BMI联合血液学指标的营养状态评估在晚期消化道肿瘤患者化疗耐受性中的价值分析

叶忠伟; 吴雪莲; 何易

doi:10.16766/j.cnki.issn.1674-4152.003676

BMI联合血液学指标的营养状态评估在晚期消化道肿瘤患者化疗耐受性中的价值分析

doi: 10.16766/j.cnki.issn.1674-4152.003676

1.
丽水市中心医院肿瘤中心，浙江丽水 323000
2.
丽水市中心医院营养科

基金项目:

浙江省医药卫生科技计划项目 2023KY1355

详细信息

通讯作者:
何易，E-mail：yiyixuan11@qq.com

中图分类号: R735 R730.53
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出版历程
- 收稿日期: 2023-12-08

Significance of nutritional status evaluation of BMI combined with hematological indexes in chemotherapy tolerance of patients with advanced digestive tract tumor after operation

YE Zhongwei¹,
WU Xuelian¹,
HE Yi^{2
, ,}

1.
Department of Cancer Center, Lishui Central Hospital, Lishui, Zhejiang 323000, China

摘要

摘要: 目的晚期消化道肿瘤患者营养状态影响患者化疗的耐受性。因此，准确评估晚期消化道肿瘤患者营养状况，有利于早期识别晚期消化道肿瘤化疗不耐受的高危人群。为此本研究纳入BMI及血液学指标用于营养状态的评估中，并分析其在识别晚期消化道肿瘤患者化疗耐受性中的价值。方法纳入2021年8月—2023年1月在丽水市中心医院接受化疗的255例晚期消化道肿瘤患者，根据患者化疗耐受性将患者分为耐受组和不耐受组，使用logistic回归分析研究晚期消化道肿瘤患者化疗耐受性的影响因素，绘制ROC曲线及列线图分析BMI联合血液学营养指标的营养评估在化疗耐受性预测中的价值。结果 255例晚期消化道肿瘤患者中共58例发生化疗不耐受，纳入不耐受组，197例患者化疗耐受，纳入耐受组。Logistic回归分析显示，年龄(OR=1.098)、BMI(OR=0.550)、ALB(OR=0.593)、前白蛋白(PAB，OR=0.885)、转铁蛋白(TRF，OR=0.779)是晚期消化道肿瘤术后患者化疗耐受性的影响因素(P＜0.05)；调整年龄后，BMI、ALB、PAB、TRF仍是晚期消化道肿瘤患者化疗耐受性的影响因素(P＜0.05)；联合BMI、ALB、PAB、TRF指标预测晚期消化道肿瘤患者化疗耐受性的C-index为0.952。结论 BMI联合血液学营养指标ALB、PAB、TRF可用于预测晚期消化道肿瘤术后患者的化疗耐受性。
- 晚期消化道肿瘤 /
- 体重指数 /
- 血液学指标 /
- 营养状态 /
- 化疗耐受性
Abstract: Objective The nutritional status of patients with advanced digestive tract tumours has been demonstrated to affect their tolerance to chemotherapy. Consequently, an accurate evaluation of the nutritional status of patients with advanced digestive tract tumours is conducive to the early identification of high-risk groups with chemotherapy intolerance of advanced digestive tract tumours. Accordingly, the evaluation of nutritional status included the measurement of BMI and hematological indices, with a view to analyzing their value in identifying chemotherapy tolerance in patients with advanced digestive tract tumours was analyzed. Methods A total of 255 patients with advanced digestive tract tumours who received chemotherapy at Lishui Central Hospital from August 2021 to January 2023 were divided into a tolerance group and an intolerance group according to their chemotherapy tolerance. Logistic regression was employed to analyze the factors influencing the chemotherapy tolerance of patients with advanced digestive tract tumours, and the receiver operating characteristic (ROC) was constructed to analyze the value of nutritional evaluation of BMI combined with hematological nutritional indicators in predicting chemotherapy tolerance. Results A total of 255 patients with advanced digestive tract tumours were included in the study. Of these, 58 patients were intolerant to chemotherapy, while 197 patients were also intolerant to chemotherapy. The results of the logistic regression analysis indicated that age (OR=1.098), BMI (OR=0.550), ALB (OR=0.593), PAB (OR=0.885) and TRF (OR=0.779) were the influencing factors of postoperative chemotherapy tolerance in patients with advanced digestive tract tumours (P < 0.05). Following age adjustment, BMI, ALB, PAB and TRF remain significant influencing factors of chemotherapy tolerance in patients with advanced digestive tract tumours (P < 0.05). The combined use of BMI, ALB, PAB and TRF yielded a C-index of 0.952 for predicting chemotherapy tolerance in patients with advanced digestive tract tumours. Conclusion The combination of BMI with hematological nutritional indexes ALB, PAB and TRF can be employed to predict the chemotherapy tolerance of patients with advanced digestive tract tumours following surgical intervention.
- Advanced digestive tract tumor /
- Body mass index /
- Hematology index /
- Nutritional status /
- Chemotherapy tolerance
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图 1 BMI、ALB、PAB、TRF及联合预测晚期消化道肿瘤患者化疗耐受性的ROC曲线

