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肝癌患者术后营养不良影响因素的Lasso-Logistic回归分析及列线图预测模型构建
作者:范兰兰  刘璐  殷淑芳  赵云  智晓旭  桂亮  孙慧敏 
单位:南京医科大学附属肿瘤医院/江苏省肿瘤医院/江苏省肿瘤防治研究所 普外科, 江苏 南京 210000
关键词:肝癌 营养不良 Lasso-Logistic回归 营养风险筛查评分 列线图 
分类号:R735.7
出版年·卷·期(页码):2024·43·第四期(531-539)
摘要:

目的: 采用Lasso-Logistic回归分析肝癌患者术后营养不良的影响因素,并进行列线图预测模型构建,为肝癌患者术后营养状况调整提供参考。方法: 选取2021年1月至2023年6月本院收治的460例肝癌手术患者,按照7:3分为训练队列和验证队列,根据患者主观整体评定量表评判患者术后营养状态,分为营养正常组和营养不良组,采用Lasso-Logistic回归分析其影响因素并构建列线图预测模型。结果: 训练队列与验证队列一般临床资料比较差异均无统计学意义(P>0.05)。Lasso-Logistic回归分析显示,年龄、术前体质量指数(BMI)、术前营养风险筛查评分(NRS2002)、贫血、糖尿病、肿瘤分期、白蛋白(ALB)、胰高血糖素样肽-1(GLP-1)、总胆汁酸(TBA)、甘胆酸(CG)均是训练队列中肝癌患者术后营养不良的独立影响因素(P<0.05)。ROC曲线显示,肝癌患者术后营养不良的列线图预测模型在训练队列、验证队列中预测的曲线下面积分别为0.873、0.902;校准曲线显示,该列线图模型在训练队列、验证队列中预测肝癌患者术后营养不良风险与实际风险状况基本一致。结论: 构建的列线图模型对肝癌患者术后营养不良预测价值较高,且有良好预测效用,但需要进一步的验证评估。

Objective: To analyze the influencing factors of postoperative malnutrition in patients with liver cancer by Lasso-Logistic regression, and to construct a nomogram prediction model to provide reference for the adjustment of postoperative nutritional status in patients with liver cancer. Methods: A total of 460 patients undergoing surgery for liver cancer in our hospital from January 2021 to June 2023 were selected and divided into a training cohort(322 cases) and a validation cohort(138 cases) according to a ratio of 7:3. The nutritional status of patients after surgery was evaluated according to the patients' subjective global rating(PG-SGA) scale, and the patients were divided into a normal nutrition group and a malnutrition group. Lasso-Logistic regression was used to analyze the influencing factors of postoperative malnutrition of liver cancer. The nomogram prediction model was constructed by rms package in the training cohort, and the predictive efficiency of the model was verified by receiver operating characteristic(ROC) curve, calibration curve and decision curve(DCA) in the validation cohort. Results: There was no statistically significant difference in general clinical data between the training queue and the validation queue(P>0.05). Lasso-Logistic regression analysis showed that age, preoperative body mass index(BMI), preoperative nutrition risk screening score(NRS2002), anemia, diabetes, tumor stage, albumin(ALB), glucagon like peptide-1(GLP-1), total bile acid(TBA), and glycocholic acid(CG) were all independent influencing factors for postoperative malnutrition of liver cancer patients in the training cohort(P<0.05). The ROC curve showed that the predicted area under the curve of the column chart prediction model for postoperative malnutrition in liver cancer surgery patients in the training and validation queues was 0.873 and 0.902, respectively. The calibration curve showed that the column chart model predicted the risk of postoperative malnutrition in liver cancer surgery patients in the training and validation queues, which was basically consistent with the actual risk status. Conclusion: The constructed nomogram model has high predictive value and good predictive utility for predicting postoperative malnutrition in patients with liver cancer surgery, but further validation and evaluation are needed.

参考文献:

