内脏型肥胖对结直肠癌根治术患者术后感染并发症的预测价值

doi:10.3877/cma.j.issn.2095-2015.2025.03.002

目的

探讨内脏型肥胖（VO）对结直肠癌根治术患者术后感染并发症的预测价值。

方法

回顾分析2021 年7 月至2023 年2 月于东南大学附属中大医院溧水分院接受结直肠癌根治术的患者共计132 例。依照患者是否诊断为VO [CT 检查结果显示内脏脂肪面积（VFA）≥80 cm²]，将患者分为VO 组69 例、非VO 组63 例。收集人口统计学特征、合并症、术前生化数据、肿瘤病理特征、围手术期及术后感染并发症发生情况。术后感染并发症定义为患者住院期间发生的任何感染，包括手术部位感染和非手术部位感染。采用logistic 回归分析寻找结直肠癌根治术患者术后感染并发症影响因素。通过绘制ROC 曲线分析VFA 和体重指数（BMI）预测结直肠癌根治术患者术后感染并发症的临床价值。

结果

VO 组患者术后感染并发症发生率明显高于非VO 组患者（P＜0.05）。多因素logistic 回归显示，吸烟（OR=4.994，95% CI 1.517～16.442，P=0.008）、空腹血糖（每增加1 mmol/L，OR=4.121，95% CI 1.791～9.480，P＜0.001）、手术时间＞4 h（OR=4.462，95% CI 1.410～14.117，P=0.011）、VO（OR=3.532，95% CI 1.083～11.513，P=0.036）是结直肠癌根治术患者术后感染并发症的危险因素。ROC 曲线显示，VFA 预测结直肠癌根治术患者术后感染并发症的曲线下面积（AUC）为0.708，高于BMI 的AUC（0.606）。

结论

VO 是结直肠癌根治术后感染并发症的危险因素；与BMI 相比，VFA 在预测术后感染并发症方面表现出较高的敏感度，但未能证明其在整体预测能力上的显著优势，仍需进一步研究验证。

关键词: 结直肠癌, 内脏型肥胖, 内脏脂肪面积, 根治手术, 术后感染

Objective

To investigate the predictive value of visceral obesity (VO) for postoperative infection complications in patients undergoing radical resection of colorectal cancer.

Methods

A total of 132 patients who undergoing radical resection of colorectal cancer in Lishui Branch of Zhongda Hospital, Southeast University from July 2021 to February 2023 were retrospectively analyzed.According to whether the patients were diagnosed with VO [visceral fat area (VFA) ≥80 cm² on CT], the patients were divided into VO group and non-VO group, including 69 and 63 patients, respectively.Demographic characteristics, comorbidities, preoperative biochemical data, tumor pathological features,perioperative conditions, and postoperative infection complications were collected.Postoperative infectious complications were defined as any infection that occurs during a patient's hospital stay, including both surgical and non-surgical site infections.Logistic regression analysis was used to find the influencing factors of postoperative infectious complications in patients with radical resection of colorectal cancer.ROC curve was drawn to analyze the clinical value of VFA and body mass index (BMI) in predicting postoperative infectious complications in patients undergoing radical resection of colorectal cancer.

Results

The incidence of postoperative infectious complications in VO group was significantly higher than that in non-VO group (P<0.05).Multivariate logistic regression results showed that smoking(OR=4.994, 95% CI 1.517-16.442, P=0.008), fasting blood glucose (increase of 1 mmol/L, OR=4.121, 95%CI 1.791-9.480, P<0.001), operation time>4 h (OR=4.462, 95% CI 1.410-14.117, P=0.011), VO (OR=3.532,95% CI 1.083-11.513, P=0.036) was risk factors for postoperative infectious complications in patients with radical resection of colorectal cancer.ROC curve results showed that the area under the curve (AUC) of VFA in predicting postoperative infectious complications in patients undergoing radical resection of colorectal cancer was 0.708, which was higher than that of BMI (0.606).

