头颈部CT对头颈部恶性肿瘤患者营养不良筛查的探索

A preliminary exploration of malnutrition screening in patients with head and neck malignancies using head and neck CT

摘要:

目的 分析第3颈椎骨骼肌质量指数(C3 SMI)是否可以成为预测头颈部恶性肿瘤患者营养不良的独立危险因素，为早期营养评估提供新思路。方法 回顾性分析2019年1月—2023年12月就诊于南京鼓楼医院耳鼻咽喉头颈外科的Ⅱ~Ⅳ期头颈部鳞状细胞癌患者(n=98)的头颈部CT结果，将C3 SMI与患者营养风险筛查2002评分(NRS2002)、体质指数(BMI)及血清学指标进行分析，依据NRS2002评分将98例患者分为营养不良组(≥3分)和无营养不良组(＜3分)，比较两组患者各指标有无差异。将上述指标进行皮尔森相关性分析，对营养不良的相关影响因素进行单因素及多因素Logistic回归分析。结果 营养不良组(13例)及无营养不良组(85例)患者相比较，营养不良组患者的体重、BMI、白蛋白、血红蛋白、淋巴细胞计数均较低，差异均具有统计学意义。患者术前的白蛋白、血红蛋白、淋巴细胞计数均高于术后1周的结果，且差异均具有统计学意义。将C3 SMI分别与NRS2002评分、实验室检测结果进行皮尔森相关性分析，NRS2002评分与C3 SMI(r²=0.140，P=0.002)、年龄(r²=0.200，P＜0.000 1)、血红蛋白(r²=0.036，P=0.05)、白蛋白(r²=0.086，P=0.003 7)、BMI(r²=0.100，P=0.001 8)呈线性相关。多因素分析显示C3 SMI是营养不良的独立危险因素。结论 C3 SMI、BMI、年龄、血红蛋白及白蛋白在有无营养不良状态的头颈部恶性肿瘤患者中具有统计学差异。在头颈部恶性肿瘤患者的营养评估中，C3 SMI与NRS2002评分具有一致性，C3 SMI是头颈部恶性肿瘤患者营养不良的独立预测因素。

Abstract:

Objective To analyze whether the skeletal muscle index of the third cervical vertebra (C3 SMI) can be an independent risk factor for predicting malnutrition in patients with head and neck malignancies, providing a new idea for early nutritional assessment. Methods A retrospective analysis was conducted on the head and neck CT results of 98 patients with stage II-IV squamous cell carcinoma of the head and neck who visited the Department of Otorhinolaryngology Head and Neck Surgery of Nanjing Drum Tower Hospital from January 2019 to December 2023. The C3 SMI was analyzed in conjunction with the patient’s nutrition risk screening 2002 (NRS2002) score, body mass index (BMI), and serological indexes. According to the NRS2002 score, the patients were divided into the malnutrition group (≥3 points) and the non-malnutrition group (<3 points), and the differences in the above indexes between the two groups were compared. The indexes were subjected to Pearson correlation analysis, and univariate and multivariate Logistic regression analyses were conducted on the related influencing factors of malnutrition. Results Comparison between the malnutrition group and the non-malnutrition group revealed a statistically significant difference in the age of the patients. The C3 SMI, BMI, body weight, hemoglobin, albumin, and lymphocyte count of the patients in the malnutrition group were all lower than those in the non-malnutrition group, and there were statistically significant differences in C3 SMI, BMI, and albumin. The preoperative levels of albumin, hemoglobin, and lymphocyte counts of the patients were higher than those one week after the operation, and there were statistically significant differences. Pearson’s correlation analyses showed that the NRS2002 score was linearly correlated with C3 SMI (r²=0.140, P=0.002), age (r²=0.200, P<0.000 1), hemoglobin (r²=0.036, P=0.05), albumin (r²=0.086, P=0.003 7), and BMI (r²=0.100, P=0.001 8). Multivariate analysis revealed that C3 SMI was an independent risk factor for malnutrition. Conclusions The C3 SMI, BMI, age, hemoglobin, and albumin show statistically significant differences among patients with head and neck malignant tumors in different nutritional states. In the nutritional assessment of patients with head and neck malignancies, C3 SMI is consistent with the NRS2002 score, and C3 SMI is an independent predictor of malnutrition in patients with head and neck malignancies.