肺癌患者并发肌肉减少症的危险因素分析及其与临床预后的相关性探讨

doi:10.12114/j.issn.1007-9572.2021.00.599

摘要/Abstract

摘要： 背景　肺癌患者常并发肌肉减少症，但对于肌肉减少症与生活质量及情绪状况之间的关系尚未明确。目的　调查肌肉减少症在肺癌患者中的发生率，并分析其危险因素及其对患者情绪状况、生命质量等临床预后的影响，为肺癌患者临床预后的整体改善提供依据。方法　招募2019年12月—2020年7月在安徽医科大学第一附属医院呼吸与危重症医学科就诊的肺癌患者87例为研究对象，收集患者年龄、性别、受教育程度、吸烟情况、肿瘤病理类型、体力状况（PS）评分、患病时长、治疗情况、合并症情况、体质指数（BMI），测量患者血红蛋白、乳酸脱氢酶、前白蛋白、白蛋白水平。采用人体成分分析仪测量四肢肌肉量并计算骨骼肌质量指数（SMI），根据亚洲老年肌肉减少症工作组（AWGSOP）诊断标准将患者分为肌肉减少症组（46例）、无肌肉减少症组（41例），采用营养风险筛查2002量表（NRS2002）评价患者的营养不良风险，采用生命质量核心量表（QLQ-C30）评价患者的生命质量，采用医院焦虑抑郁量表（HADS）评价患者的情绪状况。采用二元Logistic回归分析探索肺癌并发肌肉减少症的影响因素，采用Pearson相关分析探讨肌肉减少症与生命质量和情绪状况的相关性。结果　肺癌患者合并肌肉减少症的发生率为52.9%（46/87）。肌肉减少症组患者年龄、长期吸烟比例、Charlson合并症指数、NRS2002评分、有营养不良风险比例高于无肌肉减少症组，BMI、四肢肌肉量、SMI低于无肌肉减少症组（P<0.05）。二元Logistic回归分析结果显示，长期吸烟史〔OR=5.515，95%CI（1.234，24.646）〕、患病时长〔OR=1.132，95%CI（1.007，1.272）〕、BMI〔OR=0.676，95%CI（0.519，0.880）〕、NRS2002评分〔OR=1.773，95%CI（1.012，3.108）〕均是肺癌并发肌肉减少症的影响因素。肌肉减少症患者焦虑量表、抑郁量表、疲倦、疼痛、气促及食欲丧失得分高于无肌肉减少症组患者（P<0.05），QLQ-C30总分，躯体功能、角色功能、情感功能、社会功能得分低于无肌肉减少症组（P<0.05）。Pearson相关分析结果显示，肺癌患者并发肌肉减少症与焦虑量表得分、抑郁量表得分及疲倦、疼痛、气促、食欲丧失得分均呈正相关（P<0.05），而与QLQ-C30总分、躯体功能、角色功能、情感功能、社会功能得分均呈负相关（P<0.05）。结论　肺癌患者病程及吸烟史越长、NRS2002评分越高、BMI越低，肌肉减少症发生风险越高；肌肉减少症的发生与肺癌患者较差的生命质量以及焦虑、抑郁症状之间等不良临床预后具有相关性。

关键词: 肺肿瘤, 肌肉减少症, 营养风险, 生命质量, 情绪状况, 焦虑, 抑郁, 相关性分析

Abstract: Background　Patients with lung cancer often suffer from sarcopenia，but the relationship between sarcopenia and quality of life，emotional status is unclear. Objective　To investigate the incidence of sarcopenia in lung cancer patients，analyze its risk factors and their impact on the clinical prognosis including emotional status，quality of life，etc，so as to provide evidence for the overall improvement of the clinical prognosis of lung cancer patients. Methods　87 patients with lung cancer who attended the Department of Respiratory and Critical Care Medicine，the First Affiliated Hospital of Anhui Medical University from December 2019 to July 2020 were recruited，and their age，gender，education level，smoking status，tumor pathological type，PS score，length of illness，treatment status，comorbidities，body mass index（BMI）were collected，their hemoglobin，lactate dehydrogenase，prealbumin，albumin were measured. The body composition analyzer was used to measure the muscle mass of the limbs and calculate skeletal muscle mass index （SMI），and the patients were divided into sarcopenia group（46 cases）and no sarcopenia group（41 cases）according to the diagnostic criteria of the Asia Working Group on Sarcopenia in Older People（AWGSOP）. The Nutritional Risk Screening 2002（NRS2002）was used to evaluate the patients' malnutrition risk，the Quality-of-Life Questionnaire-Core 30（QLQ-C30）was used to evaluate the quality of life of the patients，and the Hospital Anxiety and Depression Scale（HADS）was used to evaluate the emotional state of the patients. Binary logistic regression analysis was used to explore the influencing factors of lung cancer combined with sarcopenia，and Pearson correlation analysis was used to explore the correlation between sarcopenia and quality of life，emotional status. Results　The prevalence of sarcopenia in lung cancer patients was 52.9%. Age，proportion of long-term smoking，Charlson comorbidity index，NRS2002 score，and risk of malnutrition in the sarcopenia group were higher than the non-sarcopenia group，while BMI，limb muscle mass，and SMI were lower than the non-sarcopenia group（P<0.05）. The results of binary logistic regression analysis showed that long-term smoking history〔OR=5.515，95%CI（1.234，24.646）〕，duration of illness〔OR=1.132，95%CI（1.007，1.272）〕，BMI 〔OR=0.676，95%CI（0.519，0.880）〕，NRS2002 score 〔OR=1.773，95%CI（1.012，3.108）〕 are the influencing factors of lung cancer combined with sarcopenia. The scores of anxiety scale，depression scale，fatigue，pain，shortness of breath，and loss of appetite in the sarcopenia group were higher than the no sarcopenia group（P<0.05）. The total score of QLQ-C30，the scores of physical function，role function，emotional function，and social function in sarcopenia group were lower than the no sarcopenia group（P<0.05）. Pearson correlation analysis results showed that sarcopenia was positively correlated with the scores of anxiety，depression，fatigue，pain，shortness of breath，and appetite loss（P<0.05），but negatively correlated with the scores of global quality of life，role functioning，physical functioning，emotional functioning，social functioning（P<0.05）. Conclusion　Longer disease duration，long term smoking history，higher NRS2002 score and lower BMI has higher risk for developing sarcopenia. Sarcopenia is significantly associated with poorer quality of life，and anxiety and depressive symptoms in patients with lung cancer.

Key words: Lung neoplasms, Sarcopenia, Nutritional risk, Quality of life, Emotional state, Anxiety, Depression, Correlation analysis

李周华,季爽,胡先纬,等. 肺癌患者并发肌肉减少症的危险因素分析及其与临床预后的相关性探讨[J]. 中国全科医学, 2021, 24(26): 3310-3315. DOI: 10.12114/j.issn.1007-9572.2021.00.599.
LI Zhouhua,JI Shuang,HU Xianwei, et al. Analysis of Risk Factors of Lung Cancer Patients Combined with Sarcopenia and Their Correlation with Clinical Prognosis　[J]. Chinese General Practice, 2021, 24(26): 3310-3315. DOI: 10.12114/j.issn.1007-9572.2021.00.599.

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