C反应蛋白比值对腹腔镜胃癌切除术后严重并发症的早期预测价值

The value of C-reactive protein ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer

目的探讨C反应蛋白(CRP)比值(术后第3天的CRP值/术后第1天CRP值)对预测腹腔镜胃癌切除术(LG)后严重并发症的临床价值。方法回顾性分析2015年1月至2020年1月期间在辽宁省健康产业集团阜新矿总医院普通外科行LG并具有完整随访资料的259例患者的临床资料。根据Clavien-Dindo(CD)分级系统将胃癌患者分为术后严重并发症组(n=41,15.8%)和非严重并发症组(n=218,84.2%);分析CRP比值与胃癌患者临床病理学特征的关系及其对LG后严重并发症的预测价值。结果CRP比值预测LG后严重并发症的最佳临界值为2.2,对应的受试者工作特征曲线下面积为0.766,其预测LG后严重并发症的灵敏度为63.2%,特异度为91.0%,阳性预测值为70.7%,阴性预测值为85.8%。根据CRP比值最佳临界值将患者分为高CRP比值组(>2.2,n=60)和低CRP比值组(≤2.2,n=199)。高CRP比值组患者中体质量指数≥25 kg/m2、术前伴有基础疾病、行全胃切除术、T3+T4期、TNMⅡ+Ⅲ期及术后合并严重并发症患者的比例均高于低CRP比值组(P<0.05)。多因素分析结果显示,术前伴有基础疾病[OR=3.624,95%CI(1.191,11.206),P=0.023]、TNM分期晚[OR=9.037,95%CI(1.729,47.226),P=0.009]和CRP比值>2.2[OR=20.473,95%CI(7.948,52.737),P<0.001]是导致LG后发生严重并发症的独立危险因素。结论当术后第3天与第1天的CRP比值>2.2时提示LG后存在发生严重并发症的风险,应予以足够重视。

Objective To investigate the clinical value of the C-reactive protein(CRP)ratio(CRP value on postoperative day 3/day 1)as an early predictor of postoperative severe complication after laparoscopic gastrectomy(LG)for gastric cancer.Methods This retrospective study examined the relationship between the occurrence of severe complication and the CRP ratio of 259 gastric cancer patients,who underwent LG in the Department of General Surgery of General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group from January 2015 to January 2020.According to Clavien-Dindo(CD)grading system,gastric cancer patients were divided into the severe postoperative complication group(n=41,15.8%)and the non-severe postoperative complication group(n=218,84.2%).The relationship between CRP ratio and clinicopathologic characteristics of patients and the predictive value of CRP ratio for severe complication were analyzed.Results The optimal cutoff value of CRP ratio of 2.2 offered 63.2%sensitivity,91.0%specificity,70.7%positive predictive value,and 85.8%negative predictive value for severe postoperative complication.The area under the receiver operating characteristic curve was 0.766.There had distinct differences(P<0.05)on body mass index,preoperative comorbidity,type of surgery,T stage,and TNM stage between the high CRP ratio group(CRP ratio>2.2,n=60)and the low CRP ratio group(CRP ratio≤2.2,n=199).Logistic regression showed that preoperative comorbidity[OR=3.624,95%CI(1.191,11.206),P=0.023],later of TNM stage[OR=9.037,95%CI(1.729,47.226),P=0.009],and CRP ratio >2.2 [OR=20.473, 95%CI (7.948, 52.737), P<0.001] were independent risk factors for postoperative severecomplication after LG. Conclusion There must to be paid enough attention to the CRP ratio >2.2 on the day 1 and 3after LG, it suggests that there might be a risk of severe postoperative complications.