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腹部内脏脂肪与腹部皮下脂肪面积比对根治性肾输尿管切除术后并发症的预后价值
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Abstract:
目的：探讨内脏脂肪面积/皮下脂肪面积比(VFA/SFA比)对上尿路尿路上皮癌(UTUC)患者行根治性肾输尿管切除术(RNU)后并发症的预测价值。方法：回顾性分析2018年1月至2022年12月安徽医科大学第二附属医院收治的73例UTUC患者临床资料，其中男性55例，女性18例。通过术前腹部CT定量评估内脏脂肪面积(VFA)、皮下脂肪面积(SFA)，计算VFA/SFA比。采用单因素及多因素Logistic回归分析术后并发症相关危险因素。结果：男性患者中，内脏肥胖组(VFA ≥ 100 cm2)术后并发症发生率显著高于非肥胖组(P = 0.045)，并且高VFA/SFA比也是术后并发症的潜在危险因素(P = 0.003)。多因素分析显示，只有VFA/SFA比是男性患者术后并发症的独立预测因子(OR = 7.198, 95%CI 1.593~32.517, P = 0.010)，但在总体人群及女性亚组中无统计学意义。结论：VFA/SFA比可作为男性UTUC患者RNU术后并发症的可靠生物学标志物，其预测价值具有性别特异性，提示术前脂肪分布评估在男性患者中的临床重要性。
Objective: To investigate the predictive value of visceral fat area/subcutaneous fat area ratio (VFA/SFA ratio) for complications after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC). Methods: The clinical data of 73 UTUC patients admitted to the Second Affiliated Hospital of Anhui Medical University from January 2018 to December 2022 were retrospectively analyzed, including 55 men and 18 women. Visceral fat area (VFA) and subcutaneous fat area (SFA) were quantitatively assessed by preoperative abdominal CT, and the VFA/SFA ratio was calculated. Risk factors related to postoperative complications were analyzed using univariate and multivariate logistic regression. Results: In male patients, the incidence of postoperative complications was significantly higher in the visceral obese group (VFA ≥ 100 cm2) than in the non-obese group (P = 0.045), and a high VFA/SFA ratio was also a potential risk factor for postoperative complications (P = 0.003). Multifactorial analysis showed that only the VFA/SFA ratio was an independent predictor of postoperative complications in male patients (OR = 7.198, 95% CI 1.593~32.517, P = 0.010), but it was not statistically significant in the overall population or in the female subgroup. Conclusion: The VFA/SFA ratio can be used as a reliable biological marker for postoperative complications after RNU in male UTUC patients, and its predictive value is gender-specific, suggesting the clinical importance of preoperative fat distribution assessment in male patients.
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