早期胃癌患者术后贫血的危险因素及营养状态评估

目的:评估未接受化疗及输血的早期胃癌患者术后发生贫血的危险因素以及相关营养状态。方法:收集2015年1月—2018年4月我院术后病理确诊为早期胃癌的128例患者,随访12个月,根据患者随访期间是否发生贫血分为正常组和贫血组。收集患者一般资料和术前及随访期间的贫血及营养指标进行相关危险因素分析,并比较两组在随访期营养状态的变化情况。结果:正常组85例,贫血组43例。其中贫血组34例(79.1%)为单纯缺铁性贫血,贫血组的全胃切除术+Roux-en-Y式(P=0.010)、T2期(P=0.026)和N1期(P=0.036)比例均显著高于正常组。贫血组术前血红蛋白明显低于正常组(P=0.016),但未符合贫血诊断;两组其余各指标均无统计学差异(P>0.05)。多因素分析显示全胃切除术(OR:1.248,95%CI:0.627~2.954,P<0.001)、Roux-en-Y式(OR:1.330,95%Cl:1.237~3.630,P<0.001)以及T2期(OR:1.552,95%CI:1.092~2.210,P<0.001)是早期胃癌术后发生贫血的相关危险因素。术后随访3个月时贫血组的转铁蛋白、前白蛋白、甘油三酯显著低于正常组(P<0.05);随访6个月和12个月时贫血组的转铁蛋白、前白蛋白、白蛋白、甘油三酯以及血钙水平均较正常组显著降低(P<0.05),其中前白蛋白和甘油三酯水平随时间的推移下降的最多(P<0.001)。结论:全胃切除术、Roux-en-Y吻合、T2期是早期胃癌患者术后发生贫血的危险因素,对于这类患者需要定期评估贫血情况,可预防性补充铁剂、维生素B12、叶酸等。

Risk factors and nutritional status assessment of postoperative anemia in early gastric cancer

Objective:To evaluate the risk factors and related nutritional status of postoperative anemia in patients with early gastric cancer who did not receive chemotherapy and blood transfusion.Methods:A retrospective analysis of 128 patients with pathologically confirmed early gastric cancer in our hospital from January 2015 to April 2018 was followed up for 12 months.According to whether or not anemia occurred during follow-up,the patients were divided into normal group and anemia group.Collect the general information of patients and analyze the related risk factors of anemia and nutrition indexes before and during the follow-up period,and compare the changes of nutritional status between the two groups during the follow-up period.Results:There were 85 cases in the normal group and 43 cases in the anemia group.In the anemia group,34(79.1%)cases were iron deficiency anemia.The ratio of total gastrectomy+Roux-en-Y(P=0.010),T2(P=0.026)and N1(P=0.036)was significantly higher in the anemia group.Preoperative hemoglobin was significantly lower in the anemia group than in the normal group(P=0.016),but did not meet the diagnosis of anemia;there was no statistical difference in the other indicators in the two groups(P>0.05).Multivariate analysis showed total gastrectomy(OR:1.248;95%CI:0.627~2.954,P<0.001),Roux-en-Y(OR:1.330,95%Cl:1.237~3.630,P<0.001)and T2(OR:1.552;95%CI:1.092~2.210;P<0.001)an associated risk factor for anemia after early gastric cancer surgery.The transferrin,prealbumin and triglyceride in the anemia group were significantly lower than those in the normal group at 3 months of follow-up(P<0.05).The transferrin,prealbumin,albumin,triglyceride and serum calcium levels in the anemia group were significantly lower than those in the normal group at 6 and 12 months of follow-up(P<0.05).of which prealbumin and triglyceride Levels decreased the most over time(P<0.001).Conclusion:Total gastrectomy,Roux-en-Y anastomosis,and T2 phase are risk factors for anemia in early gastric cancer,For this type of patients,regular assessment of anemia is needed.Preventive supplementation with iron,vitamin B12,folic acid.