绝对握力与相对握力对老年结直肠癌病人术后并发症的预测价值

doi:10.3969/j.issn.1003-9198.2024.03.025

摘要/Abstract

摘要： 目的探究绝对握力与相对握力(握力/体质量、握力/BMI)对老年结直肠癌病人术后并发症的预测价值。方法选取2022年9月至2023年4月于江苏省人民医院择期行结直肠癌根治术的268例老年病人为研究对象,收集所有病人的一般资料、绝对握力、相对握力及术后并发症等数据。采用单因素分析及多因素Logistic回归分析探究绝对握力及相对握力与术后并发症的关联。绘制ROC曲线,进一步分析绝对握力与相对握力对病人术后并发症的预测能力。结果并发症组与非并发症组比较,年龄、服药数量、慢性病数量、绝对握力和相对握力差异均有统计学意义。Logistic回归结果显示,低绝对握力(分别按指南标准划分、按四分位数标准划分)、低握力/体质量、低握力/BMI均为病人发生并发症的独立预测因子,OR(95%CI)分别为2.825(1.436～5.557)、3.393(1.693～6.803)、2.371(1.210～4.647)、2.112(1.074～4.154)。ROC曲线分析结果显示,绝对握力与相对握力均可有效预测术后并发症的发生,其AUC约为0.63～0.65,在男性病人中,绝对握力及相对握力的预测效能均略高,AUC约为0.70。结论绝对握力与相对握力(握力/体质量、握力/BMI)均对老年结直肠癌病人术后并发症具有一定的预测价值,将握力评估纳入老年结直肠癌病人术前评估中,可为临床早期发现高危人群提供依据。

关键词: 握力, 老年人, 结直肠癌, 并发症, 预测价值

Abstract: Objective To investigate the predictive value of absolute and relative grip strength for postoperative complications in the elderly patients with colorectal cancer. Methods A total of 268 elderly patients who underwent elective radical surgery for colorectal cancer in Jiangsu Province Hospital from September 2022 to April 2023 were enrolled in this study. The clinical data including general information, absolute grip strength, relative grip strength (grip strength to weight ratio, grip strength to BMI ratio) and occurrence of complications were collected. Univariate analysis and Logistic regression were used to explore the association between absolute and relative grip strength with postoperative complications. Receiver operating characteristic (ROC) curves were plotted to analyze the ability of absolute and relative grip strength to predict the postoperative complications in the elderly patients who underwent elective radical surgery for colorectal cancer. Results There were significant differences in age, number of drug taken, number of chronic disease, absolute grip strength and relative grip strength between the comorbidity group and non-comorbidity group. The results of Logistic regression showed that low absolute grip strength (classified by guideline or by quartile), low grip strength to weight ratio and low grip strength to BMI ratio were the independent influencing factors of complications, with odd ratio (OR) and 95%CI of 2.825 (1.436-5.557), 3.393 (1.693-6.803), 2.371 (1.210-4.647), and 2.112 (1.074-4.154), respectively. The results of ROC analysis showed that both absolute and relative grip strength (grip strength/weight, grip strength/BMI) were effective in predicting the occurrence of postoperative complications with an AUC of approximately 0.63-0.65, and in male patients, the predictive efficacy of absolute and relative strength was even higher with an AUC of approximately 0.70. Conclusions Both absolute and relative grip strength (grip strength/weight, grip strength/BMI) have a predictive value for postoperative complications in the elderly patients with colorectal cancer. Grip strength assessment can be included in the preoperative evaluation for the elderly patients with colorectal cancer.

Key words: grip strength, aged, colorectal cancer, complication, predictive value

中图分类号:

姚翠, 丁玲玉, 胡洁蔓, 孙跃明. 绝对握力与相对握力对老年结直肠癌病人术后并发症的预测价值[J]. 实用老年医学, 2024, 38(3): 317-321.

YAO Cui, DING Lingyu, HU Jieman, SUN Yueming. Predictive value of absolute and relative grip strength for postoperative complications in elderly patients with colorectal cancer[J]. Practical Geriatrics, 2024, 38(3): 317-321.

参考文献

[1] SUNG H, FERLAY J, SIEGEL R L, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71:209-249.
[2] LORIA A, FLEMING F J. Restoration of quality of life and functional recovery after colorectal cancer surgery in older adults[J]. J Clin Oncol, 2023, 30:JCO2301066.
[3] 闫新雍. 术前预康复在老年腹腔镜结直肠癌手术中的应用[J]. 中国老年学杂志,2021,41(11):2298-2300.
[4] 陈怡,王继伟. 肌肉减少症与结直肠癌关系的研究进展[J]. 肠外与肠内营养,2022,29(3):184-189.
[5] 刘杰,盛逸澜,余波. 老年原发性肌少症的诊断和评估新进展[J]. 实用老年医学,2023,37(1):1-4.
[6] LEE S Y.Handgrip strength: an irreplaceable indicator of muscle function[J]. Ann Rehabil Med,2021,45(3):167-169.
[7] ESTEBAN-SIMÓN A, DÍEZ-FERNÁNDEZ D M, ARTÉS-RODRÍGUEZ E, et al. Absolute and relative handgrip strength as indicators of self-reported physical function and quality of life in breast cancer survivors: The EFICAN Study[J]. Cancers: Basel,2021,13(21):5292.
[8] JIANG X, XU X, DING L, et al. Preoperative low absolute and relative handgrip strength as predictors of postoperative short-term outcomes: a prospective study based on patients aged 60 years and older with gastric cancer[J]. Eur Geriatr Med,2023,14(2):251-262.
[9] CHEN L K, WOO J, ASSANTACHAI P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3):300-307.
[10] BOLLIGER M, KROEHNERT J A, MOLINEUS F, et al. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients[J]. Eur Surg, 2018, 50(6):256-261.
[11] ĪMRE E, KOÇAKGÖL N, ĪMRE E. Low handgrip strength is associated with diabetic foot disease in geriatric patients with type 2 diabetes[J]. Turk J Med Sci,2022,52(6):1854-1862.
[12] CELIS-MORALES C A, WELSH P, LYALL D M,et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants[J]. BMJ, 2018, 361:k1651.
[13] BARBOSA M V, DOS SANTOS M P, LEITE J A, et al. Association between functional aspects and health-related quality of life in patients with colorectal cancer: can handgrip strength be the measure of choice in clinical practice?[J]. Support Care Cancer, 2023, 31(2):144.
[14] XIE H, RUAN G, DENG L, et al. Comparison of absolute and relative handgrip strength to predict cancer prognosis: a prospective multicenter cohort study[J]. Clin Nutr, 2022,41(8):1636-1643.
[15] BAE K H, JO Y H, LEE D R, et al. Trajectories of handgrip strength and their associations with mortality among older adults in Korea: analysis of the Korean longitudinal study of aging[J]. Korean J Fam Med, 2021, 42(1):38-46.
[16] MGBEMENA N, JONES A, SAXENA P, et al. Acute changes in handgrip strength, lung function and health-related quality of life following cardiac surgery[J]. PLoS One, 2022, 17(2):e0263683.