肝细胞癌病人介入术后急性严重腹痛发生危险因素及预测模型构建  

Risk factors for moderate and severe acute abdominal pain in patients with HCC after TACE and predictive model establishment

作　　者：赵宇亮 王魁彬[1] 刘智慧[1] 贾艳红 秦春堂[1] ZHAO Yuliang;WANG Kuibin;LIU Zhihui;JIA Yanhong;QIN Chuntang(The 2nd Digestive District,The Second People's Hospital of Jiaozuo,Jiaozuo,Henan 454100,China)

机构地区：[1]焦作市第二人民医院消化二科,河南焦作454100

出　　处：《安徽医药》2023年第2期366-369,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨肝细胞癌(HCC)病人肝动脉插管化疗栓塞(TACE)术后急性严重腹痛发生危险因素。方法回顾性分析2017年1月至2020年9月于焦作市第二人民医院行TACE治疗的HCC病人共178例临床资料,根据TACE术后急性严重腹痛发生情况分为急性严重腹痛组和非急性严重腹痛组,采用单因素和多因素法评价HCC病人TACE术后急性严重腹痛发生风险独立影响因素,并基于此构建预测模型。结果178例病人TACE术后24 h内发生急性严重腹痛28例,发生率为15.73%;急性严重腹痛组初治比例、病灶最大径>5 cm比例、病灶数量≥3个比例、病灶侵犯血管比例、既往TACE术后中重度腹痛史比例及接受载药微球TACE比例分别为75.00%(21/28),64.29%(18/28),75.00%(21/28),46.43%(13/28),28.57%(8/28),60.71%(17/28),显著高于非急性严重腹痛组的57.62%(87/151),39.07%(59/151),50.99%(77/151),25.17%(38/151),11.92%(18/151),33.77%(51/151)(P<0.05);急性严重腹痛组既往TACE治疗史比例为39.29%(11/28),显著少于非急性严重腹痛组的62.25%(94/151)(P<0.05);多因素分析结果显示,肝内多发肿瘤病灶、既往TACE术后腹痛史、既往TACE治疗史及TACE类型均是HCC病人TACE术后急性严重腹痛发生风险独立影响因素(P<0.05);TACE术后急性中重度腹痛发生风险预测模型ROC曲线分析结果显示,AUC=0.81,95%CI:(0.75,0.88),最佳截断值为0.49,灵敏度和特异度分别为75.86%,73.10%。结论HCC病人TACE术后急性严重腹痛发生风险与肝内多发肿瘤病灶、既往TACE术后腹痛史、既往TACE治疗史及TACE类型独立相关,基于此构建预测模型具有良好预测效能。Objective To investigate the risk factors for moderate and severe acute abdominal pain in patients with HCC after TACE.Methods Clinical data of 178 patients with HCC after TACE were retrospectively chosen in the Second People's Hospital of Jiaozuo from January 2017 to September 2020.All patients were grouped according to the incidence of moderate and severe acute abdominal pain after TACE and the independent risk factors for moderate and severe acute abdominal pain after TACE were evaluated by univariate and multivariate methods to establish the predictive model.Results Twenty-eight cases in 178 patients had moderate or severe acute abdominal pain within 24 hours after TACE and the incidence rate was 15.73%.The proportion of initial treatment cases,lesions with the maximum diameter of>5 cm,lesions number≥3,lesions invading blood vessels,the history of moderate and severe abdominal pain after TACE and patients receiving drug loaded microspheres TACE in acute severe abdominal pain group were 75.00%(21/28),64.29%(18/28),75.00%(21/28),46.43%(13/28),28.57%(8/28),60.71%(17/28),respectively,which were significantly higher than those of the non-acute severe abdominal pain group 57.62%(87/151),39.07%(59/151),50.99%(77/151),25.17%(38/151),11.92%(18/151),33.77%(51/151)(P<0.05).The proportion of previous TACE treatment cases in the acute severe abdominal pain group for 39.29%(11/28)was significantly lower than that of non-acute severe abdominal pain group for 62.25%(94/151)(P<0.05).Multivariate analysis showed that multiple intrahepatic tumor lesions,previous history of abdominal pain after TACE,previous TACE treatment history and type of operation were independent risk factors for the occurrence of moderate to severe acute abdominal pain in HCC patients after TACE(P<0.05).ROC curve analysis of the risk prediction model of acute moderate and severe abdominal pain after TACE showed that AUC was 0.81,95%CI:(0.75,0.88),the best cut-off value was 0.49,and the sensitivity and specificity were 75.86% and 73.10%,respectively.Conc

关 键 词：癌 肝细胞 肝动脉插管化疗栓塞 腹痛 风险 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]