基于术前LCR及PNI的结直肠癌根治术后感染性并发症预测模型的构建与评价  

Construction and Evaluation of Predictive Model for Infectious Complications after Radical Resection of Colorectal Cancer based on Preoperative LCR and PNI

作　　者：田园 汪贯龙 李瑞 徐凯 李红霞 何磊 TIAN Yuan;WANG Guanlong;LI Rui(Department of Gastrointestinal Surgery,Third Affiliated Hospital of Anhui Medical University,Anhui 230000,China)

机构地区：[1]安徽医科大学第三附属医院胃肠外科,合肥230000

出　　处：《医学研究杂志》2024年第3期135-141,共7页Journal of Medical Research

基　　金：安徽省科技厅重大项目科技惠民专项-生命健康(2022e07020060)。

摘　　要：目的探讨淋巴细胞绝对数与C反应蛋白比值(lymphocytes to C-reactive protein ratio,LCR)联合预后营养指数(prognostic nutritional index,PNI)对结直肠癌根治术后感染性并发症的预测作用,并分析影响术后感染性并发症的危险因素,建立一种能够识别术后感染性并发症风险的新模型并对其效能进行评价。方法回顾性分析2019年3月~2022年4月安徽医科大学第三附属医院收治的339例结直肠癌患者的临床资料,随机分为训练组和验证组。采用X-tile软件确定LCR及PNI的最佳截断值,采用单因素和多因素Logistic回归分析确定术后感染性并发症发生的危险因素,然后通过训练组数据构建列线图预测模型,最后评价该预测模型的效能。结果术前LCR及PNI的最佳截断值分别为0.48和45.65,结合两者构建LCR-PNI评分(0、1、2分),评分越高术后出现感染性并发症的概率越大(P<0.05)。基于列线图的预测模型,训练组和验证组的曲线下面积为0.840和0.814,校准曲线一致性较好;决策分析曲线分析表明,该模型具有较高的净获益水平。结论术前LCR-PNI评分是结直肠癌患者术后感染性并发症的独立危险因素。本研究开发的列线图对结直肠癌根治术后感染性并发症具有良好的个体预测能力。Objective To investigate the predictive effect of lymphocytes to C-reactive protein ratio(LCR)combined with prognostic nutritional index(PNI)on postoperative infectious complications after radical resection of colorectal cancer,and to analyze the risk factors affecting postoperative infectious complications.To establish a new model that can identify the risk of postoperative infectious complications and evaluate its efficacy.Methods The clinical data of 339 patients with colorectal cancer admitted to the Third Affiliated Hospital of Anhui Medical University from March 2019 to April 2022 were retrospectively analyzed and randomly divided into training group and verification group.The optimal cut-off values of LCR and PNI were determined by X-tile software.Univariate and multivariate Logistic regression analysis were used to determine the risk factors of postoperative infectious complications.After that,a nomogram prediction model was constructed through the training group data.Finally,the efficacy of the prediction model was evaluated.Results The optimal cut-off values of preoperative LCR and PNI were 0.48 and 45.65,respectively.The LCR-PNI score(0,1,2)was constructed by combining the two.The higher the score,the greater the probability of postoperative infectious complications(P<0.05).Based on the prediction model of the nomogram,the area under the curve of the training group and the verification group were 0.840 and 0.814,and the calibration curve was consistent.The decision analysis curve showed that the model has a high net benefit level.Conclusion Preoperative LCR-PNI score is an independent risk factor for postoperative infectious complications in patients with colorectal cancer.The nomogram developed in this study has good individual predictive ability for postoperative infectious complications after radical resection of colorectal cancer.

关 键 词：结直肠癌 淋巴细胞绝对数与C反应蛋白比值 预后营养指数 列线图 术后感染性并发症 

分 类 号：R735[医药卫生—肿瘤]