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投稿时间：2023-02-18 网络发布日期：2025-01-20
投稿时间：2023-02-18 网络发布日期：2025-01-20
中文摘要: 目的 探讨前白蛋白联合中性粒细胞与淋巴细胞比值(NLR)对胃癌根治术术后早期并发症（EPC）发生的预测价值。
方法 采用回顾性病例对照研究的方法，收集2019年1月至2023年3月在郑州大学第二附属医院普外科接受胃癌根治术+D2淋巴结清扫术的255例胃癌患者的临床资料,并分为EPC组（ n =63）和非EPC组( n =192)，比较两组在不同时间点的前白蛋白、NLR差异，绘制受试者工作特征(ROC)曲线，分析前白蛋白、NLR以及两者联合对胃癌患者EPC的预测价值。采用多因素logistic回归分析胃癌患者EPC的独立危险因素。
结果 EPC组的前白蛋白在术后第1、3天均低于非EPC组，差异有统计学意义（ P ＜0.01），NLR在术后第3天高于非EPC组( P ＜0.01)。ROC曲线显示，术后第1天前白蛋白预测EPC的最佳截断值为209 mg/L，曲线下面积（AUC）为0.645(95% CI: 0.559～0.731,P =0.015)，灵敏度为88.1%，特异度为44.5%；术后第3天NLR预测EPC的最佳截断值为5.89，AUC值为0.753(95% CI : 0.670～0.835， P ＜0.01)，灵敏度为69.0%，特异度为77.3%；二者联合预测的AUC值为0.818(95% CI ： 0.742～0.894，P ＜0.01)，灵敏度为76.2%，特异度为78.9%；以联合预测的AUC最大。多因素分析结果显示，手术切口类型为开放、手术时间≥ 270 min、术后第1天前白蛋白降低和术后第3天NLR升高是预测胃癌EPC的独立危险因素（ P ＜0.05）。
结论 术后第1天前白蛋白联合术后第3天NLR对胃癌根治EPC的发生具有较好的预测价值。
Abstract:Objective To investigate the predictive value of prealbumin combined with neutrophil-to-lymphocyte ratio (NLR) for early postoperative complications (EPC) in patients undergoing radical gastrectomy.
Methods A retrospective case-control study was performed. The clinical data of 255 gastric cancer patients who underwent radical gastrectomy and D2 lymph node dissection in the Department of General Surgery, the Second Affiliated Hospital of Zhengzhou University from January 2019 to March 2023 were collected and divided into EPC group (n=63) and non EPC group (n=92), and the differences of prealbumin and NLR between the two groups at different time points were compared, and the receiver operator characteristic (ROC) curve was plotted to analyze the predictive value of prealbumin, NLR and their combination on the development of EPC in gastric cancer patients after surgery. Multivariate logistic regression was used to analyze the independent risk factors for the EPC in gastric cancer patients. Results The prealbumin level in the EPC group was lower than that in the non-EPC group on postoperative day 1 and 3 (P<0.01); NLR was higher than that in the non EPC group on postoperative day 3 (P<0.01). ROC curve showed that the optimal cut-off value for prealbumin to predict EPC on postoperative day 1 was 209 mg/L, with an area under curve (AUC) of 0.645 (95%CI0.559-0.731, P<0.015), a sensitivity of 88.1% and a specificity of 44.5%; the optimal cut-off value for NLR on postoperative day 3 to predict EPC was 5.89, with an AUC of 0.753 (95%CI 0.670-0.835， P<0.01), a sensitivity of 69.0% and a specificity of 77.3%; the AUC predicted jointly by them was 0.818 (95%CI 0.742-0.894,P<0.01), with a sensitivity of 76.2% and a specificity of 78.9%, and the AUC of the joint prediction was the largest. The results of multivariate analysis showed that the type of surgical incision being open, the duration of surgery ≥ 270 min, decreased prealbumin on postoperative day 1 and increased NLR on postoperative day 3 were independent risk factors for predicting EPC in gastric cancer (P<0.05).
Conclusion Prealbumin on postoperative day 1 combined with NLR on postoperative day 3 has a good predictive value for the development of early complications after radical gastrectomy.
keywords: Gastric cancer Prealbumin Neutrophil to lymphocyte ratio Early postoperative complications Open surgery Surgical duration Radical gastrectomy
文章编号： 中图分类号：R735.2 文献标志码：A
基金项目:河南省医学科技攻关计划联合共建项目（LHGJ20210396）
附件
| Author Name | Affiliation |
| GUO Maosen, LI Hu, GAO Fei, HAN Bin | Department of Anesthesiology, Zigong First People’s Hospital, Zigong, Sichuan 643000, China |
引用文本：
郭茂森，李虎，高飞，韩斌.前白蛋白联合中性粒细胞与淋巴细胞比值预测胃癌术后早期并发症的价值[J].中国临床研究,2025,38(1):53-56.
郭茂森，李虎，高飞，韩斌.前白蛋白联合中性粒细胞与淋巴细胞比值预测胃癌术后早期并发症的价值[J].中国临床研究,2025,38(1):53-56.