胃癌患者术后低蛋白血症发生的影响因素及其Logistic回归方程的构建及其预测价值

Logistic Regression Equation Construction and Predictive Value of Influencing Factors of Postoperative Hypoproteinemia in Gastric Cancer Patients

目的探讨胃癌患者术后低蛋白血症发生的影响因素,并建立回归方程并分析其预测价值。方法回顾性分析,收集102例接受胃癌根治术的胃癌患者临床病历资料。根据术后7 d内所检测的白蛋白(ALB)水平评定术后低蛋白血症发生情况,并依据评定结果将患者分为发生组(n=32)和未发生组(n=70)。对比2组基线资料、临床资料及实验室指标,通过Logistic回归分析影响因素,并构建Logistic回归方程,通过受试者工作曲线(ROC)探讨预测价值。结果发生组肿瘤直径、合并糖尿病占比、术中输注晶体与胶体总量显著高于未发生组(P<0.05)。经Logistic回归分析结果显示,肿瘤直径、术中输注晶体与胶体总量、合并糖尿病是胃癌患者术后低蛋白血症发生的影响因素(OR>1,P<0.05)。将上述影响因素带入回归方程,得到Logist(P)=-27.349+1.001×肿瘤直径+0.015×术中输注晶体与胶体总量+1.300×合并糖尿病,对回归模型绘制Logist(P)的ROC曲线,得到曲线下面积(AUC)值为0.838,最佳截断值为0.584,敏感度为0.813,特异度为0.771。结论肿瘤直径、术中输注晶体与胶体总量、合并糖尿病是胃癌患者术后低蛋白血症发生的影响因素,根据上述指标所建立的预测模型有较好的预测价值。

Objective To explore the influencing factors of postoperative hypoproteinemia in patients with gastric cancer through Logistic regression,and establish regression equation to analyze its predictive value.Methods Retrospective analysis was conducted to collect clinical medical records of 102 gastric cancer patients who underwent radical gastrectomy.The incidence of postoperative hypoproteinemia was evaluated according to the albumin(ALB)level detected within 7 days after operation,and the patients were divided into the occurrence group(n=32)and the non occurrence group(n=70)according to the evaluation results.The baseline data,clinical data and laboratory indexes of the two groups were compared.The influencing factors were analyzed by Logistic regression,and the Logistic regression equation was constructed.The predictive value was discussed by receiver operating curve(ROC).Results The tumor diameter,the proportion of patients with diabetes and the total amount of crystalloid and colloid transfused during operation in the occurrence group were significantly higher than those in the non occurrence group(P<0.05).Logistic regression analysis showed that tumor diameter,total amount of crystalloid and colloid infused during operation,and diabetes were the influencing factors of postoperative hypoproteinemia in gastric cancer patients(OR>1,P<0.05).The above influencing factors were brought into the regression equation to obtain Logist(P)=-27.349+1.001×tumor diameter+0.015×total intraoperative infusion of crystals and colloids+1.300×diabetes.The ROC curve of Logist(P)was drawn for the regression model,and the area under the curve(AUC)value was 0.838,the best cutoff value was 0.584,the sensitivity was 0.813,and the specificity was 0.771.Conclusion Tumor diameter,the total amount of crystalloid and colloid transfused during operation,and diabetes are the influencing factors of postoperative hypoproteinemia in patients with gastric cancer.The prediction model based on the above indicators has good predictive value.