C反应蛋白与白蛋白比值联合握力和血清前白蛋白在食管癌患者中的应用价值

Application value of C-reactive protein to albumin ratio combined with grip strength and serum prealbumin in patients with esophageal cancer

目的 探讨C反应蛋白与白蛋白比值(CAR)联合握力和血清前白蛋白对食管癌患者生存期及营养不良的预测价值。方法 回顾性选取212例食管癌患者作为研究对象,收集患者的基本资料和治疗前CAR、握力、血清前白蛋白检测结果,评估患者营养不良情况并随访总生存期。采用受试者工作特征(ROC)曲线评估治疗前CAR、握力和血清前白蛋白水平对患者营养不良的预测价值,采用Kaplan-Meier生存曲线及Cox回归模型分析治疗前CAR、握力和血清前白蛋白水平对患者生存预后的预测价值。结果 ROC曲线分析结果显示,握力预测食管癌患者营养不良的曲线下面积(0.625)最大,其后依次为血清前白蛋白、CAR(分别为0.604、0.594);根据约登指数确定CAR、握力、血清前白蛋白的最佳截断值分别为0.732、23.1 kg、0.190 g/L,三者联合预测营养不良的灵敏度高达80.7%。Kaplan-Meier生存曲线分析结果显示,CAR增高(≥0.732)、握力降低(<23.1 kg)、血清前白蛋白水平降低(<0.190 g/L)患者的总生存期分别短于CAR<0.732、握力≥23.1 kg、血清前白蛋白水平≥0.190 g/L的患者,差异有统计学意义(P<0.01);多因素Cox回归分析结果显示,治疗前CAR增高(≥0.732)、握力降低(<23.1 kg)、血清前白蛋白水平降低(<0.190 g/L)是食管癌患者生存预后不良的独立危险因素(P<0.05)。结论 治疗前CAR、握力和血清前白蛋白是评估食管癌患者营养状态和生存预后的重要指标,三者联合检测有助于营养不良的早期诊断与及时干预,或可改善食管癌患者的生存预后。

Objective To investigate the predictive value of the C-reactive protein to albumin ratio(CAR) combined with grip strength and serum prealbumin for survival and malnutritionin patients with esophageal cancer.Methods A total of 212 patients with esophageal cancer were selected as study objects,and baseline characteristics,pretreatment CAR,grip strength,and serum prealbumin results were collected.Nutritional status was assessed,and overall survival was followed up.Receiver operating characteristic(ROC) curves were used to evaluate the predictive value of pretreatment CAR,grip strength,and serum prealbumin for malnutrition.Kaplan-Meier survival curves and Cox regression models were employed to analyze their predictive value for survival outcomes.Results ROC curve analysis revealed that grip strength had the largest area under the curve(0.625) for predicting malnutritionin esophageal cancer patients,followed by serum prealbumin and CAR(0.604,0.594).Based on the Youden index,the optimal cut-off values for CAR,grip strength,and serum prealbumin were 0.732,23.1 kg,and 0.190 g/L,respectively.The sensitivity of the combined detection of three indicators was 80.7%.Kaplan-Meier survival curve analysis showed that patients with elevated CAR(≥0.732),reduced grip strength(<23.1 kg),and decreased serum prealbumin levels(<0.190 g/L)had shorter overall survival compared to those with CAR <0.732,grip strength ≥23.1 kg,and serum prealbumin levels ≥0.190 g/L,respectively(P <0.01).Multivariate Cox regression analysis identified elevated pretreatment CAR(≥0.732),reduced grip strength(<23.1 kg),and decreased serum prealbumin levels(<0.190 g/L) as independent risk factors for poor survival prognosis in esophageal cancer patients(P <0.05).Conclusion Pretreatment CAR,grip strength,and serum prealbumin are important indicators for assessing nutritional status and survival prognosis in esophageal cancer patients.Combined detection of these biomarkers may facilitate early diagnosis and timely intervene malnutrition,potentially improving survival outcomes in esophageal cancer patients.