术前血清维生素A水平在肺结节良恶性预测中的应用价值  

Value of preoperative serum vitamin A level in the prediction of benign and malignant pulmonary nodules

作　　者：刘鹿[1] 喻航 张新胜[1] 张永[1] 徐庆[1] 刘英华[1] Liu Lu;Yu Hang;Zhang Xinsheng;Zhang Yong;Xu Qing;Liu Yinghua(Department of Nutrition,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;People's Liberation Army Unit 66220,Chuzhou 239000,China)

机构地区：[1]解放军总医院第一医学中心营养科,北京100853 [2]解放军66220部队,滁州239000

出　　处：《中华健康管理学杂志》2024年第11期816-823,共8页Chinese Journal of Health Management

基　　金：军队保健专项重点项目(22BJZ20)。

摘　　要：目的探索术前血清维生素A水平在肺结节良恶性预测中的应用价值。方法本研究为回顾性队列研究, 连续选取2016年1月至2018年12月于解放军总医院因肺结节接受手术治疗的1 224例患者, 收集其一般资料、术后病理结果、肺部CT、术前血清维生素A检测结果, 采用χ^(2)检验对肺癌患者和良性肺结节患者的术前血清维生素A水平进行两两比较, 采用logistic回归分析肺癌发生的相关因素并进行分层分析。根据多因素logistic回归分析结果构建肺结节良恶性预测模型, 评价模型效能并确定肺结节良恶性的最佳术前预测模型, 分析术前血清维生素A水平在肺结节良恶性预测中的应用价值。结果本研究共纳入1 224例患者, 术后病理确认肺癌1 044例、良性肺结节180例, 肺癌患者术前血清维生素A水平显著低于良性肺结节患者(0.90比1.06 μmol/L)(Z=-3.493;P<0.001)。术前血清维生素A水平是肺癌发生的负相关因素(OR=0.663, 95%CI:0.484~0.914)(P=0.011)。在年龄<60岁(OR=0.623, 95%CI:0.428~0.912)、男性(OR=0.649, 95%CI:0.438~0.976)、体重指数≥24 kg/m^(2)(OR=0.634, 95%CI:0.420~0.974)、无肿瘤家族史(OR=0.634, 95%CI:0.440~0.923)、无吸烟史(OR=0.619, 95%CI:0.412~0.941)、无饮酒史(OR=0.625, 95%CI:0.424~0.933)、肺结节直径1~3 cm(OR=0.643, 95%CI:0.455~0.920)、实性肺结节患者(OR=0.681, 95%CI:0.466~1.001)中, 术前血清维生素A与肺癌发生均呈显著负相关(均P<0.05)。纳入术前血清维生素A、CT肺结节特征(结节直径、密度)、临床特征(年龄、性别)的联合预测模型对肺结节良恶性的预测效能最佳(曲线下面积为0.792)。结论在肺结节手术治疗患者中, 肺癌患者术前血清维生素A水平低于良性肺结节患者, 术前血清维生素A水平是肺癌发生的负相关因素, 纳入术前血清维生素A水平的联合模型可以较好地预测肺结节良恶性。Objectivee To explore the application value of preoperative serum vitamin A level in the prediction of benign or malignant pulmonary nodules.Methods Itwas aretrospective cohort study.A total of 1224 patients who underwent surgery for pulmonary nodules at the General Hospital of the People's Liberation Army from January 2016 to December 2018 were consecutively included.The demographic information,postoperative pathological results,pulmonary CT findings and preoperative serum vitamin A test results were collected.The preoperative serum vitamin A levels of patients with lung cancer and benign pulmonary nodules were compared pairwise using the χ^(2) test.Logistic regression analysis was used to analyze the relevant factors for the occurrence of lung cancer and a stratified analysis was performed too.Prediction models for the benignity or malignancy of pulmonary nodules were constructed based on the results of multivariate logistic regression analysis.The efficacy of the models was evaluated,and the optimal preoperative prediction model was determined.The application value of preoperative serum vitamin A levels in predicting the benignity or malignancy of pulmonary nodules was then analyzed.Results Of the 1224 patients,postoperative pathology confirmed 1044 cases with lung cancer and 180 cases with benign pulmonary nodules.The mean preoperative serum vitamin A level of patients with lung cancer was significantly lower than that in patients with benign pulmonary nodules(o.90 vs 1.06μmol/L)(Z=-3.493;P<0.001).Preoperative serum vitamin A level was a negative related factor for the occurrence of lung cancer(0R=0.663,95%CI:0.484-0.914)(P=0.011).In patients aged<60 years(OR=0.623,95%Cl:0.428-0.912),male(0R=0.649,95%CI:0.438-0.976),with a body mass index≥24 kg/m^(2)(OR=0.634,95%CI:0.420-0.974),no family history of tumors(OR=0.634,95%Cl:0.440-0.923),no smoking history(OR=0.619,95%Cl:0.412-0.941),no drinking history(OR=0.625,95%Cl:0.424-0.933),with pulmonary nodules measuring 1-3 cm in diameter(0R=0.643,95%Cl:0.455-0.920),

关 键 词：肺结节 维生素A 肺肿瘤 预测 

分 类 号：R734.2[医药卫生—肿瘤]