食管癌手术病人相位角与营养状况的相关性研究
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摘要
目的:探讨生物电阻抗法(相位角)与食管癌手术病人营养风险及营养状况的相关性。方法:73例食管癌手术病人应用营养风险筛查2002(NRS 2002)、采用欧洲肠外肠内营养学会营养不良诊断共识及病人主观整体评估法(patient-generated subjective global assessment,PG-SGA)、白蛋白、前白蛋白、人体成分分析,人体测量、握力,PA评价其营养风险及营养状况的相关。结果:PA与BMI、上臂肌围、上臂围、大腿围、前白蛋白、肌酐、HGB、RBC呈正相关性(P <0.05);PA与PG-SGA呈负相关性(P <0.05)。按PG-SGA评价营养不良分组,结果显示营养良好组PA值明显高于可疑或中度营养不良+重度营养不良组(P <0.05);按ESPEN营养不良诊断共识分组,发现营养良好组PA值高于营养不良组(P=0.069);按NRS 2002分组,发现无营养风险组PA值稍高于营养风险组,(P=0.792)。按PALB分组,发现PALB正常组PA值明显高于PALB偏低组,(P <0.05);按PNI均值分组,发现高PNI组PA值稍高于低PNI组,(P=0.338)。结论:PA与多项营养指标密切相关,PA测量有助于快速判断病人是否存在营养风险,为及时进行营养干预的实施提供了客观依据。
Objective: To explore the correlation between phase angle(PA)of bioelectrical impedance analysis(BIA) and nutritional risk or nutritional status in patients with esophageal cancer undergoing surgery. Methods: 73 patients with esophageal cancer undergoing surgery were included, and the correlation between nutritional risk or nutritional status was evaluated for nutritional risk and nutritional status by nutritional risk screening(NRS 2002),european society parenteral and enteral nutrition(ESPEN) consensus on the diagnosis of malnutrition, patient-generated subjective global assessment(PG-SGA), albumin, prealbumin, BIA, anthropometric measures, and grip. Results: The PA values were positively correlated with BMI, upper arm muscle circumference, upper arm circumference, thigh circumference, prealbumin(PALB), creatinine, HGB and RBC(P < 0.05), and were negatively correlated with PG-SGA(P < 0.05). On the basis of the criteria of PG-SGA, the PA values in the patients with non-malnutrition were significantly higher than those of the patients with malnutrition(P < 0.05). According to the ESPEN consensus, the PA values in the patients with non-malnutrition were higher than those of the patients with malnutrition(P = 0.069). Based on NRS 2002,the PA values in the patients with non-malnutrition were a little higher than those of the patients with malnutrition(P =0.792). In the light of PALB, the PA values in the patients with normal value were significantly higher than those of the patients with low value(P < 0.05). On the ground of prognostic nutritional index(PNI), the PA values in the patients with high value were a little higher than those of the patients with low value(P = 0.338). Conclusion: PA has a significant correlation with nutritional indices and is helpful to identify the patients with nutritional risk, and thereby provides an objective evidences of the nutritional intervention.
Objective: To explore the correlation between phase angle(PA)of bioelectrical impedance analysis(BIA) and nutritional risk or nutritional status in patients with esophageal cancer undergoing surgery. Methods: 73 patients with esophageal cancer undergoing surgery were included, and the correlation between nutritional risk or nutritional status was evaluated for nutritional risk and nutritional status by nutritional risk screening(NRS 2002),european society parenteral and enteral nutrition(ESPEN) consensus on the diagnosis of malnutrition, patient-generated subjective global assessment(PG-SGA), albumin, prealbumin, BIA, anthropometric measures, and grip. Results: The PA values were positively correlated with BMI, upper arm muscle circumference, upper arm circumference, thigh circumference, prealbumin(PALB), creatinine, HGB and RBC(P < 0.05), and were negatively correlated with PG-SGA(P < 0.05). On the basis of the criteria of PG-SGA, the PA values in the patients with non-malnutrition were significantly higher than those of the patients with malnutrition(P < 0.05). According to the ESPEN consensus, the PA values in the patients with non-malnutrition were higher than those of the patients with malnutrition(P = 0.069). Based on NRS 2002,the PA values in the patients with non-malnutrition were a little higher than those of the patients with malnutrition(P =0.792). In the light of PALB, the PA values in the patients with normal value were significantly higher than those of the patients with low value(P < 0.05). On the ground of prognostic nutritional index(PNI), the PA values in the patients with high value were a little higher than those of the patients with low value(P = 0.338). Conclusion: PA has a significant correlation with nutritional indices and is helpful to identify the patients with nutritional risk, and thereby provides an objective evidences of the nutritional intervention.
引文
[1]韩东景,赵楠,李伟,等.食管癌患者术前营养不足和营养风险发生率及临床营养支持现状调查.中华肿瘤防治杂志, 2013,20(16):1274-1277.
[2]石汉平,凌文华,李薇.肿瘤营养学.北京:人民卫生出版社,2012.
[3] Ringaitiene D, Gineityte D, Vicka V, et al. Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients. Clin Nutr, 20l6, 35(6):1328-1332.
[4] Bauer J, Capra S, Ferguson M. Use of the scored PatientGenerated Subjective Global Assessment(PG-SGA)as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002, 56(8):779-785.
[5]石英英,张晓伟,袁凯涛,等.PG-SGA操作标准介绍.中华肿瘤防治杂志, 2013, 20(22):1779-1782.
[6] Kondrup J, Rasmussen HH,Hamberg O,et al. Nutritional risk screening(NRS 2002):a new method based on an analysis of controlled clinical trials.Clin Nutr,2003, 22(3):321-336.
