不同营养指标对老年胃肠道肿瘤病人术后衰弱的预测价值

doi:10.3969/j.issn.1003-9198.2024.02.012

摘要/Abstract

摘要： 目的分析与老年胃肠道肿瘤病人术后衰弱有关的营养指标,并探讨其预测价值。方法纳入 2021 年 12 月至 2022 年7月就诊于安徽省某三级甲等医院外科病房的 315 例老年胃肠道肿瘤病人为研究对象。根据中文版 Tilburg 衰弱量表将病人分为术后衰弱组180 例和术后非衰弱组135例。收集2组病人的人口学资料、疾病资料和营养相关资料,并采用单因素和多因素Logistic回归分析老年胃肠道肿瘤病人术后衰弱的影响因素。绘制不同营养指标预测老年胃肠道肿瘤病人术后衰弱的ROC曲线,并计算 AUC。结果 2组病人年龄、BMI、术前衰弱、肿瘤位置、手术方式、病理分期、老年营养风险指数(GNRI)、预后营养指数(PNI)、Hb、血清白蛋白(ALB)、营养风险筛查2002(NRS2002)评分比较,差异均有统计学意义(P<0.01)。多因素Logistic回归分析显示,肿瘤位置、GNRI、Hb、NRS2002评分是老年胃肠道肿瘤病人术后衰弱的独立影响因素。ROC曲线显示,GNRI、Hb、NRS2002评分预测老年胃肠道肿瘤病人术后衰弱的 AUC 分别为0.827(95%CI:0.781～0.867)、0.767(95%CI:0.717～0.813)、0.699(95%CI:0.645～0.749)。GNRI的AUC大于Hb(Z=2.112,P=0.035) 和NRS2002评分(Z=3.665,P<0.001)。结论应用 GNRI、Hb、NRS2002 评估老年胃肠道肿瘤病人术前营养状况,能有效预测术后衰弱的发生,其中 GNRI 的预测能力最强。

关键词: 胃肠道肿瘤, 老年人, 术后衰弱, 营养指标, 影响因素

Abstract: Objective To analyze the different nutritional indexes affecting postoperative frailty in the elderly patients with gastrointestinal tumor, and to explore their predictive value for frailty. Methods A total of 315 elderly patients with gastrointestinal tumors were enrolled in this study from the surgical ward of the First Affiliated Hospital of Anhui Medical University from December 2021 to July 2022. According to the Chinese version of Tilburg scale, the patients were divided into frailty group(n=180) and non-frailty group(n=135). The demographic data, disease data and nutrition-related data of the two groups were collected. Multivariate Logistic regression analysis was used to analyze the influencing factors of postoperative frailty in the elderly patients with gastrointestinal tumors. Receiver operating characteristic(ROC) curve of different nutritional indexes to predict postoperative frailty was drawn, and the area under ROC curve(AUC) was calculated to compare the predictive value of the nutritional indexes. Results There were significant differences in age, body mass index(BMI), preoperative frailty, tumor location, operation mode, pathological stage, geriatric nutritional risk index(GNRI), prognostic nutritional index(PNI), hemoglobin(Hb), serum albumin(ALB) and nutritional risk screening 2002(NRS2002) score between the two groups(P<0.01). Logistic regression analysis showed that tumor location, GNRI, Hb and NRS2002 score were the independent influencing factors of postoperative frailty in the elderly patients with gastrointestinal tumors(P<0.05). The AUC of GNRI, Hb and NRS2002 in predicting postoperative frailty in the elderly patients with gastrointestinal tumors was 0.827(95%CI: 0.781-0.867), 0.767(95%CI: 0.717-0.813) and 0.699(95%CI: 0.645-0.749), respectively. The AUC of GNRI was greater than that of Hb(Z=2.112, P=0.035) and NRS2002(Z=3.665, P<0.001). Conclusions The assessment of preoperative nutritional status of elderly patients with gastrointestinal tumors by GNRI, Hb and NRS2002 can be used to predict postoperative frailty. GNRI may have the strongest predictive ability.

Key words: gastrointestinal tumor, aged, postoperative frailty, nutritional index, influencing factors

中图分类号:

李佳佳, 王梅, 武长美, 耿兰. 不同营养指标对老年胃肠道肿瘤病人术后衰弱的预测价值[J]. 实用老年医学, 2024, 38(2): 157-161.

LI Jiajia, WANG Mei, WU Changmei, GENG Lan. Predictive value of different nutritional indexes on postoperative frailty in elderly patients with gastrointestinal tumors[J]. Practical Geriatrics, 2024, 38(2): 157-161.

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