围术期血磷浓度变化趋势对胃肠道恶性肿瘤患者术后吻合口瘘的预测价值  

The value of changes in perioperative serum phosphate levels in predicting postoperative anastomotic leakage in patients with gastrointestinal malignancy

作　　者：刘智龙 杨宇[2] 胡时栋[2] 晏阳[2] 赵鹏跃 李松岩[2] 杜晓辉[2] LIU Zhi-long;YANG Yu;HU Shi-dong;YAN Yang;ZHA Peng-yue;LI Song-yan;DU Xiao-hui(Department of General Surgery,Hainan Hospital,Chinese PLA General Hospital,Sanya,Hainan 572000,China;Department of General Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院海南医院普通外科,海南三亚572000 [2]解放军总医院第一医学中心普通外科,北京100853

出　　处：《军事医学》2022年第2期132-135,139,共5页Military Medical Sciences

基　　金：国家自然科学基金(81871317)。

摘　　要：目的 探究围术期血磷浓度变化趋势在胃肠道恶性肿瘤患者术后吻合口瘘中的预测效果。方法 回顾性分析解放军总医院第一医学中心普通外科384例胃肠道恶性肿瘤患者的临床病例资料。其中,发生吻合口瘘的60例患者作为观察组,未发生吻合口瘘的324例患者作为对照组,选取术前(pre-op)血磷浓度(P_(pre-op))、术后第1、3和5天血磷浓度(P_(POD1),P_(POD3) and P_(POD5))之间的变化值(P_(pre-op)/P_(POD1)、P_(POD1)/P_(POD3)和P_(POD3)/P_(POD5)比值)作为观察指标,比较两组围术期不同时间点血磷浓度的变化值之间的差异,绘制受试者工作特征(ROC)曲线和应用多因素Logistic回归分析其预测价值。依据多因素分析结果,运用R软件构建列线图风险预测模型,绘制校正曲线及计算一致性指数(C-index)验证其效能。结果 观察组P_(POD1)/P_(POD3)比值明显大于对照组,差异有统计学意义(P<0.001)。ROC曲线分析显示,当P_(POD1)/P_(POD3)比值为1.561时,敏感度和特异度最高,分别为61.7%、81.2%,曲线下面积为0.712。多因素Logistic回归分析显示,P_(POD1)/P_(POD3)比值(≥1.561)(P<0.001)和男性(P<0.05)是胃肠道恶性肿瘤患者术后吻合口瘘的独立危险因素。校正曲线显示,实际概率与预测概率的一致性较好,C-index为0.761(95%CI:0.701-0.821)。结论P_(POD1)/P_(POD3)比值可预测胃肠道恶性肿瘤患者术后吻合口瘘的发生。Objective To investigate the value of changes in perioperative serum phosphate levels in predicting postoperative anastomotic leakage in patients with gastrointestinal malignancy. Methods Clinical data on 384 patients with gastrointestinal malignancy in the First Medical Center of Chinese PLA General Hospital was retrospectively analyzed. The60 patients developing anastomotic leakage were chosen as the observation group,while another 324 patients without anastomotic leakage served as the control group.The ratio of serum phosphate levels of preoperation(P_(pre-op))/serum phosphate levels on postoperative day 1(P_(POD1)),P_(POD1)/P_(POD3) and P_(POD3)/P_(POD5)was calculated. The changes in perioperative phosphate levels were analyzed. The ROC curves and logistic regression analysis were performed to evaluate the prognostic values of changes of perioperative serum phosphate levels in predicting postoperative anastomotic leakage. According to the results of logistic regression analysis,the risk prediction model of the nomogram was constructed by R software,and validated by the calibration curve and concordance index(C-index). Results The P_(POD1)/P_(POD3) ratio of the observation group was significantly greater than that of the control group(P<0.001). The sensitivity and specificity were 61.7% and 81.2% at the ratio of 1.561 when the area under curve(AUC)was 0.712,respectively. Multiple Logistic regression analysis showed the P_(POD1)/P_(POD3) ratio(≥1.561)(P<0.001)and masculinity(P<0.05)as independent predictors associated with postoperative anastomotic leakage in patients with gastrointestinal malignancy. The calibration curve demonstrated good consistency between the predicted and actual probability,with a C-index of 0.761(95%CI:0.701-0.821). Conclusion The P_(POD1)/P_(POD3) ratio of gastrointestinal malignancy could potentially predict the occurrence of anastomotic leakage.

关 键 词：胃肠肿瘤 血磷浓度 吻合口瘘 预测 围手术期 

分 类 号：R735[医药卫生—肿瘤]