Figure 1. ROC curve analysis of BMI, ALB, PAB, TRF, and their combination for predicting chemotherapy tolerance in patients with advanced gastrointestinal tumors

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图 2 BMI、血液学营养指标及联合预测晚期消化道肿瘤患者化疗耐受性的列线图

Figure 2. Nomogram analysis of BMI, hematologic nutritional indices, and their combination for predicting chemotherapy tolerance in patients with advanced gastrointestinal tumors

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表 1 2组晚期消化道肿瘤患者一般资料比较

Table 1. Comparison of general data between two groups of patients with advanced digestive tract tumors

项目	耐受组(n=197)	不耐受组(n=58)	统计量	P值
年龄(x±s，岁)	62.32±10.79	67.78±13.11	2.896^a	0.005
性别[例(%)]
男性	105(53.30)	36(62.07)	1.394^b	0.238
女性	92(46.70)	22(37.93)
婚姻状况[例(%)]
已婚	153(77.66)	50(86.21)	2.163^b	0.339
未婚	31(15.74)	5(8.62)
其他	13(6.60)	3(5.17)
吸烟[例(%)]	134(68.02)	45(77.59)
饮酒[例(%)]	46(23.35)	17(29.31)	0.856^b	0.355
受教育程度[例(%)]
初中及以下	118(59.90)	31(53.45)	0.770^b	0.680
高中	56(28.43)	19(32.76)
大学及以上	23(11.68)	8(13.79)
高血压[例(%)]	43(21.83)	10(17.24)	0.572^b	0.449
糖尿病[例(%)]	36(18.27)	9(15.52)	0.234^b	0.628
冠心病[例(%)]	45(22.85)	12(20.69)	0.120^b	0.729
家族史[例(%)]	19(9.64)	8(13.79)	0.815^b	0.367
病变部位[例(%)]
上消化道	77(39.09)	20(34.48)	0.403^b	0.526
下消化道	120(60.91)	38(65.52)
病理分期[例(%)]
cT3	85(43.15)	31(53.45)	3.022^b	0.221
cT4a	75(38.07)	15(25.86)
cT4b	37(18.78)	12(20.69)
手术方式[例(%)]
腹腔镜	81(41.12)	20(34.48)	0.824^b	0.364
开腹	116(58.88)	38(65.52)
BMI(x±s)	22.43±1.76	19.54±1.63	11.651^a	＜0.001
ALB(x±s，g/L)	38.47±2.36	34.36±3.41	8.593^a	＜0.001
PAB(x±s，g/L)	326.21±12.65	296.53±13.64	14.803^a	＜0.001
TRF(x±s，g/L)	2.89±0.93	2.30±0.71	4.611^a	＜0.001
HGB(x±s, g/L)	122.87±12.09	111.07±9.15	7.982^a	＜0.001
NRS 2002[M(P₂₅, P₇₅), 分]	2.80(2.00, 4.20)	3.00(2.50，5.00)	2.402^c	0.018
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 晚期消化道肿瘤患者化疗耐受性影响因素的logistic回归分析

Table 2. Logistic regression analysis of factors influencing chemotherapy tolerance in patients with advanced digestive tract tumors

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.093	0.042	5.003	0.025	1.098	1.012~1.191
BMI	-0.598	0.265	5.083	0.024	0.550	0.327~0.925
ALB	-0.523	0.186	7.933	0.005	0.593	0.412~0.853
PAB	-0.122	0.031	15.950	＜0.001	0.885	0.834~0.940
TRF	-0.250	0.074	11.282	0.001	0.779	0.673~0.901
HGB	-1.278	0.692	3.409	0.065	0.279	0.072~0.982
NRS 2002评分	0.263	0.692	0.145	0.704	1.301	1.135~5.055

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表 3 调整混杂因素后晚期消化道肿瘤患者化疗耐受性影响因素的logistic回归分析

Table 3. Logistic regression analysis of factors influencing chemotherapy tolerance in patients with advanced digestive tract tumors after adjusting confounders

变量	B	SE	Waldχ²	P值	OR值	95% CI
BMI	-0.669	0.179	14.018	＜0.001	0.512	0.361~0.727
ALB	-0.495	0.126	15.530	＜0.001	0.610	0.477~0.780
PAB	-0.109	0.023	21.711	＜0.001	0.897	0.857~0.939
TRF	-1.139	0.470	5.874	0.015	0.320	0.127~0.804
注：调整年龄混杂因素。

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表 4 BMI、血液学营养指标及联合预测晚期消化道肿瘤患者化疗耐受性的价值分析

Table 4. Value analysis of BMI, hematologic nutritional indices, and their combined predictive ability for chemotherapy tolerance in patients with advanced digestive tract tumors

变量	灵敏度(%)	特异度(%)	AUC	95% CI
BMI	89.66	62.94	0.844	0.794~0.887
ALB	77.59	85.28	0.874	0.827~0.912
PAB	82.76	90.86	0.906	0.879~0.949
TRF	70.69	72.59	0.768	0.711~0.818
联合预测	86.55	95.91	0.952	0.857~0.984

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