老年肝癌TACE术后感染影响因素及预测模型构建  

Influencing factors for infection after transcatheter arterial chemoembolization in elderly patients with primary liver cancer and construction of a predictive model

作　　者：张薇 刘小艳 欧云 王利蓉 朱奕欣 ZHANG Wei;LIU Xiaoyan;OU Yun;WANG Lirong;ZHU Yixin(Department of Health Care,Nanchong Hospital of Beijing Anzhen Hospital,Capital Medical University,Nanchong Central Hospital,Nanchong 637000,China)

机构地区：[1]首都医科大学附属北京安贞医院南充医院(南充市中心医院)保健科,四川南充637000 [2]首都医科大学附属北京安贞医院南充医院(南充市中心医院)老年病科 [3]营山县人民医院健康管理中心 [4]北京大学深圳医院超声影像科

出　　处：《青岛大学学报（医学版）》2024年第5期719-723,共5页Journal of Qingdao University(Medical Sciences)

基　　金：四川省科技重点研发计划项目(2023YFS0473)。

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(χ^(2)=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%CI=(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IL-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。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 nomogram 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 operation,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(χ^(2)=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 independent 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 characteristic curve of 0.811.Conclusion Comorbidity with diabetes melli

关 键 词：癌 肝细胞 老年人 肝动脉 化学栓塞 治疗性 感染 影响因素分析 列线图 

分 类 号：R730.261[医药卫生—肿瘤] R195.1[医药卫生—临床医学]