[7] Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition-An ESPEN Consensus Statement. Clin Nutr,2015, 34(3):335-340.
[8] Migita K, Takayama T, Saeki K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol, 2013, 20(8):2647-2654.
[9]宁华英,赵崇法,齐玉梅,等.相位角预测手术病人营养风险及住院时间.肠外肠内营养, 2017, 24(5):296-300.
[10] Gupta D, Lis CG, Dahlk SL, et al. The relationship between bioelectrical impedance phase angle and subjective global assessment in advanced colorectal cancer. Nutr J, 2008,7:719.
[11] Stob?us N, Pirlich M, Valentini L, et al. Determinants of bioelectrical phase angle in disease. Br J Nutr, 2012, 107(8):1217-1220.
[12] Barbosa-Silva MC, Barros AJ, Wang J, et al. Bioelectrical impedance analysis:population reference values for phase angle by age and sex. Am J Clin Nutr, 2005, 82(1):49-52.
[13] Stegel P, Kozjek NR, Brumen BA, et al. Bioelectrical impedance phase angle as indicator and predictor of cachexia in head and neck cancer patients treated with(chemo)radiotherapy. Eur J Clin Nutr, 2016, 70(5):602-626.
[14] Hui D, Bansal S, Morgado M, et al. Phase angle for prognostication of survival in patients with advanced cancer:prelimiary findings. Cancer, 2014, 120(14):2207-2214.
[15] Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi, 1984, 85(9):1001-1005.
[16]徐世斌,徐美青,孙效辉,等.预后营养指数与食管鳞癌患者术后并发症和远期预后的相关性研究.中国肿瘤临床, 2018, 45(15):789-794.
[17]秦淑国,许元元,陈雯雯,等.血清前白蛋白、白蛋白水平与食管癌术后生存的相关性.医学临床研究, 2017, 34(3):548-550.
[18] Wagner D, Adunka C, Kniepeiss D, et al. Serum albumin,subjective global assessment, body mass index and the bioimpedance analysis in the assessment of malnutrition in patients up to 15 years afer liver transplantation. Clin Transplant,2011,25(4):E396-400.
[19] Farias CL, Campos DJ, Bonfin CM, et al.Phase angle from BIA as a prognostic and nutritional status tool for children and adoles‐cents undergoing hematopoietic stem cell transplantation. Clin Nutr, 2013, 32(3):420-425.
[2]石汉平,凌文华,李薇.肿瘤营养学.北京:人民卫生出版社,2012.
[3] Ringaitiene D, Gineityte D, Vicka V, et al. Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients. Clin Nutr, 20l6, 35(6):1328-1332.
[4] Bauer J, Capra S, Ferguson M. Use of the scored PatientGenerated Subjective Global Assessment(PG-SGA)as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002, 56(8):779-785.
[5]石英英,张晓伟,袁凯涛,等.PG-SGA操作标准介绍.中华肿瘤防治杂志, 2013, 20(22):1779-1782.
[6] Kondrup J, Rasmussen HH,Hamberg O,et al. Nutritional risk screening(NRS 2002):a new method based on an analysis of controlled clinical trials.Clin Nutr,2003, 22(3):321-336.
[7] Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition-An ESPEN Consensus Statement. Clin Nutr,2015, 34(3):335-340.
[8] Migita K, Takayama T, Saeki K, et al. The prognostic nutritional index predicts long-term outcomes of gastric cancer patients independent of tumor stage. Ann Surg Oncol, 2013, 20(8):2647-2654.
[9]宁华英,赵崇法,齐玉梅,等.相位角预测手术病人营养风险及住院时间.肠外肠内营养, 2017, 24(5):296-300.
[10] Gupta D, Lis CG, Dahlk SL, et al. The relationship between bioelectrical impedance phase angle and subjective global assessment in advanced colorectal cancer. Nutr J, 2008,7:719.
[11] Stob?us N, Pirlich M, Valentini L, et al. Determinants of bioelectrical phase angle in disease. Br J Nutr, 2012, 107(8):1217-1220.
[12] Barbosa-Silva MC, Barros AJ, Wang J, et al. Bioelectrical impedance analysis:population reference values for phase angle by age and sex. Am J Clin Nutr, 2005, 82(1):49-52.
[13] Stegel P, Kozjek NR, Brumen BA, et al. Bioelectrical impedance phase angle as indicator and predictor of cachexia in head and neck cancer patients treated with(chemo)radiotherapy. Eur J Clin Nutr, 2016, 70(5):602-626.
[14] Hui D, Bansal S, Morgado M, et al. Phase angle for prognostication of survival in patients with advanced cancer:prelimiary findings. Cancer, 2014, 120(14):2207-2214.
[15] Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi, 1984, 85(9):1001-1005.
[16]徐世斌,徐美青,孙效辉,等.预后营养指数与食管鳞癌患者术后并发症和远期预后的相关性研究.中国肿瘤临床, 2018, 45(15):789-794.
[17]秦淑国,许元元,陈雯雯,等.血清前白蛋白、白蛋白水平与食管癌术后生存的相关性.医学临床研究, 2017, 34(3):548-550.
[18] Wagner D, Adunka C, Kniepeiss D, et al. Serum albumin,subjective global assessment, body mass index and the bioimpedance analysis in the assessment of malnutrition in patients up to 15 years afer liver transplantation. Clin Transplant,2011,25(4):E396-400.
[19] Farias CL, Campos DJ, Bonfin CM, et al.Phase angle from BIA as a prognostic and nutritional status tool for children and adoles‐cents undergoing hematopoietic stem cell transplantation. Clin Nutr, 2013, 32(3):420-425.