第三腰椎骨骼肌指数与血浆白蛋白/球蛋白比值预测晚期非小细胞肺癌营养不良的潜能价值  

The ratio of L_(3) paravertebral muscle index to white ball predicts the potential value of dystrophy in advanced non-small cell lung cancer

作　　者：李虹[1] 乔可宏[1] 尚晓凤[1] Li Hong;Qiao Kehong;Shang Xiaofeng(Department of Respiratory and Critical Care Medicine,Taiyuan Central Hospital,Taiyuan 030000,Shanxi,China)

机构地区：[1]太原市中心医院呼吸与危重症医学科,山西太原030000

出　　处：《肿瘤代谢与营养电子杂志》2025年第1期123-129,共7页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：太原市2022年医学科技项目(202244)。

摘　　要：目的探索第三腰椎骨骼肌指数(L3-SMI)、血浆白蛋白/球蛋白比值与晚期非小细胞肺癌(NSCLC)营养不良关系,以明确L3-SMI、血浆白蛋白/球蛋白比值预测晚期NSCLC患者重度营养不良状态效能。方法回顾性分析在太原市中心医院2021年2月至2024年2月期间收住的217例晚期NSCLC患者资料,根据患者主观整体评估(PG-SGA)评分分为两组,即重度营养不良组(n=43,C级),非重度营养不良(n=174,A+B级),比较两组患者人口统计学和临床特征,采用单因素、多因素Logistic回归分析影响患者营养不良独立因素,利用列线图分析模型预测效能,同时,经受试者操作特征曲线(ROC曲线)分析L3-SMI、血浆白蛋白/球蛋白比值预测效能。结果与非重度营养不良患者相比,重度营养不良患者临床分期更晚、年龄更高,血浆白蛋白/球蛋白比值、L3-SMI更低,差异具有统计学意义(P<0.05)。进一步经多因素Logistic回归分析,临床分期Ⅳ期、年龄越大、血浆白蛋白/球蛋白比值越低、L3-SMI越低是晚期NSCLC患者重度营养不良的独立影响因素。将独立影响因素构建列线图,C-index为0.99,模型阈值概率范围为1%~99%,其净收益率>0,真实值和预测值吻合度绝对误差为0.011,预测模型曲线下面积(AUC)为0.942,95%CI=0.879~0.999。同时,经ROC曲线分析,血浆白蛋白/球蛋白比值、L3-SMI预测晚期NSCLC患者重度营养不良的AUC分别为0.919、0.908。结论L3-SMI、血浆白蛋白/球蛋白比值是晚期NSCLC患者重度营养不良主要评估指标,具有较高预测效能,同时高龄、较晚的临床分期也是患者重度营养不良的独立影响因素,通过重点监测L3-SMI、血浆白蛋白/球蛋白比值水平变化,能够及时发现机体异常,从而加以干预,改善预后。Objective Explore the relationship between skeletal muscle index at the third lumbar vertebra(L_(3)-SMI)and white ball ratio and advanced non-small cell lung cancer(NSCLC)malnutrition to clarify the efficacy of L_(3)-SMI and white ball ratio to predict severe malnutrition status in patients with advanced NSCLC.Method Data of 217advanced NSCLC patients collected in Taiyuan Central Hospital from February 2021 to February 2024 were divided into two groups according to PG-SGA score,namely severe malnutrition group(n=43,grade C)and non-severe malnutrition(n=174,grade A+B),comparing the demographics and clinical characteristics of the two groups,univariate and binary Logisticregression analysis to affect independent factors of patients'malnutrition,using nomogram analysis model,L_(3)-SMI and A/G ratio by ROC curve analysis.Result Compared with non-severe malnutrition,later clinical stage,higher age and lower A/G ratio,L_(3)-SMI in severe malnutrition(P<0.05).Further binary Logistic regression analysis indicated that clinical stage Ⅳ,older age,lower A/G ratio,and lower L_(3)-SMI were independent factors affecting severe malnutrition in advanced NSCLC patients.The nomogram was constructed from independent factors with C-index of 0.99,model threshold probability range from 1% to 99%,with net yield>0,absolute agreement between true and predicted values of 0.011 and prediction model AUC of 0.942,95%CI 0.879-0.999.Meanwhile,by the ROC curve analysis,the A/G ratio and L_(3)-SMI predicted the AUC of severe malnutrition in advanced NSCLC were 0.919 and 0.908,respectively.Conclusion L_(3)-SMIand A/G ratio is the main evaluation index of severe malnutrition in patients with advanced NSCLC,which has high prediction efficacy.At the same time,clinical stage of advanced and late are also independent factors that induce severe malnutrition in patients.By focusing on monitoring the change of L_(3)-SMI and A/G ratio levels,it can detect body abnormalities in time to intervene and improve the prognosis.

关 键 词：椎旁肌肉指数 血浆白蛋白/球蛋白比值 晚期非小细胞肺癌 营养不良 临床分期 预测模型 影响因素 预后 

分 类 号：R73[医药卫生—肿瘤]