摘要
目的 探究老年原发性肝癌病人肝动脉化疗栓塞术(TACE)后感染影响因素并构建预测模型.方法 对南充市中心医院、营山县人民医院和北京大学深圳医院行TACE的老年中晚期原发性肝癌病人466例的临床资料进行回顾性分析,根据其术后是否发生感染分为感染组(92例)和未感染组(374例).分析老年原发性肝癌病人TACE术后发生感染的相关影响因素,构建术后感染的风险列线图模型,并评价该模型的预测能力.结果 两组病人合并糖尿病和低蛋白血症、Child-Pugh分级、手术时间、术中出血量、腹水、降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-8(IL-8)、碘化油剂量、加用补充栓塞材料等因素比较,差异均有统计学意义(x2=5.230～24.666,t=12.404～33.053,P＜0.05).多因素Logistic回归分析显示,合并糖尿病和低蛋白血症、Child-Pugh分级、手术时间、术中出血量、腹水、PCT、CRP、IL-8、碘化油剂量＞12 mL和加用补充栓塞材料等变量均是影响老年原发性肝癌病人TACE术后感染的独立危险因素(OR=1.649～2.322,95％CJ=(1.192～1.852)～(2.229～3.512),P＜0.05).根据回归分析构建病人TACE术后感染的风险列线图模型(Harrell's C指数=0.763,P＜0.05),该模型预测的风险预测值与实际值基本一致,校准曲线与标准曲线吻合度较好,ROC曲线下面积为0.811.结论 合并糖尿病和低蛋白血症、Child-Pugh分级、手术时间、术中出血量、腹水、PCT、CRP和1L-8等因素均是影响老年原发性肝癌病人TACE术后感染的独立危险因素,通过这些变量构建的TACE术后感染风险列线图模型具有较好的预测价值.
Abstract
Objective To investigate the influencing factors for infection after transcatheter arterial chemoembolization(TACE)in elderly patients with primary liver cancer,and to establish a predictive model.Methods A retrospective analysis was performed for the clinical data of 466 elderly patients with advanced primary liver cancer who underwent TACE in Nanchong Central Hospital,Yingshan people's Hospital,and Peking University Shenzhen Hospital,and according to the presence or absence of postoperative infection,they were divided into infection group with 92 patients and non-infection group with 374 patients.The influencing factors for infection in elderly patients with primary liver cancer after TACE were analyzed to construct a risk nomo-gram model for postoperative infection,and the predictive ability of the model was evaluated.Results There were significant differences between the two groups in comorbidity with diabetes mellitus and hypoproteinemia,Child-Pugh class,time of opera-tion,intraoperative blood loss,ascites,procalcitonin(PCT),C-reactive protein(CRP),interleukin-8(IL-8),dose of iodized oil,and the addition of supplementary embolic material(x2=5.230-24.666,t=12.404-33.053,P＜0.05).The multivariate Logistic regression analysis showed that comorbidity with diabetes mellitus and hypoproteinemia,Child-Pugh class,time of operation,in-traoperative blood loss,ascites,PCT,CRP,IL-8,dose of iodized oil,and the addition of supplementary embolic material were in-dependent risk factors for infection after TACE in elderly patients with primary liver cancer(OR=1.649-2.322,95％CI=1.192-1.852 to 2.229-3.512,P＜0.05).The risk nomogram model for infection after TACE was constructed based on the regression analysis(Harrell's C index=0.763,P＜0.05).The predicted risk value of the model was basically consistent with the actual value,and there was a good degree of fit between the calibration curve and the standard curve,with an area under the receiver operating charac-teristic curve of 0.811.Conclusion Comorbidity with diabetes mellitus and hypoproteinemia,Child-Pugh class,time of operation,intraoperative blood loss,ascites,PCT,CRP,and IL-8 are independent risk factors for infection after TACE in elderly patients with primary liver cancer,and the nomogram model established based on these factors has a relatively good value in predicting the risk of infection after TACE.
维普
万方数据