基于预后营养指数及总蛋白、血红蛋白、转铁蛋白水平建立预后评估模型在肝癌放疗和化疗患者中的应用效果

摘要/Abstract

摘要： 目的: 探究基于预后营养指数（PNI）及血清总蛋白（TP）、血红蛋白（Hb）、转铁蛋白（TF）水平建立预后评估模型在肝癌放疗和化疗患者中的应用效果。
方法: 依据入组标准选取河北北方学院附属第一医院2018年5月至2021年1月收治的肝癌放疗和化疗患者100例,采用实体瘤疗效评价标准将患者分为稳定组（46例）和进展组（54例）。检测所有患者血清TP、白蛋白、Hb、TF水平,并根据其血生化检测结果计算患者PNI。使用多因素Logistic回归分析PNI、TP、Hb、TF水平对肝癌放疗和化疗患者预后的影响。建立PNI联合TP、Hb、TF的预后评估模型。观察不同基线资料、临床资料患者预后评估模型最终得分,并使用受试者操作特征（ROC）曲线评估该模型对患者预后的预测价值。
结果: 稳定组的PNI、TP、Hb水平显著高于进展组,TF水平显著低于进展组（均P<0.05）。多因素Logistic回归分析结果显示PNI、TP、TF、Hb均是影响患者预后的因素（均P<0.05）。预后评估模型结果显示年龄>60岁、肿瘤数量>3个、最大肿瘤直径>5 cm患者的预后较差（均P<0.05）,不同性别、是否手术切除患者的预后差异均无统计学意义（均P>0.05）;合并并发症、生存时间<1年、疾病进展患者预后较差（均P<0.05）,是否复发和转移患者预后差异无统计学意义（均P>0.05）。ROC曲线显示预后评估模型截断值为0.621,此时预测敏感度为87.04%,特异度为86.96%,ROC曲线下面积为0.913。
结论: 肝癌放疗和化疗患者预后与其PNI及TP、Hb、TF水平具有密切联系,且PNI联合TP、Hb、TF水平建立预后评估模型对患者预后评估具有较高敏感度、特异度。

关键词: 预后营养指数, 总蛋白, 血红蛋白, 转铁蛋白, 预后评估模型, 肝癌, 放疗, 化疗, 预后

Abstract: Objective:To explore the application effect of establishing a prognostic evaluation model based on prognostic nutritional index(PNI) and total protein (TP), hemoglobin (Hb), transferrin (TF) levels in patients with liver cancer radiotherapy and chemotherapy.
Methods:According to enrollment criteria,the research subjects selected a total of 100 patients with liver cancer treated with radiotherapy and chemotherapy in First Affiliated Hospital of Hebei North University from May 2018 to January 2021. According to the prognosis of the patients, they were divided into a stable group (46 cases) and a progressive group (54 cases). The levels of TP, ALB, Hb, and TF were detected, and the PNI was calculated according to their blood biochemical test results. Multivariate Logistic regression was used. The correlation between PNI, TP, Hb, TF levels and patient prognosis was analyzed, and prognostic evaluation model of PNI combined with TP, Hb and TF was established. The final scores of the patient outcome assessment model were observed for different baseline and clinical data, and the predictive value of prognostic evaluation model was assessed using the receiver operating characteristic (ROC) curve.
Results:The PNI, TP and Hb levels of the two groups in the stable group were significantly higher than those in the progressive group, and the TF level was significantly lower than that in the progressive group (all P<0.05). is an independent risk factor affecting the prognosis of patients (all P<0.05); the results of the prognostic evaluation model in patients with age greater than 60 years, the number of tumors greater than 3, and the largest tumor diameter greater than 5 cm were significantly lower (all P<0.05). There was no significant difference in the results (all P>0.05); the results of the prognostic evaluation model in patients with complications, survival less than 1 year, and disease progression were significantly lower (all P<0.05), and there was no statistical difference in the prognostic evaluation model results in patients with recurrence and metastasis. (all P>0.05). ROC curve showed that the cut-off value of the prognostic evaluation model was 0.621, and the predictive sensitivity was 87.04% and the specificity was 86.96%. The area under the curve is 0.913. Conclusion:The prognosis of patients with liver cancer radiotherapy and chemotherapy is closely related to the nutritional index and the levels of TP, Hb and TF, and the nutritional index combined with the levels of TP, Hb and TF to establish a prognostic evaluation model has high sensitivity and specificity for the prognosis evaluation of patients.

Key words: Prognostic nutritional index, Total protein, Hemoglobin, Transferrin, Prognostic evaluation model, Liver cancer, Radiotherapy, Chemotherapy, Prognosis

任东静, 马海燕, 郭飞. 基于预后营养指数及总蛋白、血红蛋白、转铁蛋白水平建立预后评估模型在肝癌放疗和化疗患者中的应用效果[J]. 肝癌电子杂志, 2023, 10(4): 38-41.

Ren Dongjing, Ma Haiyan, Guo Fei. Application effect of establishing prognostic evaluation model based on prognostic nutritional index and total protein, hemoglobin, transferrin levels in patients with liver cancer radiotherapy and chemotherapy[J]. Electronic Journal of Liver Tumor, 2023, 10(4): 38-41.