Conclusion

VO is a risk factor for postoperative infectious complications in patients undergoing radical resection of colorectal cancer.Compared with BMI, VFA exhibits higher sensitivity in predicting postoperative infectious complications in patients undergoing radical resection for colorectal cancer.However, the current study do not demonstrate a significant advantage in overall predictive ability, and further research is needed to validate these findings.

Key words: Colorectal cancer, Visceral obesity, Visceral fat area, Radical operation, Postoperative infection

表1 两组接受结直肠癌根治术患者的一般资料比较

临床资料	内脏型肥胖组(n=69)	非内脏型肥胖组(n=63)	t值/χ²值	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	67.7±6.8	67.4±5.6	0.247	0.805
性别[例(%)]			0.732	0.392
男	31(44.9)	33(52.4)
女	38(55.1)	30(47.6)
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	23.5±2.0	22.8±1.7	2.083	0.039
吸烟[例(%)]	18(26.1)	15(23.8)	0.091	0.763
合并症[例(%)]
糖尿病	18(26.1)	18(28.6)	0.102	0.749
高血压	30(43.5)	25(39.7)	0.195	0.659
慢性阻塞性肺疾病	6(8.7)	5(7.9)	0.025	0.875
冠心病	8(11.6)	10(15.9)	0.512	0.474
术前血清白蛋白(g/L, $\overset{ˉ}{x}$ ± s )	43.2±5.0	42.1±5.2	1.221	0.224
术前血红蛋白(g/L, $\overset{ˉ}{x}$ ± s )	126.1±13.1	124.2±14.4	0.828	0.409
术前空腹血糖(mmol/L, $\overset{ˉ}{x}$ ± s )	5.1±0.8	5.0±0.7	0.116	0.908
肿瘤最大直径(cm, $\overset{ˉ}{x}$ ± s )	4.1±1.0	4.2±0.9	0.360	0.719
肿瘤位置			0.106	0.745
结肠[例(%)]	32(46.4)	31(49.2)
直肠[例(%)]	37(53.6)	32(50.8)
分化程度			0.929	0.335
低分化[例(%)]	18(26.1)	12(19.0)
中、高分化[例(%)]	51(73.9)	51(81.0)
TNM 分期			0.127	0.721
＜Ⅱ b 级[例(%)]	35(50.7)	30(47.6)
≥Ⅱ b 级[例(%)]	34(49.3)	33(52.4)
术中输血[例(%)]	7(10.1)	9(14.3)	0.530	0.467
手术时间			0.038	0.846
＞4 h[例(%)]	23(33.3)	20(31.7)
≤4 h[例(%)]	46(66.7)	43(68.3)
手术入路			-	0.747
腔镜手术[例(%)]	63(91.3)	59(93.7)
开腹手术[例(%)]	6(8.7)	4(6.3)
造瘘[例(%)]	21(30.4)	17(27.0)	0.191	0.662
术后感染并发症[例(%)]	19(27.5)	8(12.7)	4.456	0.035
手术部位感染	10(14.5)	2(3.2)	5.104	0.024
非手术部位感染	9(13.0)	6(9.5)	0.405	0.525
术后入ICU 人数[例(%)]	9(13.0)	3(4.8)	2.273	0.098

