摘要目的:探索非糖尿病胃癌患者的骨骼肌浸润及术后补充性肠外营养（supplementary parenteral nutrition，SPN）期间血糖对术后并发症的影响。方法:回顾2017年3月至2021年6月兰州大学第一医院肿瘤外科胃癌根治术后予以SPN患者的一般资料及营养炎症指标，术前CT第三腰椎骨骼肌指标，术后血糖及30天内的并发症。根据是否存在骨骼肌脂肪浸润［用CT骨骼肌密度（skeletal muscle density，SMD）评估］将患者分组，比较术后血糖及并发症的差异。通过中介效应模型，分析血糖在SMD与术后并发症关联中的中介效应。结果:共纳入357例患者，与无肌脂肪浸润的患者（299例，83.8%）相比，肌脂肪浸润组（58例，16.2%）术后SPN期间高血糖发生率、血糖的平均值、最高值及波动幅度均更高，且综合并发症指数、并发症发生率更高（ P<0.05）。血糖在SMD与综合并发症指数间存在中介效应（效应值为-0.0892， P<0.05），占总效应的19.3%。 结论:骨骼肌脂肪浸润及高血糖均与术后较高的并发症发生率相关，且血糖在骨骼肌脂肪浸润与并发症关联中起中介作用。

abstractsObjective:To explore the effects of myosteatosis and blood glucose (BG) on postoperative complications in non-diabetic gastric cancer patients receiving supplemental parenteral nutrition (SPN) after gastrectomy.Methods:Patients who underwent radical gastrectomy between March 2017 and June 2021 in the Department of Surgical Oncology, the First Hospital of Lanzhou University were included in this study. Various preoperative inflammatory and nutritional indicators, including skeletal muscle metrics at the third lumbar level on CT, were collected retrospectively. Postoperative BG within 3 days and complications within 30 days were monitored. Patients were divided into two groups according to the presence or absence of myosteatosis (assessed via skeletal muscle density [SMD]) and the differences in postoperative BG and complication incidence were compared. Mediation model was used to analyze the mediating effect of BG in the association between SMD and postoperative complications.Results:A total of 357 patients were included in the study. Compared with the 299(83.8%) patients without myosteatosis , the incidence of hyperglycemia, mean BG, maximal BG, and BG fluctuation while on SPN in the 58(16.2%) patients with myosteatosis were higher, and the comprehensive complication index (CCI) and the incidence of complication were higher ( P<0.05). More importantly, BG showed the mediation effect of -0.0892 in the effect of SMD on CCI ( P<0.05), with the effect size of 19.3％. Conclusion:Myosteatosis and postoperative hyperglycemia are associated with higher incidence of complications, and BG plays an intermediary role in the association between myosteatosis and CCI.