参考文献

[1] 王月波,陈加源.CT及MRI对原发性肝癌经导管肝动脉化疗栓塞术后疗效评估的对比[J].实用医学杂志,2017,33(18):3110-3114.
[2] 张典,姜凤良,胡志芳,等.原发性肝癌的预防措施[J].中国老年学杂志,2018(17):4317-4319.
[3] 杨耕夫, 余松远. 微波消融/阿帕替尼治疗中晚期肝细胞癌的研究进展[J/CD]. 消化肿瘤杂志(电子版), 2019, 11(3):190-194.
[4] PHILLIPS W T, BAO A, BRENNER A J, et al.Image-guided interventional therapy for cancer with radiotherapeutic nanoparticles[J]. Adv Drug Deliv Rev, 2014, 76(4):39-59.
[5] 赵彦,祝淑钗,宋春洋,等. 放疗前预后营养指数对临床Ⅲ期食管癌患者生存的影响分析[J]. 中华放射医学与防护杂志,2021,41(6):426-430.
[6] 谌小春,张真真,谢晓莺,等.预后营养指数与靶向治疗中晚期肝癌患者的预后关系[J].中国临床医学,2021,28(3):476-481.
[7] 翁敏,代正燕,王昆华. 肝癌患者不同疾病状态时的营养治疗[J/CD]. 肿瘤代谢与营养电子杂志,2022,9(1):1-6.
[8] 周健国,黄彪,范文川,等.肝癌患者围手术期营养风险和营养支持状况的研究[J].中国医师进修杂志,2021,44(9):838-841.
[9] 肖慧娟,张明,齐玉梅,等.相位角与原发性肝癌患者营养状况及临床结局的关系[J].肿瘤防治研究,2021,48(5):503-507.
[10] 邹添添,覃伟,朱迎,等. 肝癌免疫微环境与免疫治疗:研究进展与发展趋势[J]. 中国普通外科杂志,2020,29(7):785-797.
[11] 李娟,周丽娟,李海霞,等.预后营养指数对肝癌术后患者病情进展的预测价值[J].中国现代普通外科进展,2020,23(12):992-995.
[12] 吴婧文,于学娟,杨秋安.小野寺预后营养指数与食管鳞癌同步放化疗不良反应的相关性研究[J].中国癌症杂志,2020,30(7):525-530
[13] 朱润,蒋圣军,隋韬,等.血液炎症-营养指标在晚期肝癌患者的预后价值研究[J].结直肠肛门外科,2021,27(S01):45-46.
[14] 李娟,周丽娟,李海霞,等. 预后营养指数对肝癌术后患者病情进展的预测价值[J]. 中国现代普通外科进展,2020,23(12):992-995.

[1]	刘少卿, 齐曼. 晚期肝癌患者信号转导子和激活子3、微小核糖核苷酸-200表达与程序性细胞死亡配体1关联性及在程序性细胞死亡配体1抑制剂抵抗中的作用[J]. 肝癌电子杂志, 2023, 10(4): 55-59.
[2]	李慧民, 依荷芭丽·迟, 许晓英, 谭慧晶. 颅内孤立性纤维肿瘤/血管外皮细胞瘤复发伴肝、肺、骨多发转移1例及文献复习[J]. 肝癌电子杂志, 2023, 10(4): 68-71.
[3]	范卫君. 原发性肝癌血管介入治疗研究现状概述[J]. 肝癌电子杂志, 2023, 10(3): 27-30.
[4]	任志忠, 岳元勋, 汪桠琴, 王雅静, 张跃伟. 微粒-经导管动脉化疗栓塞治疗肝细胞癌外周血程序性死亡受体1表达及临床意义初探[J]. 肝癌电子杂志, 2023, 10(3): 48-51.
[5]	王瑜, 童列杏, 康婉英, 丁鑫, 钱和生. 机器学习识别肝细胞癌骨转移驱动基因及体外放疗分析[J]. 肝癌电子杂志, 2023, 10(3): 64-75.
[6]	潘文冰, 陆瑶, 李岩, 史卓林, 刘玉娣. 基于循证医学的叙事护理模式对原发性肝癌患者经导管动脉化疗栓塞术后早期离床活动和依从性的影响[J]. 肝癌电子杂志, 2023, 10(3): 89-92.
[7]	陈晓, 毛一雷, 邵国良. 仑伐替尼联合经导管动脉化疗栓塞术一线治疗晚期肝细胞癌：Ⅲ期随机临床试验（LAUNCH）[J]. 肝癌电子杂志, 2023, 10(2): 1-6.
[8]	卞涛, 秦峰, 王胜杰, 王会, 韩山山. 微小RNA-551a参与晚期肝细胞癌患者索拉非尼应答机制研究[J]. 肝癌电子杂志, 2023, 10(2): 16-26.
[9]	郭雪蓉, 曹凌, 张瑞锋, 王昕琛, 乔楠, 张永贞. 2019年山西省肿瘤登记地区肝癌发病与死亡情况分析[J]. 肝癌电子杂志, 2023, 10(2): 27-32.
[10]	余晨曦, 姚雪松. 自噬在肝癌介入治疗中的研究进展[J]. 肝癌电子杂志, 2023, 10(2): 33-36.
[11]	谷兴璐, 赵晓航, 孙玉琳. 组蛋白去乙酰化酶抑制剂伏立诺他抑制肝癌细胞生长的机制[J]. 肝癌电子杂志, 2023, 10(1): 15-24.
[12]	孙弟波, 马海燕, 郭飞, 武雪亮. 原发性肝癌患者营养状态与肌肉减少症的关系[J]. 肝癌电子杂志, 2023, 10(1): 25-30.
[13]	宋天强. 肝癌新辅助治疗的热点与经验分享[J]. 肝癌电子杂志, 2023, 10(1): 53-56.
[14]	曾昭冲. 原发性肝癌立体定向放射治疗进展[J]. 肝癌电子杂志, 2022, 9(4): 12-14.
[15]	单天昊, 安澜, 徐梦圆, 曾红梅, 蔡建强. 2020年全球肝癌和胆囊癌发病死亡分析[J]. 肝癌电子杂志, 2022, 9(4): 46-51.