术前CRP/ALB比值对结直肠癌术后肠梗阻的预测价值研究

Research on the predictive value of preoperative CRP/ALB ratio for postoperative intestinal obstruction of colorectal cancer

目的 探讨术前血清C反应蛋白与清蛋白(CRP/ALB)比值(CAR)对患者术后肠梗阻发生的预测价值,以制定更好的临床诊治及护理决策。方法 回顾性收集2012年1月至2020年12月于联勤保障部队第923医院手术治疗的304例结直肠癌(CRC)患者的临床资料。采用Lasso logistic回归分析筛选CRC患者发生术后肠梗阻的相关危险因素、相关的特征绘制列线图并验证。结果 304例术后CRC患者中31例(10.2%)发生肠梗阻,经治疗后恢复良好。肠梗阻组术前CRP水平、CAR明显高于非肠梗阻组,在CAR对CRC患者术后肠梗阻发生的预测价值方面,受试者工作特征曲线下面积为0.695,差异有统计学意义(P=0.003)。CRP、CAR和手术方式是导致术后肠梗阻的主要原因。列线图评估与验证情况良好,模型一致性指数为0.817。决策曲线分析显示列线图具有临床应用价值。结论 该研究构建了包含CAR在内的预测CRC术后肠梗阻风险的列线图。该列线图可以帮助识别肠梗阻高危患者并促进术前决策优化。

Objective To investigate the predictive value of preoperative serum C-reactive protein to albumin(CRP/ALB) ratio(CAR) on postoperative intestinal obstruction in patients, so as to make better clinical diagnosis and nursing decisions.Methods The clinical data of 304 patients with colorectal cancer(CRC) who were operated in the hospital from January 2012 to December 2020 were retrospectively collected.The Lasso logistic regression analysis was used to screen the related risk factors and characteristics of postoperative intestinal obstruction in CRC patients, and to draw a nomogram and verify it.Results In the 304 cases postoperative CRC patients, 31(10.2%) developed intestinal obstruction and recovered well after treatment.The preoperative CRP level, CAR of the intestinal obstruction group was significantly higher than those of the non-intestinal obstruction group.In terms of the predictive value of CAR for postoperative intestinal obstruction of CRC patients, the area under the receiver operating characteristic curve of the subjects was 0.695,and the difference was statistically significant(P=0.003).The CRP,CAR,and surgical methods were the main causes of postoperative intestinal obstruction.The nomogram was well evaluated and verified, and the model consistency index was 0.817.Decision curve analysis showed that nomograms were clinically useful.Conclusion The study constructed a nomogram including CAR to predict the risk of intestinal obstruction after CRC.This nomogram can help identify high-risk patients with intestinal obstruction and promote preoperative decision-making.