原发性肝癌患者营养状态与肌肉减少症的关系

摘要/Abstract

摘要： 目的: 研究原发性肝癌患者营养状态与肌肉减少症（以下简称肌少症）的关系,为原发性肝癌患者肌少症的防治提供参考。
方法: 选取2017年1月至2021年12月河北北方学院附属第一医院收治的原发性肝癌患者207例进行回顾性分析。其中59例发生肌少症（肌少症组）,148例未发生肌少症（非肌少症组）。比较两组患者人口学资料、实验室指标、营养相关体测指标、日常生活能力评分差异。采用多因素Logistic回归分析筛选原发性肝癌患者发生肌少症的影响因素。
结果: 肌少症组原发性肝癌患者年龄大于非肌少症组,体重、体重指数（body mass index,BMI）均低于非肌少症组。肌少症组原发性肝癌患者空腹血糖、尿微量白蛋白肌酐比值（urinary microalbumin creatinine ratio,UACR）、脂蛋白a（lipoproteina,Lpa）、超敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）水平均高于非肌少症组（P<0.05）,红细胞计数、白蛋白水平均低于非肌少症组（P<0.05）。肌少症组原发性肝癌患者上臂围度、上臂肌围、去脂体重、骨骼肌质量指数（skeletal muscle mass index,SMI）、4m步行速度（gait speed,GS）、最大握力值、日常生活活动能力（activity of daily living,ADL）量表评分、工具性日常生活活动能力（instrumental activity of daily living,IADL）量表评分、微型营养评价（mini-nutritional assessment,MNA）量表评分均低于非肌少症组（P<0.05）,脂肪量高于非肌少症组（P<0.05）。肌少症组原发性肝癌患者MNA分级差于非肌少症组（P<0.05）,且随着MNA评分的降低,肌少症患者上臂围度、上臂肌围、去脂体重、SMI、4m GS、最大握力值降低,脂肪量上升,且不同MNA分级肌少症原发性肝癌患者以上指标差异均有统计学意义（P<0.05）。年龄、BMI、空腹血糖、白蛋白、hs-CRP、上臂肌围、SMI、4m GS、最大握力值、ADL量表评分、IADL量表评分及MNA量表评分是原发性肝癌患者发生肌少症的影响因素（P<0.05）。
结论: 高龄、低BMI、高空腹血糖水平、高hs-CRP水平、低白蛋白水平、低上臂肌围、营养状态较差、活动量较低的原发性肝癌患者有更高的肌少症发生风险,尤其营养状态与原发性肝癌患者肌少症的发生密切相关。

关键词: 原发性肝癌, 营养状态, 肌少症, 影响因素

Abstract: Objective: To study the relationship between nutritional status and the incidence of sarcopenia in patients with primary liver cancer, so as to provide reference for the prevention and treatment of sarcopenia in patients with liver cancer.
Methods: A total of 207 patients with primary liver cancer who were admitted to The First Affiliated Hospital of Hebei North University from January 2017 to December 2021 were selected and divided into sarcopenia group (n=59) and non-sarcopenia group (n=148) according to the occurrence of sarcopenia. Their clinical datas were collected. The differences in demographic data, physical examination, laboratory examination, and daily living ability scores were compared between the two groups. The influencing factors of the patients with primary liver cancer for sarcopenia were screened by multivariate Logistic regression analysis.
Results: The age of sarcopenia group was higher than that of non-sarcopenia group, and the body weight and body mass index (BMI) were lower than those of non-sarcopenia group; fasting blood glucose, urinary albumin-to-creatinine ratio (UACR), lipoproteina (Lpa), high-sensitivity C-reactive protein (hs-CRP) were higher than those in the non-sarcopenia group (P<0.05). The red blood cell count and albumin in the sarcopenia group were lower than those in the non-sarcopenia group (P<0.05). Upper arm muscle circumference, lean body mass, skeletal muscle mass index (SMI), 4m walking speed (GS), maximal grip strength, activity of daily living (ADL) score, instrumental activity of daily living (IADL), and mini-nutrition assessment (MNA) scores of sarcopenia group were lower than those of the non-sarcopenic group (P<0.05), and the fat mass was higher than that of the non-sarcopenic group (P<0.05). Sarcopenia group (P<0.05), with the decrease of MNA score, sarcopenia patients had lower arm circumference, upper arm muscle circumference, lean body mass, SMI, 4m GS, maximal grip strength value, and increased fat mass. Comparison of indicators in patients with different MNA grades, the difference was statistically significant (P<0.05); age, BMI, fasting blood glucose, albumin, hs-CRP, upper arm muscle circumference, SMI, 4m GS, maximum grip strength, ADL score, IADL score and MNA score were all different from the original score. The incidence of sarcopenia in patients with hepatocellular carcinoma was related to the occurrence of sarcopenia (P<0.05).
Conclusion: Older age, low BMI, high fasting blood glucose, high hs-CRP level, low albumin, low upper arm muscle circumference, poor nutritional status, and low activity level in primary liver cancer patients have higher incidence of sarcopenia risk. Nutritional status is closely related to the development of sarcopenia especially.

Key words: Primary liver cancer, Nutritional status, Sarcopenia, Influencing factors

孙弟波, 马海燕, 郭飞, 武雪亮. 原发性肝癌患者营养状态与肌肉减少症的关系[J]. 肝癌电子杂志, 2023, 10(1): 25-30.

Sun Dibo, Ma Haiyan, Guo Fei, Wu Xueliang. Relationship between nutritional status and sarcopenia incidence in patients with primary liver cancer[J]. Electronic Journal of Liver Tumor, 2023, 10(1): 25-30.

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