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住院肺癌患者衰弱现况及影响因素分析

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目的 探讨肺癌患者衰弱的发生现状及其影响因素.方法 选取2022年3月至2023年3月在中南大学湘雅医院就诊且未进行抗肿瘤治疗的老年肺癌患者作为研究对象,使用FRAIL量表将患者分为非衰弱组、衰弱前期组和衰弱组,比较患者基本资料、疾病资料、相关实验室指标间的差异,筛选肺癌患者衰弱发生的影响因素.结果 共纳入肺癌患者240例,其中非衰弱组有46例(19.2%)、衰弱前期组有121例(50.4%)、衰弱组有73例(30.4%).衰弱组和衰弱前期组的年龄较非衰弱组高(P<0.05);衰弱组体质指数(BMI)较非衰弱组和衰弱前期组低(P=0.005);男性患者中衰弱者占比较女性低,衰弱前期者占比较女性患者高(P=0.017);有亲属照料的患者中衰弱者和衰弱前期者占比均较无亲属照料者低(P<0.001);衰弱组患者的白细胞(WBC)、中性粒细胞(NEUT)、氨基末端脑钠肽前体(NT-proBNP)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、中性粒细胞与淋巴细胞计数比值(NLR)、单核细胞与淋巴细胞计数比值(MLR)、系统炎症指数(SII)均高于非衰弱组,而红细胞(RBC)、血红蛋白(Hb)、红细胞比容(HCT)、淋巴细胞(LYMPH)、总蛋白(TP)、白蛋白(Alb)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平均低于非衰弱组(均P<0.05);衰弱组患者的NEUT、NT-proBNP、NLR、MLR、SII与血小板和淋巴细胞计数比值(PLR)高于衰弱前期组,而RBC、Hb、HCT、LYMPH、TP、Alb、TC、HDL-C、LDL-C低于衰弱前期组(均P<0.05);衰弱前期组的NT-proBNP高于非衰弱组(P<0.05);多因素Logistic回归分析结果显示,男性与肺癌患者衰弱风险增加有关(OR=2.80、P=0.033),亲属照料与肺癌患者衰弱的风险降低有关(OR=0.37、P=0.004),年龄增加与肺癌患者衰弱的风险升高有关(OR=1.06、P=0.004);Alb水平升高与肺癌患者的衰弱风险降低有关(OR=0.91、P=0.023);LDL-C水平升高与肺癌患者的衰弱风险降低有关(OR=0.59、P=0.027);CEA水平升高与肺癌患者发生衰弱的风险增高有关(OR=1.01、P=0.003).结论 男性、年龄和高CEA水平与肺癌患者的衰弱风险升高相关,有亲属照料、高Alb水平和高LDL-C水平与肺癌患者衰弱风险降低相关,临床上应加大对肺癌患者的衰弱筛查力度,识别患者的衰弱风险,并及早干预患者衰弱的发生和发展.
Analysis on the occurrence and influencing factors of frailty in hospitalized patients with lung cancer
Objective To investigate the occurrence of frailty and its influencing factors in patients with lung cancer.Methods Patients with lung cancer receiving treatment at Xiangya Hospital of Central South University were recruited between March 2022 and March 2023.The FRAIL scale was employed to categorize the patients into non-frailty,pre-frailty,and frailty groups.A comparison of their basic data,disease data,and relevant laboratory indicators before treatment was conducted to identify factors influencing frailty in lung cancer patients.Results A total of 240 patients with lung cancer were analyzed in this study,comprising 46 patients(19.2%)in the non-frailty group,121 patients(50.4%)in the pre-frailty group,and 73 patients(30.4%)in the frailty group.The average age of the frailty and pre-frailty groups was significantly higher than that of the non-frailty group(P<0.05).Additionally,the body mass index(BMI)of the frailty group was significantly lower compared to both the non-frailty and pre-frailty groups(P=0.005).The proportion of male patients in the frailty group was lower than that of female patients,while the proportion of pre-frailty patients was higher among females(P=0.017).Furthermore,the percentage of patients receiving family care was lower in both the frailty and pre-frailty groups compared to those without family care(P<0.001).Various blood markers such as white blood cells(WBC),neutrophils(NEUT),N terminal pro B type natriuretic peptide(NT-proBNP),carcinoembryonic antigen(CEA),neuron-specific enolase(NSE),neurophil to lymphocyte ratio(NLR),monocyte-lymphocyte ratio(MLR),and systemic inflammatory index(SII)were significantly elevated in the frailty group compared to the non-frailty group,whereas red blood cells(RBC),hemoglobin(Hb),hematocrit(HCT),lymphocytes(LYMPH),total protein(TP),albumin(Alb),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-desity lipoprotein cholesterol(LDL-C)were notably lower in the frailty group(all P<0.05).Similarly,NEUT,NLR,platelet to lymphocyte ratio(PLR),MLR,and SII were higher in the frailty group compared to the pre-frailty group,while RBC,Hb,HCT,LYMPH,TP,Alb,TC,HDL-C,and LDL-C were lower in the frailty group than the pre-frailty group(P<0.05).Moreover,NT-proBNP levels were higher in the pre-frailty group than in the non-frailty group,with all these differences being statistically significant(all P<0.05).The results of multifactorial Logistic regression analyses revealed several significant associations with frailty in lung cancer patients.Males had an increased risk of frailty(OR=2.80,P=0.033),while family care was linked to a decreased risk(OR=0.37,P=0.004).Additionally,advancing age was associated with a higher risk of frailty(OR=1.06,P=0.004).Furthermore,higher Alb levels were correlated with a reduced risk of frailty(OR=0.91,P=0.023),elevated LDL-C levels were associated with a lower risk(OR=0.59,P=0.027),and increased CEA levels were linked to a higher risk of frailty(OR=1.01,P=0.003)in lung cancer patients.Conclusions In lung cancer patients,older age,male gender,and higher CEA levels were linked to a higher risk of frailty,whereas family care,higher Alb levels,and high LDL-C levels were associated with a lower risk of frailty.These findings imply the importance of intensifying frailty screening in lung cancer patients to identify and intervene in frailty risk early on.

Lung neoplasmsFrailtyInfluencing factor

李伟、李宇青、陈琼、石柯

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中南大学湘雅医院老年医学科 国家老年疾病临床研究中心(湘雅医院),长沙 410008

肺肿瘤 衰弱 影响因素

2024

中华老年医学杂志
中华医学会

中华老年医学杂志

CSTPCD北大核心
影响因子:1.606
ISSN:0254-9026
年,卷(期):2024.43(11)