[1] 王瑛,袁鹤立,赵利,等.伴营养不良风险的原发性肝癌患者临床特征及预后因素分析[J].中西医结合肝病杂志,2022,32(6):494-498.
[2] BULLOCK A F,GREENLEY S L,MCKENZIE G A G,et al.Relationship between markers of malnutrition and clinical outcomes in older adults with cancer:systematic review,narrative synthesis and meta-analysis[J].Eur J Clin Nutr,2020,74(11):1519-1535.
[3] 胡相友,易明超,卢攀.肝癌切除术和TACE治疗后肿瘤复发的预测模型构建与评估[J].现代医学,2022,50(1):41-46.
[4] OMIYA S,URADE T,KOMATSU S,et al.Impact of GLIM criteria-based malnutrition diagnosis on outcomes following liver resection for hepatocellular carcinoma[J].HPB (Oxford),2023,25(12):1555-1565.
[5] MIWA T,HANAI T,NISHIMURA K,et al.Usefulness of the Global Leadership Initiative on Malnutrition criteria to predict sarcopenia and mortality in patients with chronic liver disease[J].Hepatol Res,2022,52(11):928-936.
[6] 中华人民共和国国家卫生健康委员会医政医管局.原发性肝癌诊疗规范(2019年版)[J].临床肝胆病杂志,2020,36(2):277-292.
[7] 姚晶,李鸿,夏东.预后营养指数对原发性肝癌肝切除术后感染性并发症的预测价值[J].现代肿瘤医学,2022,30(16):2961-2964.
[8] 林赛短,王云,陈家诚,等.肝癌患者疾病接受度现状及影响因素分析[J].现代医学,2023,51(4):468-473.
[9] SALAS S,COTTET V,DOSSUS L,et al.Nutritional factors during and after cancer:impacts on survival and quality of life[J].Nutrients,2022,14(14):2958.
[10] 蒋婷婷,孙芳芳,曾湛,等.代谢相关脂肪性肝病相关肝癌研究进展[J].中国肝脏病杂志(电子版),2022,14(3):14-17.
[11] 徐婷,张存泰.免疫衰老和老年营养[J].中国临床保健杂志,2023,26(4):446-451.
[12] 尹倩,王桦,章桂芬,等.湖北钟祥市长寿老人贫血与营养状况相关性分析[J].中国临床保健杂志,2022,25(2):213-217.
[13] KOBUNE M.Diagnosis and treatment of anemia by malnutrition in the elderly[J].Rinsho Ketsueki,2023,64(9):900-907.
[14] BURGOS R,GARCÍA-ALMEIDA J M,MATÍA-MARTÍN P,et al.Malnutrition management of hospitalized patients with diabetes/hyperglycemia and COVID-19 infection[J].Rev Endocr Metab Disord,2022,23(2):205-213.
[15] 牟莉莎,龚涛,徐惠旎,等.中式改良DASH饮食对高血压合并2型糖尿病患者营养健康状况的影响研究[J].中国全科医学,2022,25(34):4304-4311.
[16] 杨君茹,何玲玲,高美欣,等.糖基化修饰在代谢相关脂肪性肝病中作用研究进展[J].中国肝脏病杂志(电子版),2022,14(4):20-27.
[17] 程洁,金琳琳,李勇华,等.NRS 2002与PG-SGA营养测评联合用于淋巴瘤患者营养风险评估的价值[J].中华保健医学杂志,2022,24(6):486-488.
[18] 韩辰宇,叶晓梅,张敏.重组人胰高血糖素样肽-1对2型糖尿病合并肥胖患者脂肪组织功能障碍的影响[J].临床内科杂志,2023,40(7):489-490.
[19] GARCÍA-CASARES N,GONZÁLEZ-GONZÁLEZ G,DE LA CRUZ-COSME C,et al.Effects of GLP-1 receptor agonists on neurological complications of diabetes[J].Rev Endocr Metab Disord,2023,24(4):655-672.
[20] SCHEEN A J.Dual GIP/GLP-1 receptor agonists:new advances for treating type-2 diabetes[J].Ann Endocrinol (Paris),2023,84(2):316-321.
[21] YABUT J M,DRUCKER D J.Glucagon-like peptide-1 receptor-based therapeutics for metabolic liver disease[J].Endocr Rev,2023,44(1):14-32.
[22] 周华.血清胰高血糖素样肽-1水平可预测新诊断2型糖尿病患者的颈动脉粥样硬化[J].内科急危重症杂志,2022,28(3):200-203.
[23] 蒋和平,王劢,吴国荣,等.血清缺氧诱导因子-1α、肾上腺髓质素前体、甘胆酸水平与老年慢性阻塞性肺疾病急性加重期患者肺功能损伤进展的相关性[J].实用临床医药杂志,2022,26(5):122-126.
[24] 汪学耀,张涛,荆成宝.血清总胆汁酸与甘胆酸水平诊断妊娠期肝内胆汁淤积症能力的Meta分析[J].现代检验医学杂志,2020,35(5):73-76.
[25] 喻茂文,汤洪波,陈建军,等.血清甘胆酸、总胆汁酸、胰高血糖素样肽-1在脂肪肝向肝癌转化中的意义及与机体糖脂代谢的关系探讨[J].中国医师进修杂志,2022,45(4):314-318.

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