.

关 键 词：结直肠癌 肌少症 列线图 风险预测模型 

分 类 号：R735.3[医药卫生—肿瘤]