载脂蛋白A-1、D-二聚体对转移性胃肠道癌临床预后的预测价值

Predictive value of apolipoprotein A-1 and D-dimer in the clinical prognosis of patients with metastatic gastrointestinal cancer

目的:评估血清载脂蛋白A-1(ApoA-1)、D-二聚体水平对转移性胃肠道癌临床预后的预测价值。方法:选取2015年1月~2019年10月收治的转移性胃肠道癌患者72例为研究对象。收集患者一般资料、临床资料、生化检验、凝血指标等。通过ROC曲线分析确定最佳诊断阈值;采用单因素和多因素Cox回归分析ApoA-1、D-二聚体水平对转移性胃肠道癌晚期患者生存的影响,同时用Kaplan-Meier方法评估生存时间。结果:单因素Cox回归分析结果显示,年龄、治疗方式、ApoA-1、ApoA-1/ApoB、D-二聚体与转移性胃肠道癌患者总生存率均有关(P<0.05);多因素Cox回归分析结果显示,高水平ApoA-1、低水平D-二聚体是转移性胃肠道癌患者预后的保护因素(P均<0.05)。高水平ApoA-1转移性胃肠道癌患者中位生存时间高于低水平者(20个月vs.10个月,P=0.005)。低水平D-二聚体转移性胃肠道癌患者中位生存时间高于高水平者(22个月vs.8个月,P<0.001)。结论:ApoA-1、D-二聚体对转移性胃肠道癌生存率有较好的预测价值,高水平ApoA-1、低水平D-二聚体可能是转移性胃肠道癌预后的良好指标。

Objective:To evaluate the value of serum apolipoprotein A-1(ApoA-1)and D-dimer levels in predicting the clinical prognosis of patients with metastatic gastrointestinal cancer.Methods:Seventy-two cases of metastatic gastrointestinal cancer in advanced stage,admitted to and treated in our center,were included from January 2015 to October 2019.The case data,including general information,medical records,biochemical test results and coagulation indicators,were collected.Receiver operator characteristic(ROC)curve was used to determine the optimal diagnostic cut-off point,and univariate Cox proportional hazard model and multivariate Cox proportional hazard model were used to analyze the effect of ApoA-1,ApoA-1/ApoB and D-dimer levels on the survival of the patients.Kaplan-Meier method was used to evaluate the survival time.Results:Univariate Cox regression analysis showed that age,treatment methods,ApoA-1,ApoA-1/ApoB and D-dimer levels were related to the overall survival rate of patients with metastatic gastrointestinal cancer(P<0.05),and multivariate Cox proportional hazard analysis revealed that higher ApoA-1 and lower D-dimer levels were protective factors for patients with metastatic gastrointestinal cancer(both P<0.05).Kaplan-Meier analysis demonstrated that the median survival time was significantly longer in patients with high ApoA-1 than in those with low ApoA-1(20 months vs.10 months,P=0.005).Patients with low D-dimer had longer median survival time than those with high D-dimer(8 months vs.22 months,P<0.001).Conclusion:ApoA-1 and D-dimer levels can be good predictive value for the survival rate of patients with metastatic gastrointestinal cancer.High ApoA-1 and low D-dimer may appropriately serve as indicator for estimating the prognosis of such patients.