胃癌术后营养不良风险预测模型的构建及验证

Establishment and verification of the risk prediction model for malnutrition after gastrectomy

目的分析胃癌术后3个月出现营养不良的危险因素并建立预测模型。方法选取2017年7月~2019年3月我院手术治疗的263例胃癌患者,采用患者主观整体评估量表(Patient-generated subjective globe assessment,PGSGA)评估患者的营养状态。建立营养不良的风险预测模型,并选取58例患者验证预测模型的效果。结果胃癌术后3个月有60例(22.8%)患者出现营养不良。单因素分析显示年龄、术前营养不良、全胃切除、术后并发症以及术后辅助化疗是发生术后营养不良的危险因素(P<0.05)。多因素分析显示年龄、术前营养不良、全胃切除、术后并发症以及术后辅助化疗是术后营养不良的独立危险因素(P<0.05)。本模型ROC曲线下面积为0.849,灵敏度为81.3%,特异度为80.0%。模型验证结果:灵敏度为80.0%,特异度为89.6%,提示其预测效果较好。结论胃癌术后营养不良的发生率较高,医护人员可根据预测模型判断患者营养不良的发生风险,及时对高危患者采取强化营养支持。

Objective To analyze the risk factors of malnutrition 3 months after operation of gastric cancer and establish a risk prediction model for malnutrition.Methods A total of 263 patients with gastric cancer who were treated in our hospital from Jul 2017 to Mar 2019 were selected.The patient-generated subjective globe assessment(PG-SGA)was used to assess the nutritional status of the patients.A risk prediction model for malnutrition was established,and 58 patients were selected to verify the effect of the prediction model.Results A total of 60(22.8%)patients with gastric cancer occured malnutrition 3 months after gastrectomy.Univariate analysis showed that age,preoperative malnutrition,total gastrectomy,postoperative complications and postoperative adjuvant chemotherapy were risk factors for postoperative malnutrition(P<0.05).Multivariate analysis showed that age,preoperative malnutrition,total gastrectomy,postoperative complications and postoperative adjuvant chemotherapy were independent risk factors for postoperative malnutrition(P<0.05).The area under ROC curve of this model was 0.849,the sensitivity was 81.3%and the specificity was 80.0%.Model verification results showed that the sensitivity was 80.0%,the specificity was 89.6%,it suggested that the prediction effect was better.Conclusion The incidence of malnutrition after gastrectomy is high.Medical staff can judge the risk of malnutrition in patients according to the prediction model,and promptly adopt intensive nutritional support for high-risk patients.