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肝癌患者放化疗后营养不良风险预测列线图模型构建及验证研究
张 莎,王九萍,杨 进
空军军医大学第一附属医院(西京医院) 感染性疾病科,陕西 西安 710032
Construction and validation of nomogram model for risk prediction of malnutrition in patients with liver cancer after radiotherapy and chemotherapy
Zhang Sha, Wang Jiuping, Yang Jin
Department of Infection Xijing Hospital Xi'an 710032 Shaanxi China
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摘要 目的 探讨肝癌患者放化疗后出现营养不良的影响因素,并基于列线图构建风险预测模型。 方法 选取 2019 年 6 月 至 2020 年 12 月于空军军医大学第一附属医院(西京医院)接受放化疗且随访至 2023 年 12 月的肝癌患者 155 例作为研究对 象,按照放化疗后有无出现营养不良分为营养不良组(n = 49)和非营养不良组( n = 106),对比基线资料,分析放化疗后出现营 养不良的危险因素,并构建列线图预测模型。 结果 营养不良组和非营养不良组在年龄、TNM 分期、门静脉癌栓、分化程度、淋 巴结转移、吞咽功能障碍、消化道症状条目、白蛋白、血红蛋白等基线资料比较,差异具有统计学意义(P<0. 05)。 多因素 Logistic 回归分析显示,门静脉癌栓、低分化、淋巴结转移、吞咽功能障碍、消化道症状条目≥2 个、白蛋白<40 g / L、血红蛋白<110 g / L 是影 响肝癌患者放化疗后出现营养不良的危险因素(P<0. 05)。 受试者操作特征(ROC)曲线分析显示,列线图预测模型预测肝癌 患者放化疗后出现营养不良的 ROC 曲线的曲线下面积(AUC)为 0. 936,敏感度为 0. 880,特异度为 0. 984。 结论 门静脉癌栓、低分化、淋巴结转移、吞咽功能障碍、消化道症状≥2 个、白蛋白<40 g / L、血红蛋白<110 g / L 会对肝癌患者放化疗后出现营养不良产生影响,依据这些危险因素构建列线图模型对预测营养不良具有一定价值,进而制订防治措施。
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张 莎
王九萍
杨 进
关键词 ： 肝癌,  动脉栓塞化疗,  三维适形放射治疗,  营养不良,  列线图模型,  营养干预,  康复护理,  预后    
Abstract：Objective To investigate the influencing factors of malnutrition in patients with liver cancer after radiotherapy and chemotherapy and to build a risk prediction model based on the column graph. Method A total of 155 patients with liver cancer who received radiotherapy and chemotherapy in the First Affiliated Hospital of Air Force Military Medical University Xijing Hospital from June 2019 to December 2020 and were followed up until December 2023 were selected as the study objects. According to whether there was malnutrition after radiotherapy and chemotherapy they were divided into the malnourished group n = 49 and the non - malnourished group n = 106 . Compared with baseline data the risk factors of malnutrition after chemoradiotherapy were analyzed and the prediction model was constructed with a nomogram. Result There were significant differences in age TNM stage portal vein cancer thrombus differentiation degree lymph node metastasis swallowing dysfunction gastrointestinal symptoms albumin hemoglobin and other baseline data between the malnutrition group and the non -malnutrition group P< 0. 05 . Logistic regression analysis showed that portal vein cancer thrombus low differentiation lymph node metastasis swallowing dysfunction gastrointestinal symptoms ≥2 items albumin < 40 g / L hemoglobin <110 g / L were the risk factors for malnutrition in patients with liver cancer after radiotherapy and chemotherapy P< 0. 05 . ROC curve analysis showed that the ROC curve of the line chart prediction model for predicting nutritional malnutrition in liver cancer patients after chemoradiotherapy had an area under the curve AUC is 0. 936 the sensitivity is 0. 880 and the specificity is 0. 984. Conclusion Portal vein cancer thrombolus low differentiation lymph node metastasis swallowing dysfunction digestive tract symptom items≥2 albumin <40 g / L hemoglobin <110 g / L may have an impact on malnutrition after radiotherapy and chemotherapy in patients with liver cancer. The construction of a nomogram model based on these risk factors is of certain value in predicting malnutrition so as to formulate prevention and treatment measures.
Key words： Liver cancer    Arterial embolization chemotherapy    3-dimensional conformal radiation therapy    Malnutrition    Nomogram model    Nutrition intervention    Rehabilitation nursing    Prognosis
    
基金资助:西安市科技创新计划项目(2022JQ1018)
通讯作者: 杨 进,电子邮箱:zs180668@163.com   
引用本文:   
张 莎,王九萍,杨 进. 肝癌患者放化疗后营养不良风险预测列线图模型构建及验证研究[J]. 肿瘤代谢与营养电子杂志, 2024, 11(5): 698-705.
Zhang Sha, Wang Jiuping, Yang Jin. Construction and validation of nomogram model for risk prediction of malnutrition in patients with liver cancer after radiotherapy and chemotherapy. Electron J Metab Nutr Cancer, 2024, 11(5): 698-705.