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目的 评估使用炎症、免疫及营养指标对于胃癌根治术后发生腹膜转移的预测作用,并建立适用于术前风险评估的预测模型。方法 回顾性收集2022—2024年苏州市立医院85例晚期胃癌患者的临床资料,按术后是否发生腹膜转移分为转移组44例与非转移组41例。通过分析比较两组间的营养参数[血清白蛋白、纤维蛋白原及预后营养指数(PNI)]、炎症指标[中性粒细胞计数、C反应蛋白、中性粒细胞与淋巴细胞比值(NLR)及全身免疫炎症指数(SII)]、肿瘤标志物以及免疫功能指标(淋巴细胞计数、IL-2、IL-6、TNF-α和IFN-γ)等。使用单因素及多因素Logistic回归分析确定独立预测因子,并构建预测模型,采用Bootstrap法内部验证,计算校正后的曲线下面积及收缩因子,以优化模型性能。结果 多因素分析结果显示,IL-6(OR=1.116,95%CI:1.020~1.224)与CA125(OR=1.016,95%CI:1.006~1.026)为术后腹膜转移的独立预测因素,构建的预测模型区分能力良好,初始AUC为0.801(95%CI:0.702~0.900),经Bootstrap校正后AUC为0.797,模型校准度理想,具有良好的临床稳健性。结论 基于术前IL-6和CA125水平的预测模型,可用于评估胃癌患者根治术后发生腹膜转移的风险。该模型可在术前阶段有效识别高风险病例,为临床制定个体化辅助治疗方案及随访策略提供关键参考,并具有改善患者预后的潜在价值。
Objective To evaluate the predictive value of inflammatory,immune,and nutritional indicators for peritoneal metastasis after radical gastrectomy in gastric cancer and to establish a predictive model applicable for preoperative risk assessment.Methods Clinical data from 85 patients with advanced gastric cancer treated at Suzhou Municipal Hospital between 2022 and 2024 were retrospectively collected.Patients were divided into two groups based on postoperative peritoneal metastasis occurrence:a metastasis group(n=44)and a non-metastasis group(n=41).Indicators analyzed and compared between groups included nutritional parameters(serum albumin,fibrinogen,PNI),inflammatory markers(neutrophil count,CRP,NLR,SII),tumor markers and immune indicators(lymphocyte count,IL-2,IL-6,TNF-α,IFN-γ).Univariate and multivariate logistic regression analyses identified independent predictors for constructing the prediction model.Internal validation was performed using 1 000 bootstrap resamples to calculate the adjusted area under the curve(AUC)and shrinkage factor for model optimization.Results Multivariate analysis identified IL-6(OR=1.116,95%CI:1.020-1.224)and CA125(OR=1.016,95%CI:1.006-1.026) as independent predictors of postoperative peritoneal metastasis.The constructed predictive model demonstrated good discriminatory ability,with an initial AUC of 0.801(95%CI:0.702–0.900)and a bootstrap-corrected AUC of 0.797.The model exhibited ideal calibration and good clinical robustness.Conclusions This study established a predictive model based on preoperative IL-6 and CA125 levels to assess the risk of peritoneal metastasis after radical surgery in gastric cancer patients.The model effectively identifies high-risk cases preoperatively,providing critical guidance for developing individualized adjuvant treatment and follow-up strategies,with potential to improve patient prognosis.
目的 探讨降钙素原(PCT)联合营养指标对肝硬化营养状况的评定价值。方法 选取2021年2月—2022年3月在右江民族医学院附属医院感染科住院的140例肝硬化患者,根据营养风险筛查2002(NRS 2002)将其分为有营养风险组和无营养风险组。比较两组肝硬化患者中营养指标体质指数(BMI)、血红蛋白(HGB)、前白蛋白(PA)、白蛋白(ALB)、视黄醇结合蛋白(RBP)水平, 并分析它们与PCT的相关性。结果 BMI、HGB、ALB、PA及RBP水平低于低营养风险组(P<0.05); 营养指标(BMI、HGB、ALB、PA、RBP)与PCT呈负相关(P<0.05)。二元Logistics回归分析发现ALB、PCT是肝硬化患者营养风险的危险因素(P<0.05)。ROC结果显示PCT与ALB的联合营养指标评定肝硬化营养不良的曲线下面积为0.984,(95%CI:0.964~1.000), 灵敏度98.8%, 特异度93.3%, 约登指数0.921; ALB、PCT的AUC分别为0.919、0.974。结论 肝硬化患者PCT水平与其营养状况密切相关, 对营养状况的评定有一定的价值, 联合评定能有效提高其评定价值。
Objective To explore the value of procalcitonin(PCT)combined with nutritional indexes in evaluating the nutritional status of liver cirrhosis.Methods A total of 140 patients with cirrhosis admitted to the Department of Infection of the Affiliated Hospital of Youjiang Medical College for Nationalities from February 2021 to March 2022, they were selected and divided into with and without nutritional risk group according to nutritional risk screening 2002(NRS 2002).The levels of body mass index(BMI), hemoglobin(HGB), prealbumin(PA), albumin(ALB)and retinol binding protein(RBP)in two groups of patients with cirrhosis were compared, and the correlation between them and PCT was analyzed.Results The levels of BMI, HGB, ALB, PA and RBP were lower than those of low nutritional risk group(P<0.05).The nutritional indices(BMI, HGB, ALB, PA, RBP)were negatively correlated with PCT(P<0.05).Binary Logistics regression analysis showed that ALB and PCT were risk factors affecting nutritional risk in patients with cirrhosis(P<0.05).ROC results showed that the area under the curve was 0.984(95% confidence interval:0.964 ~ 1.000), sensitivity 98.8%, specificity 93.3%, and Yoden index 0.921 for the combined PCT and ALB indexes predicting malnutrition in cirrhosis.The AUC of ALB and PCT were 0.919 and 0.974, respectively.Conclusions The level of PCT in patients with cirrhosis is closely related to their nutritional status, which has certain value in the evaluation of nutritional status, and combined prediction can effectively improve the evaluation value.