表1 两组接受结直肠癌根治术患者的一般资料比较

临床资料	内脏型肥胖组(n=69)	非内脏型肥胖组(n=63)	t值/χ²值	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	67.7±6.8	67.4±5.6	0.247	0.805
性别[例(%)]			0.732	0.392
男	31(44.9)	33(52.4)
女	38(55.1)	30(47.6)
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	23.5±2.0	22.8±1.7	2.083	0.039
吸烟[例(%)]	18(26.1)	15(23.8)	0.091	0.763
合并症[例(%)]
糖尿病	18(26.1)	18(28.6)	0.102	0.749
高血压	30(43.5)	25(39.7)	0.195	0.659
慢性阻塞性肺疾病	6(8.7)	5(7.9)	0.025	0.875
冠心病	8(11.6)	10(15.9)	0.512	0.474
术前血清白蛋白(g/L, $\overset{ˉ}{x}$ ± s )	43.2±5.0	42.1±5.2	1.221	0.224
术前血红蛋白(g/L, $\overset{ˉ}{x}$ ± s )	126.1±13.1	124.2±14.4	0.828	0.409
术前空腹血糖(mmol/L, $\overset{ˉ}{x}$ ± s )	5.1±0.8	5.0±0.7	0.116	0.908
肿瘤最大直径(cm, $\overset{ˉ}{x}$ ± s )	4.1±1.0	4.2±0.9	0.360	0.719
肿瘤位置			0.106	0.745
结肠[例(%)]	32(46.4)	31(49.2)
直肠[例(%)]	37(53.6)	32(50.8)
分化程度			0.929	0.335
低分化[例(%)]	18(26.1)	12(19.0)
中、高分化[例(%)]	51(73.9)	51(81.0)
TNM 分期			0.127	0.721
＜Ⅱ b 级[例(%)]	35(50.7)	30(47.6)
≥Ⅱ b 级[例(%)]	34(49.3)	33(52.4)
术中输血[例(%)]	7(10.1)	9(14.3)	0.530	0.467
手术时间			0.038	0.846
＞4 h[例(%)]	23(33.3)	20(31.7)
≤4 h[例(%)]	46(66.7)	43(68.3)
手术入路			-	0.747
腔镜手术[例(%)]	63(91.3)	59(93.7)
开腹手术[例(%)]	6(8.7)	4(6.3)
造瘘[例(%)]	21(30.4)	17(27.0)	0.191	0.662
术后感染并发症[例(%)]	19(27.5)	8(12.7)	4.456	0.035
手术部位感染	10(14.5)	2(3.2)	5.104	0.024
非手术部位感染	9(13.0)	6(9.5)	0.405	0.525
术后入ICU 人数[例(%)]	9(13.0)	3(4.8)	2.273	0.098

表2 结直肠癌根治术后感染并发症的单因素logistic 回归分析

影响因素	B	SE	Wald	OR	95% CI	P值
年龄	-0.030	0.034	0.811	0.970	0.908～1.037	0.368
性别
男	0.204	0.434	0.221	1.226	0.524～2.870	0.638
女				参考值
体重指数	0.222	0.119	3.469	1.249	0.988～1.578	0.063
吸烟	1.373	0.458	8.969	3.946	1.607～9.691	0.003
糖尿病	0.581	0.458	1.606	1.787	0.728～4.388	0.205
高血压	-0.243	0.445	0.299	0.784	0.328～1.875	0.585
慢性阻塞性肺疾病	0.416	0.714	0.339	1.516	0.374～6.147	0.560
冠心病	0.475	0.577	0.678	1.608	0.519～4.986	0.410
血清白蛋白	0.003	0.043	0.005	1.003	0.922～1.090	0.945
血红蛋白	0.024	0.017	1.982	1.025	0.990～1.060	0.159
空腹血糖	1.430	0.360	15.762	4.178	2.063～8.464	＜0.001
最大直径	-0.377	0.234	2.591	0.686	0.434～1.085	0.107
位置
结肠	-0.021	0.432	0.002	0.979	0.420～2.283	0.961
直肠				参考值
分化程度
低分化	0.463	0.485	0.911	0.630	0.243～1.628	0.340
中、高分化				参考值
TNM 分期
＜Ⅱ b 级	-0.508	0.438	1.348	0.602	0.255～1.419	0.246
≥Ⅱ b 级				参考值
输血	0.298	0.623	0.230	1.348	0.398～4.566	0.632
手术时间
＞4 h	1.436	0.451	10.139	4.202	1.737～10.168	0.001
≤4 h				参考值
手术入路
腔镜	-0.030	0.822	0.001	0.970	0.194～4.856	0.970
开腹				参考值
造瘘	1.494	0.454	10.858	4.457	1.832～10.840	＜0.001
内脏型肥胖
是	0.960	0.465	4.273	2.612	1.051～6.494	0.039
否				参考值

