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胰腺癌患者纳米刀术后心肌损伤的危险因素分析

海珑珠 胡强夫 李晓勇 郭佩垒 杨玲伟

引用本文:
Citation:

胰腺癌患者纳米刀术后心肌损伤的危险因素分析

DOI: 10.3969/j.issn.1001-5256.2022.12.019
基金项目: 

河南省医学科技攻关计划联合共建项目 LHGJ20190425

伦理学声明:本研究方案于2021年12月10日经由郑州大学第五附属医院伦理委员会审批,批号:Y2021050。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:海珑珠负责课题设计,资料分析,撰写论文;郭佩垒、杨玲伟参与收集数据,修改论文;李晓勇提供统计学支持;胡强夫拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    胡强夫,huli2004803@sina.com

Risk factors for myocardial injury after Nano-Knife surgery in patients with pancreatic cancer

Research funding: 

Medical science and Technology project of Henan Province LHGJ20190425

More Information
  • 摘要:   目的  探讨胰腺癌患者纳米刀术后发生心肌损伤的危险因素,并建立预测风险模型的列线图。  方法  回顾性分析2020年9月—2021年11月于郑州大学第五附属医院行纳米刀治疗的92例胰腺癌患者的临床资料,以术后3天内出现血清肌钙蛋白I>0.03 ng/mL作为心肌损伤的诊断标准,将患者分为心肌损伤组(n=51)和非心肌损伤组(n=41), 收集所有患者的年龄、性别、BMI、美国麻醉师协会分级、吸烟史、酗酒史、术前合并症等基线资料。计量资料用组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验或Fisher检验。采用单因素和多因素Logistic回归分析筛选有统计学差异的变量,筛选出相关因素建立预测胰腺癌患者纳米刀术后发生心肌损伤风险的列线图。采用受试者工作特征曲线下面积(AUC)评估模型的区分能力和临床效用。  结果  相较于非心肌损伤组,心肌损伤组消融时间更长(χ2=7.410,P=0.006),探针数量更多(χ2=6.130,P=0.047), 术前合并高血压(χ2=12.124,P<0.001)、慢性肾脏病(χ2=12.829,P<0.001)者更多。单因素Logistic回归分析显示,肿瘤直径、消融时间、手术方式、探针数量、高血压史及慢性肾脏病史均与心肌损伤的发生有关(P值均<0.05);多因素Logistic回归分析显示,肿瘤直径[比值比(OR)=3.94, 95%CI: 1.09~14.18, P=0.036]、消融时间(OR=4.15, 95%CI: 1.30~13.27, P=0.016)、手术方式(OR=6.92, 95%CI: 1.92~25.07, P=0.003)及合并高血压史(OR=4.07,95%CI: 1.12~14.77, P=0.034)是胰腺癌患者纳米刀术后发生心肌损伤的独立危险因素。AUC=0.859表明,列线图具有较好的区分能力和临床效用。  结论  胰腺癌患者纳米刀术后心肌损伤发生率较高,术前合并高血压、肿瘤直径>4 cm、消融时间>1 h是心肌损伤发生的独立危险因素,手术方式(纳米刀+旁路吻合)能增加心肌损伤的风险,列线图对预测心肌损伤发生的风险有较好效果。

     

  • 图  1  术中超声引导下布针

    Figure  1.  Intraoperative ultrasound-guided needle placement

    图  2  Lasso回归中回归系数随Log(λ)变化曲线

    Figure  2.  Variation cure of regression coefficient with Log(λ)in Lasso regression

    图  3  Lasso回归的交叉验证

    Figure  3.  Cross-validation of Lasso regression

    图  4  胰腺癌患者纳米刀术后发生心肌损伤列线图

    Figure  4.  Nomogram of myocardial injury after nanoscale surgery in a patient with pancreatic cancer

    图  5  评估胰腺癌患者纳米刀术后发生心肌损伤的ROC曲线

    Figure  5.  To evaluate the ROC curve of myocardial injury after nanoscale surgery in patients with pancreatic cancer

    表  1  两组患者临床资料进行比较

    Table  1.   the clinical data of the two groups were compared

    指标 心肌损伤组(n=51) 非心肌损伤组(n=41) 统计值 P
    性别[例(%)] χ2=0.601 0.438
      女 27(52.9) 27(65.9)
      男 24(47.1) 14(34.1)
    年龄[例(%)] χ2=0.344 0.558
      <65岁 22(43.1) 19(46.3)
      ≥65岁 29(56.9) 22(53.7)
    BMI 22.7(21.2~24.5) 22.0(19.6~23.8) Z=-1.603 0.109
    肿瘤直径[例(%)] χ2=3.426 0.064
      >4 cm 32(62.7) 15(36.6)
      ≤4 cm 19(37.3) 26(63.4)
    糖尿病[例(%)] χ2=0.091 0.763
      无 23(45.1) 19(46.3)
      有 28(54.9) 22(53.7)
    高血压[例(%)] χ2=12.124 <0.001
      无 26(51.0) 35(85.4)
      有 25(49.0) 6(14.6)
    慢性肾脏病[例(%)] χ2=12.829 <0.001
      无 20(39.2) 27(65.9)
      有 31(60.8) 14(34.1)
    吸烟[例(%)] χ2=0.015 0.903
      否 42(82.4) 33(80.5)
      是 9(17.6) 8(19.5)
    酗酒[例(%)] χ2=0.030 0.862
      否 32(62.7) 25(61.0)
      是 19(37.3) 16(39.0)
    消融时间[例(%)] χ2=7.410 0.006
      ≤1 h 18(35.3) 33(80.5)
      >1 h 33(64.7) 8(19.5)
    手术方式[例(%)] χ2=0.780 0.677
      IRE 11(21.6) 29(70.7)
      IRE+吻合 31(60.8) 7(17.1)
      经皮 9(17.6) 5(12.2)
    探针数量[例(%)] χ2=6.130 0.047
      2个 11(21.6) 30(73.2)
      3个 10(19.6) 5(12.2)
      4个 30(58.8) 6(14.6)
    下载: 导出CSV

    表  2  纳米刀术后发生心肌损伤的单因素分析结果

    Table  2.   Univariate analysis of myocardial injury after NanoKnife surgery

    变量 OR(95%CI) P
    性别 0.213
      女性
      男性 1.71(0.73~4.00)
    年龄 0.759
      <65岁
      ≥65岁 0.88(0.38~2.01)
    糖尿病史 0.905
      无
      有 1.05(0.46~2.40)
    吸烟 0.819
      否
      是 0.88(0.31~2.54)
    酗酒 0.862
      否
      是 1.08(0.46~2.51)
    肿瘤直径 0.014
      ≤4 cm
      >4 cm 2.92(1.25~6.84)
    消融时间 <0.001
      ≤1 h
      >1 h 7.56(2.89~19.80)
    手术方式
      IRE
      IRE+吻合 11.68(3.99~34.19) <0.001
      经皮 4.75(1.30~17.32) 0.018
    探针数量
      2个
      3个 5.45(1.52~19.55) 0.001
      4个 13.64(4.47~41.63) <0.001
    高血压病史 0.001
      无
      有 5.61(2.01~15.64)
    慢性肾脏病史 0.012
      无
      有 2.99(1.27~7.04)
    下载: 导出CSV
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  • 收稿日期:  2022-09-30
  • 录用日期:  2022-11-02
  • 出版日期:  2022-12-20
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