第三腰椎骨骼肌指数与血浆白蛋白/ 球蛋白比值预测晚期非小细胞肺癌营养不良的潜能价值

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摘要目的探索第三腰椎骨骼肌指数( L3 -SMI)、血浆白蛋白/ 球蛋白比值与晚期非小细胞肺癌(NSCLC) 营养不良关系,以明确 L3 -SMI、血浆白蛋白/ 球蛋白比值预测晚期 NSCLC 患者重度营养不良状态效能。方法回顾性分析在太原市中心医院 2021 年 2 月至 2024 年 2 月期间收住的 217 例晚期 NSCLC 患者资料,根据患者主观整体评估(PG-SGA)评分分为两组,即重度营养不良组(n = 43,C 级),非重度营养不良(n = 174,A+B 级),比较两组患者人口统计学和临床特征,采用单因素、多因素 Logistic 回归分析影响患者营养不良独立因素,利用列线图分析模型预测效能,同时,经受试者操作特征曲线(ROC 曲线)分析 L3 -SMI、血浆白蛋白/ 球蛋白比值预测效能。结果与非重度营养不良患者相比,重度营养不良患者临床分期更晚、年龄更高,血浆白蛋白/ 球蛋白比值、L3 -SMI 更低,差异具有统计学意义(P<0. 05)。进一步经多因素 Logistic 回归分析,临床分期Ⅳ 期、年龄越大、血浆白蛋白/ 球蛋白比值越低、L3 -SMI 越低是晚期 NSCLC 患者重度营养不良的独立影响因素。将独立影响因素构建列线图,C-index 为 0. 99,模型阈值概率范围为 1% ~ 99%,其净收益率>0,真实值和预测值吻合度绝对误差为 0. 011,预测模型曲线下面积(AUC)为 0. 942,95%CI = 0. 879~ 0. 999。同时,经 ROC 曲线分析,血浆白蛋白/ 球蛋白比值、L3 -SMI 预测晚期 NSCLC 患者重度营养不良的 AUC 分别为 0. 919、0. 908。结论 L3 -SMI、血浆白蛋白/ 球蛋白比值是晚期 NSCLC 患者重度营养不良主要评估指标,具有较高预测效能,同时高龄、较晚的临床分期也是患者重度营养不良的独立影响因素,通过重点监测 L3 -SMI、血浆白蛋白/ 球蛋白比值水平变化,能够及时发现机体异常,从而加以干预,改善预后。

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	李虹
	乔可宏
	尚晓凤

关键词 ：椎旁肌肉指数, 血浆白蛋白/ 球蛋白比值, 晚期非小细胞肺癌, 营养不良, 临床分期, 预测模型, 影响因素, 预后

Abstract：Objective Explore the relationship between skeletal muscle index at the third lumbar vertebra L3 -SMI and white ball ratio and advanced non-small cell lung cancer NSCLC malnutrition to clarify the efficacy of L3 -SMI and white ball ratio to predict severe malnutrition status in patients with advanced NSCLC. Method Data of 217 advanced NSCLC patients collected in Taiyuan Central Hospital from February 2021 to February 2024 were divided into two groups according to PG - SGA score namely severe malnutrition group n = 43 grade C and non-severe malnutrition n = 174 grade A+B comparing the demographics and clinical characteristics of the two groups univariate and binary Logistic regression analysis to affect independent factors of patients ' malnutrition using nomogram analysis model L3 -SMI and A/ G ratio by ROC curve analysis. Result Compared with non -severe malnutrition later clinical stage higher age and lower A/ G ratio L3 -SMI in severe malnutrition P<0. 05 . Further binary Logistic regression analysis indicated that clinical stage Ⅳ older age lower A/ G ratio and lower L3 -SMI were independent factors affecting severe malnutrition in advanced NSCLC patients. The nomogram was constructed from independent factors with C- index of 0. 99 model threshold probability range from 1% to 99% with net yield> 0 absolute agreement between true and predicted values of 0. 011 and prediction model AUC of 0. 942 95% CI 0. 879 - 0. 999. Meanwhile by the ROC curve analysis the A/ G ratio and L3 - SMI predicted the AUC of severe malnutrition in advanced NSCLC were 0. 919 and 0. 908 respectively. Conclusion L3 -SMI and A/ G ratio is the main evaluation index of severe malnutrition in patients with advanced NSCLC which has high prediction efficacy. At the same time clinical stage of advanced and late are also independent factors that induce severe malnutrition in patients. By focusing on monitoring the change of L3 - SMI and A/ G ratio levels it can detect body abnormalities in time to intervene and improve the prognosis.

Key words： Paravertebral muscle index White-ball ratio Advanced non-small cell lung cancer Malnutrition Clinical stage Predictive model Influencing factors Prognosis

基金资助:太原市 2022 年医学科技项目(202244)

通讯作者: 李虹,电子邮箱:19935195864@163.com

引用本文:

李虹,乔可宏,尚晓凤. 第三腰椎骨骼肌指数与血浆白蛋白/ 球蛋白比值预测晚期非小细胞肺癌营养不良的潜能价值[J]. 肿瘤代谢与营养电子杂志, 2025, 12(1): 123-129.
Li Hong, Qiao Kehong, Shang Xiaofeng. The ratio of L3 paravertebral muscle index to white ball predicts the potential value of dystrophy in advanced non-small cell lung cancer. Electron J Metab Nutr Cancer, 2025, 12(1): 123-129.