CT与生物电阻抗法测定胃癌患者骨骼肌质量的比较研究  

A comparative study of skeletal muscle mass detected by computed tomography and bioelectrical impedance analysis in gastric cancer patients

作　　者：陈思敏[1] 毛杰[2] 杜潇利[1] 张树泽 Chen Simin;Mao Jie;Du Xiaoli;Zhang Shuze(Department of Clinical Nutrition,the Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of General Surgery,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院临床营养科,730030 [2]兰州大学第二医院普通外科,730030

出　　处：《中华普通外科学文献(电子版)》2025年第1期28-33,共6页Chinese Archives of General Surgery(Electronic Edition)

基　　金：甘肃省卫生健康行业科研资助项目(GSWSKY2022-12)。

摘　　要：目的探讨计算机断层扫描(CT)和生物电阻抗分析(BIA)测定胃癌手术患者骨骼肌质量的相关性与一致性。方法连续纳入兰州大学第二医院普通外科2022年12月至2023年12月诊断为胃癌并行根治手术治疗的170例患者,分别使用CT和BIA对其进行肌肉质量测定,两种检查时间间隔不超过1个月,根据第三腰椎水平骨骼肌指数(L3-SMI)将其分成肌量减少组和肌量正常组,比较两组一般资料的差异,对性别和体质指数(BMI)进行分层,根据BIA检测的四肢骨骼肌质量指数(ASMI)定义的肌量减少,分析CT和BIA两种检测方法的诊断相关性和一致性。结果170例患者的年龄为(58.72±12.60)岁,其中男性114例(67.06%),女性56例(32.94%);CT诊断的肌量减少为70例(41.18%),肌量减少组和肌量正常组的L3-SMI、年龄、BMI、营养风险筛查2002评分、美国麻醉医师学会(ASA)评分、HU差异均有统计学意义(P<0.001)。BIA诊断的肌量减少80例(47.06%),两种工具测量下的总人群肌量减少发生率差异无统计学意义(χ^(2)=1.913,P=0.275)。通过建立L3-SMI与ASMI、性别、BMI和年龄的相关模型,显示ASMI与L3-SMI有良好的线性相关性(R^(2)=0.724,P<0.001)。分层分析显示,BMI在(18.5~24.0)kg/m^(2)范围内,两种测量结果的相关性更强(R^(2)=0.715,P<0.05)。在男性受试者中,两类测量指标相关性优于女性受试者(R^(2)=0.613,P<0.05)。ASMI与L3-SMI测量指标具有中度一致性(k=0.643,P<0.001)。结论基于CT和BIA两种方法诊断胃癌患者肌量减少的相关性较好,尤其是BMI在(18.5~24.0)kg/m^(2)及男性受试者中,两种诊断结果具有中度一致性,可能与测量L3-SMI值及ASMI的影响因素不同有关。Objective To investigate the correlation and consistency of computed tomography(CT)and bioelectrical impedance analysis(BIA)in the determination of skeletal muscle mass in presurgery patients with gastric cancer.Methods 170 patients diagnosed as gastric cancer and treated with radical surgery from December 2022 to December 2023 in the Department of General Surgery of the Second Hospital of Lanzhou University were continuously enrolled,and their muscle mass was measured by CT and BIA respectively,the interval between the two checks should not exceed 1 month.According to the skeletal muscle mass index at the level of the third lumbar vertebra(L3-SMI),they were divided into muscle mass reduction group and normal group,and the differences in general data and appendicular skeletal muscle mass index(ASMI)between the two groups were compared and stratified by gender and body mass index(BMI),for analysis of diagnosis relevance and consistency of the two methods.Results Among the 170 patients,there were 114 males(67.06%)and 56 females(32.94%)with an average age of(58.72±12.60)years.There were 70 cases(41.18%)of reduced muscle mass diagnosed by CT,and significant differences existed in L3-SMI,age,BMI and NRS2002 score,ASA,HU between the muscle mass reduction group and the normal group(P<0.001).80 patients(47.06%)were diagnosed with decreased muscle mass by BIA.There was no significant difference in the incidence of muscle mass reduction rate in the total population measured by the two instruments(χ^(2)=1.913,P=0.275).The correlation model between L3-SMI and ASMI,gender,BMI and age showed high liner correlation(R^(2)=0.724,P<0.001).Stratified analysis showed a stronger correlation between the two measurements in the BMI range of(18.5-24.0)kg/m^(2)(R^(2)=0.715,P<0.05).In male patients,the correlation between the two measures was stronger than that in female patients(R^(2)=0.613,P<0.05).There was moderate consistency between the two measures(k=0.643,P<0.001).Conclusion There is good correlation between CT and BIA in the dia

关 键 词：体层摄影术 X线计算机 电阻抗 胃肿瘤 骨骼肌质量 肌量减少 

分 类 号：R73[医药卫生—肿瘤]