食管癌患者围术期营养不良的多因素分析及预测模型建立

Multivariate regression analysis and predictive model establishment of perioperative malnutrition in esophageal cancer patients

目的:探讨影响食管癌患者围术期营养不良的相关因素,比较各因素对术后快速康复的影响,并建立风险预测模型。方法:收集2022年2月至2023年8月在郑州大学第一附属医院胸外科200例食管癌患者的资料,根据欧洲临床营养与代谢学会的诊断标准,将患者分为营养不良组68例和营养良好组132例,比较两组患者的临床资料。采用二元Logistic回归分析食管癌患者围术期发生营养不良的独立影响因素,并绘制受试工作者曲线(ROC),建立风险预测模型。结果:营养不良组年龄、新辅助放化疗、高血压、癌症家族史、血红蛋白、白蛋白、总胆固醇、Ⅱ~Ⅲ临床分期和术后放化疗分别为67.190±6.591、45(66.2)、38(35.2)、16(23.5)、115.235±13.318、40.706±2.701、3.781±0.863、44(64.7)、39(57.4),营养良好组分别为64.120±8.754、68(51.5)、41(20.1)、16(12.1)、127.455±16.218、42.170±4.301、4.221±0.809、68(51.5)、56(42.4),经单因素分析,以上指标是食管癌患者围术期营养不良的危险因素(t=-2.780、3.925、8.500、4.346、5.697、2.943、3.489、6.392、4.011,P<0.05)。二元Logistic回归分析显示,高龄、高血压、血红蛋白、和总胆固醇是独立危险因素[比值比(OR)=0.947、0.436、1.070、2.029,P<0.05]。血红蛋白和总胆固醇的ROC曲线显示:血红蛋白预测界值为119.5 g/L,敏感度为0.750,特异度为0.686。结论:高龄、高血压、血红蛋白和总胆固醇是导致食管癌患者围术期发生营养不良的多因素预测模型,其中最佳截断值为119.5 g/L的血红蛋白浓度有助于预测食管癌患者发生营养不良。

Objective To explore the related factors of perioperative malnutrition in patients with esophageal cancer,compare the influence of each factor on postoperative rapid recovery,and establish a risk prediction model.Methods The data of 200 patients with esophageal cancer in the Thoracic Surgery Department of the First Affiliated Hospital of Zhengzhou University from February 2022 to August 2023 were collected.According to the diagnostic criteria of the European Society of Clinical Nutrition and Metabolism,the patients were divided into a malnourished group(n=68)and a well-nourished group(n=132),and the clinical data of the two groups were compared.Binary Logistic regression was used to analyze the independent influencing factors of perioperative malnutrition in patients with esophageal cancer,and the ROC curve was drawn to establish the risk prediction model.Results Malnutrition group:Age,neoadjuvant chemoradiotherapy,hypertension,family history of cancer,hemoglobin,albumin,total cholesterol,Ⅱ-Ⅲclinical stage and postoperative chemoradiotherapy were 67.190±6.591,45(66.2),38(35.2),16(23.5),115.235±13.318,40.706±2.701,respectively 3.781±0.863,44(64.7),39(57.4),In the well-nourished group,the numbers were 64.120±8.754,68(51.5),41(20.1),16(12.1),127.455±16.218,42.170±4.301,4.221±0.809,68(51.5),56(42.4),respectively.The above indexes were risk factors for perioperative malnutrition in patients with esophageal cancer(t=-2.780,3.925,8.500,4.346,5.697,2.943,3.489,6.392,4.011,P<0.05).Binary Logistic regression analysis showed that old age,hypertension,hemoglobin,and total cholesterol were independent risk factors[odds ratio(OR)=0.947,0.436,1.070,2.029,P<0.05].The ROC curves of hemoglobin and total cholesterol showed that the prediction threshold of hemoglobin was 119.5 g/L,the sensitivity was 0.750,and the specificity was 0.686.Conclusion Elderly,hypertension,hemoglobin and total cholesterol are multifactor predictive models for perioperative malnutrition in patients with esophageal cancer.The optimal cut-off value of 119.5 g/L hemoglobin concentration can be used as predictive indexes for malnutrition in patients with esophageal cancer.