相位角与原发性肝癌患者营养状况及临床结局的关系

目的 观察用生物电阻抗法测得的相位角（PA）与原发性肝癌患者营养状况的关系，探讨其对患者临床结局的影响。方法 收集原发性肝癌住院患者120例，进行营养风险筛查、综合营养状况评估、人体测量、血生化检查、人体成分分析，根据相位角将患者分为低PA组和正常PA组，分析PA与营养相关指标的关系；随访1年，比较两组生存情况。结果 原发性肝癌患者中56.7%（68/120）PA低于正常。低PA组血清总蛋白（TP）、白蛋白（ALB）和胆碱酯酶（CHE）、血红蛋白（HB）、上臂肌围（AMC）、握力（GS）、身体细胞量（ B C M ）、去脂体重（FFM）、骨骼肌质量指数（ASMI）均低于正常PA组（均P<0.05），浮肿指数（ECW/TBW）高于后者（P<0.05）。相关性分析显示，PA与ECW/TBW呈负相关（P<0.05）；而与TP、ALB、CHE、HB、AMC、GS、BCM、FFM、ASMI呈正相关（均P<0.05）。低PA与肝功能恶化、肝癌临床分期、营养风险、营养不良程度明显相关（均P<0.05）。随访期间低PA组死亡率高于正常PA组（P<0.05），其死亡风险升高2.738倍（OR=3.738, 95%CI: 1.465, 9.535）。结论 PA是反映原发性肝癌患者营养状况经济、有效指标，与患者死亡风险密切相关。相位角的检测有助于原发性肝癌患者的营养状况评估及临床结局预测。

Relation of Phase Angle with Nutritional Status and Clinical Outcomes of Primary LiverCancer Patients

Objective To observe the relation of phase angle (PA) measured by bioelectrical impedance method with nutritional status of patients with primary liver cancer, and to explore its influence on clinical outcomes. Methods We collected 120 inpatients with primary liver cancer for nutritional risk screening, patient-generated subjective nutrition assessment(PG-SGA), anthropometry, biochemical examination and body composition analysis. According to the phase angle, the patients were divided into low PA group and normal PA group. The correlation between PA and nutrition-related indicators was analyzed. The survival and complications of the two groups were compared after 1-year follow-up. Results There were 56.7% (68/120) of primary liver cancer patients with lower PA. TP, ALB, CHE, HB, AMC, GS, BCM, FFM and ASMI in low PA group were lower while ECW/TBW was higher than those in normal PA group (all P<0.05). The correlation analysis showed that PA was negatively correlated with ECW/TBW (P<0.05), but positively correlated with TP, ALB, CHE, HB, AMC, GS, BCM, FFM and ASMI (all P<0.05). Low PA was significantly associated with nutritional risk, deterioration of liver function, progress of liver cancer staging and severe malnutrition (all P<0.05). During the follow-up period, the mortality of the low PA group was higher than that of the normal PA group (P<0.05). The risk of death in the low PA group increased by 2.738 times (OR=3.738, 95%CI: 1.465-9.535). Conclusion Phase angle is an economic and effective index to reflect the nutritional status of patients with primary liver cancer, and closely related to the risk of death. Phase angle measurement is helpful for assessing nutritional status and predicting clinical outcome of patients with primary liver cancer.