表2 结直肠癌根治术后感染并发症的单因素logistic 回归分析

影响因素	B	SE	Wald	OR	95% CI	P值
年龄	-0.030	0.034	0.811	0.970	0.908～1.037	0.368
性别
男	0.204	0.434	0.221	1.226	0.524～2.870	0.638
女				参考值
体重指数	0.222	0.119	3.469	1.249	0.988～1.578	0.063
吸烟	1.373	0.458	8.969	3.946	1.607～9.691	0.003
糖尿病	0.581	0.458	1.606	1.787	0.728～4.388	0.205
高血压	-0.243	0.445	0.299	0.784	0.328～1.875	0.585
慢性阻塞性肺疾病	0.416	0.714	0.339	1.516	0.374～6.147	0.560
冠心病	0.475	0.577	0.678	1.608	0.519～4.986	0.410
血清白蛋白	0.003	0.043	0.005	1.003	0.922～1.090	0.945
血红蛋白	0.024	0.017	1.982	1.025	0.990～1.060	0.159
空腹血糖	1.430	0.360	15.762	4.178	2.063～8.464	＜0.001
最大直径	-0.377	0.234	2.591	0.686	0.434～1.085	0.107
位置
结肠	-0.021	0.432	0.002	0.979	0.420～2.283	0.961
直肠				参考值
分化程度
低分化	0.463	0.485	0.911	0.630	0.243～1.628	0.340
中、高分化				参考值
TNM 分期
＜Ⅱ b 级	-0.508	0.438	1.348	0.602	0.255～1.419	0.246
≥Ⅱ b 级				参考值
输血	0.298	0.623	0.230	1.348	0.398～4.566	0.632
手术时间
＞4 h	1.436	0.451	10.139	4.202	1.737～10.168	0.001
≤4 h				参考值
手术入路
腔镜	-0.030	0.822	0.001	0.970	0.194～4.856	0.970
开腹				参考值
造瘘	1.494	0.454	10.858	4.457	1.832～10.840	＜0.001
内脏型肥胖
是	0.960	0.465	4.273	2.612	1.051～6.494	0.039
否				参考值

表3 结直肠癌根治术后感染并发症的多因素logistic 回归分析

影响因素	B	SE	Wald	OR	95% CI	P值
年龄	-0.082	0.046	3.265	0.921	0.842～1.007	0.071
体重指数	0.132	0.148	0.798	1.141	0.854～1.524	0.372
吸烟	1.608	0.608	6.998	4.994	1.517～16.442	0.008
空腹血糖	1.416	0.425	11.099	4.121	1.791～9.480	＜0.001
手术时间
＞4 h	1.496	0.588	6.477	4.462	1.410～14.117	0.011
≤4 h				参考值
造瘘	0.765	0.572	1.785	2.149	0.700～6.599	0.181
内脏型肥胖
是	1.262	0.603	4.380	3.532	1.083～11.513	0.036
否				参考值

表3 结直肠癌根治术后感染并发症的多因素logistic 回归分析

影响因素	B	SE	Wald	OR	95% CI	P值
年龄	-0.082	0.046	3.265	0.921	0.842～1.007	0.071
体重指数	0.132	0.148	0.798	1.141	0.854～1.524	0.372
吸烟	1.608	0.608	6.998	4.994	1.517～16.442	0.008
空腹血糖	1.416	0.425	11.099	4.121	1.791～9.480	＜0.001
手术时间
＞4 h	1.496	0.588	6.477	4.462	1.410～14.117	0.011
≤4 h				参考值
造瘘	0.765	0.572	1.785	2.149	0.700～6.599	0.181
内脏型肥胖
是	1.262	0.603	4.380	3.532	1.083～11.513	0.036
否				参考值

图1 VFA 和BMI 预测结直肠癌根治术后感染并发症的ROC 曲线注：VFA 内脏脂肪面积；BMI 体重指数

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Predictive value of visceral obesity for postoperative infection complications in patients undergoing radical resection of colorectal cancer

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Predictive value of visceral obesity for postoperative infection complications in patients undergoing radical resection of colorectal cancer