基于炎症、营养复合指标的诊断模型对早期结直肠癌的预测价值  

Value of a diagnostic model based on composite inflammatory and nutritional indicators in predicting early colorectal cancer

作　　者：刘心悦 丁雪丽[2] 于亚男[2] 刘爱玲[2] 田字彬[2] LIU Xinyue;DING Xueli;YU Yanan;LIU Ailing;TIAN Zibin(Department of Digestive Di-seases,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院消化内科,上海200040 [2]青岛大学附属医院消化内科

出　　处：《精准医学杂志》2025年第2期142-147,共6页Journal of Precision Medicine

基　　金：山东省自然科学基金资助项目(ZR2021MH-077)。

摘　　要：目的构建基于炎症、营养复合指标的早期结直肠癌诊断模型,并评估该模型的预测价值。方法将2019年1月—2021年4月于青岛大学附属医院行结肠镜检查并治疗的患者作为训练集,根据病变不同分为早期结直肠癌组(106例)和癌前病变组(244例);将2021年5—10月于青岛大学附属医院行结肠镜检查并治疗的患者作为验证集,分为早期结直肠癌组(22例)和癌前病变组(30例)。收集并比较训练集两组患者的临床特征、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、单核细胞/淋巴细胞比值(MLR)、纤维蛋白原/前白蛋白比值(FPR)、纤维蛋白原/白蛋白比值(FAR)及预后营养指数(PNI),分析影响早期结直肠癌发生的独立危险因素。构建早期结直肠癌的诊断模型,使用受试者工作特征(ROC)曲线评估模型的诊断效能,使用Hosmer-Lemeshow检验评估模型拟合度,并将模型应用于验证集进行验证。结果训练集中早期结直肠癌组患者NLR、PLR、MLR、FPR显著高于癌前病变组(Z=-5.269~-2.917,P<0.05)。多因素logistic回归分析结果显示,NLR>1.71、PLR>169.47、FPR>11.25均为影响早期结直肠癌发生的独立危险因素(P<0.05)。构建的诊断模型诊断训练集早期结直肠癌患者的ROC曲线下面积(AUC)为0.697,Hosmer-Lemeshow检验提示模型拟合度良好(P>0.05);诊断模型诊断验证集早期结直肠癌患者的AUC为0.727,Hosmer-Lemeshow检验提示模型拟合度良好(P>0.05)。结论NLR>1.71、PLR>169.47、FPR>11.25是影响早期结直肠癌发生的独立危险因素,基于NLR、PLR、FPR构建的早期结直肠癌诊断模型具有较高预测价值。Objective To construct a diagnostic model based on composite inflammatory and nutritional indicators for early colorectal cancer,and to evaluate the predictive value of the model.Methods The patients who underwent colonoscopy and received treatment in The Affiliated Hospital of Qingdao University from January 2019 to April 2021 were enrolled as the training set,and according to their lesions,they were divided into early colorectal cancer group with 106 patients and precancerous lesion group with 244 patients.The patients who underwent colonoscopy and received treatment in The Affiliated Hospital of Qingdao University from May to October 2021 were enrolled as the validation set and were divided into early colorectal cancer group with 22 patients and precancerous lesion group with 30 patients.The two groups of patients in the training set were compared in terms of clinical features,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),monocyte-to-lymphocyte ratio(MLR),fibrinogen-to-prealbumin ratio(FPR),fibrinogen-to-albumin ratio(FAR),and prognostic nutritional index(PNI),and the independent risk factors for early colorectal cancer were analyzed.A diagnostic model for early colorectal cancer was constructed,and the receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy of the model.The Hosmer-Lemeshow test was used to assess the degree of fitting of the model,and the model was assessed in the validation set.Results In the training set,the early colorectal cancer group had significantly higher NLR,PLR,MLR,and FPR than the precancerous lesion group(Z=-5.269--2.917,P<0.05).The multivariate logistic regression analysis showed that NLR>1.71,PLR>169.47,and FPR>11.25 were independent risk factors for early colorectal cancer(P<0.05).The diagnostic model constructed for the diagnosis of early colorectal cancer in the training set had an area under the ROC curve(AUC)of 0.697,and the Hosmer-Lemeshow test showed that the model had a good degree of fitting(P>0.05).In the validati

关 键 词：结直肠肿瘤 中性白细胞 淋巴细胞 血小板 纤维蛋白原 前白蛋白 危险因素 模型 统计学 

分 类 号：R735.34[医药卫生—肿瘤]