胃癌患者术前氨基转移酶和胆红素及白蛋白水平对预测生存预后的临床意义

Clinical significance of preoperative aminotransferase,BIL and ALB levels in predicting survival prognosis in patients with gastric cancer

目的探讨胃癌患者术前血液中氨基转移酶、白蛋白、胆红素及体质指数(BMI)水平与临床和病理特征的关系及其对生存预后的影响。方法收集310例胃癌患者的临床资料并随访151个月;应用Cox单因素和Cox多因素回归模型分析影响胃癌患者生存预后的独立危险因素;应用Kaplan-Meier法分析各指标对胃癌患者生存预后的影响。结果(1)影响胃癌患者生存的独立危险因素有:胃癌晚期Ⅲ+Ⅳ(P<0.001)、DBIL>3.4μmol/L(P=0.026)、ALB<40g/L(P=0.033)、ALT(男性>50IU/L或女性>40IU/L)(P=0.024)。(2)异常水平的ALT(P=0.048)、AST(P=0.045)、DBIL(P=0.02)及ALB(P=0.002)分别是影响胃癌患者生存预后的不良因素。结论研究发现ALT和A/G的水平与胃癌患者生存预后相关,并验证了AST、ALB、DBIL和BMI的水平也可影响其生存预后。由此提出:临床医生可参考以上术前指标为患者设计最佳个体化治疗方案,为提高患者术后生活质量及延长生存时间创造有利条件。

Objective To investigate relationships of the preoperative blood levels of aminotransferase,albumin,bilirubin and body mass index(BMI)with clinical and pathological features and survival prognosis in patients with gastric cancer(GC).Methods We collected clinical data from 310 patients with gastric cancer and followed up for 151 months.Cox univariate and multivariate regression analyses were used to analyze independent risk factors for survival prognosis in patients with gastric cancer.We used the Kaplan-Meier method to analyze the indexes about the survival prognosis of GC patients.Results(1)The independent risk factors which affect the survival prognosis of GC patients were as follows:TNM stages(Ⅲ+Ⅳ)(P<0.001),DBIL>3.4μmol/L(P=0.026),ALB<40 g/L(P=0.033),ALT(>50 IU/L in males or>40 IU/L in females)(P=0.024);(2)Abnormal levels of ALT(P=0.048),AST(P=0.045),DBIL(P=0.02),and ALB(P=0.002)were adverse factors affecting the survival prognosis of patients with gastric cancer.Conclusions We found that levels of ALT and A/G are associated with survival prognosis in patients with gastric cancer and verified that the levels of AST,ALB,DBIL and BMI can also affect their survival prognosis.This study proposes:Clinicians can refer to the above preoperative indicators to design the best individualized treatment plan for patients,and create favorable conditions for improving the quality of life and prolonging the survival time of patients.