原发性肝癌CA125水平与CONUT评分的关系研究

Relationship between CA125 level and CONUT score in primary liver cancer

目的 探讨原发性肝癌糖类抗原(CA)125水平与控制营养状况(CONUT)评分的关系。方法 选择2016年1月至2020年1月于南昌大学第一附属医院确诊为原发性肝癌的195例患者为肝癌组和195例体检健康者为对照组。将CONUT评分<3分记为营养正常(营养正常组,90例),CONUT评分≥3分记为营养不良(营养不良组,105例)。收集并比较各组临床资料和CA125、白蛋白、淋巴细胞计数、胆固醇水平,采用Spearman相关分析肝癌患者营养状态与CA125的相关性,采用多因素Logistic回归分析肝癌合并营养不良的影响因素,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)以评估CA125判断肝癌合并营养不良的能力。结果 肝癌组CA125水平高于对照组(P<0.05),而淋巴细胞计数、胆固醇水平低于对照组,差异均有统计学意义(P<0.05);营养不良组Child-Pugh评分及CA125水平均高于营养正常组,差异有统计学意义(P<0.05)。Spearman相关分析显示,CA125水平与CONUT评分、Child-Pugh评分均呈正相关(r=0.657、0.647,P<0.001),与白蛋白、淋巴细胞计数、胆固醇水平均呈负相关(r=-0.623、-0.420、-0.272,P<0.001)。不同CA125水平肝癌患者COUNT评分及营养不良发生率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,CA125水平升高(≥35 U/mL)是肝癌发生营养不良的危险因素(OR=5.560,P=0.002)。ROC曲线结果显示,CA125水平判断肝癌合并营养不良的AUC为0.826(95%CI 0.768~0.884),CA125最佳临界值为25.99 U/mL时,其诊断灵敏度为73.5%,特异度为81.1%。结论 原发性肝癌患者CA125水平与营养状态有一定关系,且CA125水平升高为肝癌合并营养不良的危险因素。

Objective To investigate the relationship between carbohydrate antigen(CA)125 level and controlling nutritional status(CONUT)score in patients with primary liver cancer.Methods A total of 195 patients diagnosed with primary liver cancer in the First Affiliated Hospital of Nanchang University from January 2016 to January 2020 were selected as the liver cancer group,and 195 healthy people were selected as the control group.CONUT score<3 points were defined as normal nutrition(normal nutrition group,90 cases),CONUT score≥3 points were defined as malnutrition(malnutrition group,105 cases).The clinical data and levels of CA125,albumin,lymphocyte count and cholesterol in each group were collected and compared.Spearman correlation analysis was used to analyze the correlation between nutritional status and CA125,and multivariate Logistic regression analysis was used to analyze the influencing factors of liver cancer combined with malnutrition.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the ability of CA125 to distinguish malnutrition.Results The level of CA125 in the liver cancer group was higher than that in the control group(P<0.05),while the lymphocyte count and cholesterol level were lower than those in the control group(P<0.05).The Child-Pugh score and CA125 level of the malnutrition group were higher than those of the normal nutrition group,and the differences were statistically significant(P<0.05).Spearman correlation analysis showed that CA125 level was positively correlated with CONUT score and Child-Pugh score(r=0.657,0.647,P<0.001),and it was negatively correlated with albumin,lymphocyte count and cholesterol level(r=-0.623,-0.420,-0.272,P<0.001).There were significant differences in the COUNT score and the incidence of malnutrition among liver cancer patients with different CA125 levels (P <0.05).Multivariate Logistic regression analysis showed thatelevated CA125 level (≥35 U/mL) was a risk factor for malnutrition in hepatocellular carcinoma (OR=5.560,P =0.002).The ROC curve showed that the AUC of CA125 in the diagnosis of liver cancer combinedwith malnutrition was 0.826 (95%CI 0.768-0.884),the cut-off value of CA125 was 25.99 U/mL,the diagnosticsensitivity was 73.5%,and the specificity was 81.1%.Conclusion There is a certain relationship betweenCA125 level and nutritional status in patients with primary liver cancer,and the elevated CA125 level isa risk factor for hepatocellular carcinoma complicated with malnutrition.