目的 探讨血清游离甲状腺素(free triiodothyronine,FT4)及复合模型对颅咽管瘤(craniopharyngioma,CP)患者术后短期预后不良的预测价值.方法 回顾性分析2018-01/2023-11月于作者医院收治的95例CP患者术后的临床资料,根据患者出院后3个月回访的卡氏评分(Karnofsky,KPS)将患者分为预后良好组(KPS＞70分,n=46)与预后不良组(KPS≤70分,n=49).收集两组患者的临床资料,包括年龄、性别、体质量指数(body mass index,BMI)、高血压、糖尿病、尿崩、肿瘤大小相关因素及实验室检查等,并用二元Logistic冋归分析CP患者术后预后不良的影响因素,构建预测CP患者术后短期预后不良的复合模型.使用受试者工作特征(receiver operating characteristic,ROC)曲线、限制性立方样条模型(restricted cubic spline,RCS)、决策曲线评估术后血清FT4及复合模型对CP患者术后短期预后的预测价值.结果 单因素分析结果表明,两组患者年龄、肿瘤大小、BMI、尿崩、术前C反应蛋白、术后血清FT4差异均有统计学意义(P均＜0.05);二元Logistic回归分析结果显示,大肿瘤、BMI、尿崩是影响CP患者术后短期预后不良的独立危险因素(P均＜0.05),而术后FT4是其保护因素(P＜0.05).术后FT4和复合模型预测CP患者术后短期预后不良的ROC 曲线下面积(area under the curve,AUC)分别为 0.732(95％CI 为0.622～0.842)、0.972(95％CI 为 0.909～1.000).术后FT4与短期预后不良的关联强度表现为非线性剂量反应关系(P＜0.01).决策曲线结果显示,阈值概率为0.00～0.90时,复合模型比术后FT4的净获益率高.结论 大肿瘤、BMI、尿崩是影响CP患者术后短期预后不良的独立危险因素,FT4是其保护因素.复合模型比术后FT4更能预测CP患者术后短期预后不良的发生.
Prognostic Value of Serum Free Thyroxine and Composite Modeling for Postoperative Short-term Poor Prognosis in Patients with Craniopharyngioma
Objective To investigate the predictive value of serum free triiodothyronine(FT4)and composite mod-eling for postoperative short-term poor prognosis in patients with craniopharyngioma(CP).Methods The postoperative clinical data of 95 patients with CP admitted to the author's hospital from January 2018 to November 2023 were retrospec-tively analyzed,and the patients were divided into good prognosis group[Karnofsky(KPS)＞7,n=46]and poor prog-nosis group(KPS≤7,n=49)according to the KPS score of the follow-up visit at 3 months ofter discharge.Clinical data of the two groups were collected,including age,gender,body mass index(BMI),hypertension,diabetes mellitus,diabe-tes insipidus,tumor size and laboratory endocrine related tests,the influencing factors of poor prognosis of CP patients were analyzed by binary Logistic regression,a composite model predicting the poor prognosis in the short-term postopera-tive period in patients with CP was constructed.The predictive value of postoperative FT4 and the composite model for postoperative prognosis in CP patients was assessed using the receiver operator characteristic(ROC),restricted cubic spline(RCS)and decision curve.Results Univariate analysis showed that there were significant differences in age,tumor size,BMI,diabetes insipidus,preoperative C-reactive protein and postoperative serum FT4 between the two groups(all P＜0.05);the results of binary Logistic regression analysis showed that big tumor,BMI and diabetes insipidus were independent risk factors affecting poor short-term postoperative prognosis in CP patients(all P＜0.05),while the postoperative FT4 was a protective factor(P＜0.05).The ROC area under the curve(AUC)of postoperative FT4 and composite model for predicting poor short-term prognosis in CP patients was 0.732(95％CI:0.622-0.842)and 0.972(95％CI:0.909-1.000),respectively.The strength of association between postoperative FT4 and short-term poor prognosis showed a nonlinear dose-response relationship(P＜0.01).Decision curve results showed a higher net benefit of the composite model over postop-erative FT4 at threshold probabilities of 0.00-0.90.Conclusion Big tumor size,BMI and diabetes insipidus are independ-ent risk factors for poor short-term prognosis of CP patients after surgery,and FT4 is its protective factor.Composite model can predict the CP patients more than postoperative FT4 short-term prognosis after surgery.
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