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第三腰椎骨骼肌指数联合白细胞介素6、激活素A对胰腺癌恶病质的早期预测价值

李新省 张丽敏 王顺祥 冯宁宁

引用本文:
Citation:

第三腰椎骨骼肌指数联合白细胞介素6、激活素A对胰腺癌恶病质的早期预测价值

DOI: 10.12449/JCH240624
基金项目: 

河北省医学科学研究课题计划 (20240222)

伦理学声明: 本研究方案于2020年1月19日经由河北医科大学第四医院伦理委员会审批,批号:2020KY085。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:李新省负责资料分析,撰写论文;张丽敏、王顺祥参与收集数据,修改论文;冯宁宁负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    冯宁宁, syanshuxuesan@163.com (ORCID: 0009-0002-8784-3918)

Value of skeletal muscle index combined with interleukin-6 and activin A in predicting early-stage pancreatic cancer cachexia

Research funding: 

Hebei Medical Science Research Project (20240222)

More Information
  • 摘要:   目的  研究第三腰椎骨骼肌指数(L3-SMI)联合白细胞介素6(IL-6)、激活素A(Activin A)检测对胰腺癌恶病质的早期预测价值。  方法  将2020年7月—2023年7月经河北医科大学第四医院确诊的74例胰腺癌患者纳入研究。根据患者入院后是否发生恶病质,分为恶病质组(n=58)、非恶病质组(n=16)。观测患者入院后48 h内的L3-SMI、IL-6、Activin A水平。正态分布的计量资料两组间比较采用成组t检验;计数资料组间比较采用χ2检验。采用多因素Logistic回归分析筛选胰腺癌恶病质的影响因素,并通过受试者工作特征曲线(ROC曲线)分析L3-SMI以及血清IL-6、Activin A单独或联合检测对胰腺癌恶病质的预测价值。ROC曲线下面积(AUC)比较采用Z检验。  结果  恶病质组L3-SMI水平明显低于非恶病质组,血清IL-6、Activin A水平明显高于非恶病质组(t值分别为8.649、3.049、8.100,P值均<0.05)。多因素Logistic回归分析结果显示,L3-SMI(OR=0.266,95%CI:0.103~0.683)以及血清IL-6(OR=4.158,95%CI:1.368~12.333)、Activin A(OR=5.124,95%CI:1.550~16.939)是胰腺癌恶病质发生的影响因素(P值均<0.05)。L3-SMI、IL-6、Activin A预测胰腺癌恶病质的AUC分别为0.851、0.752、0.791,均明显低于三者联合检测的0.946(Z值分别为-2.841、-2.552、-2.647,P值均<0.001),其敏感度、特异度、约登指数最高,分别为90.9%、87.8%、0.788。  结论  L3-SMI联合血清IL-6、Activin A检测对胰腺癌恶病质具有较好的早期预测价值。

     

  • 图  1  L3-SMI、IL-6、Activin A单独及联合检测预测胰腺癌恶病质的ROC曲线

    Figure  1.  ROC curve for L3-SMI, IL-6, and Activin A measured alone or in combination for perdiction of pancreatic cancer cachexia

    表  1  两组患者基线资料比较

    Table  1.   Cmparison of the baseline data between the two groups

    指标 恶病质组(n=58) 非恶病质组(n=16) χ2 P
    性别[例(%)] 0.416 0.519
    31(53.4) 10(62.5)
    27(46.6) 6(37.5)
    年龄[例(%)] 0.083 0.774
    ≥65岁 42(72.4) 11(68.7)
    <65岁 16(27.6) 5(31.3)
    肿瘤大小[例(%)] 0.019 0.984
    ≥3 cm 47(81.0) 13(81.2)
    <3 cm 11(19.0) 3(18.8)
    TNM分期[例(%)] 8.919 0.030
    Ⅰ期 0(0.0) 1(6.2)
    Ⅱ期 11(19.0) 6(37.5)
    Ⅲ期 20(34.5) 3(18.8)
    Ⅳ期 27(46.5) 6(37.5)
    肿瘤组织学分型[例(%)] 0.783 0.676
    低分化 8(13.8) 2(12.5)
    中分化 28(48.3) 6(37.5)
    高分化 22(37.9) 8(50.0)
    BMI分类[例(%)] 6.948 0.031
    正常体质量 30(51.7) 12(75.0)
    低体质量 24(41.4) 1(6.2)
    超重或肥胖 4(6.9) 3(18.8)
    NRS2002[例(%)] 7.485 0.006
    ≥3分 40(69.0) 5(31.2)
    <3分 18(31.0) 11(68.8)
    PG-SGA[例(%)] 14.233 <0.001
    ≥4分 44(75.9) 4(25.0)
    <4分 14(24.1) 12(75.0)

    注:正常体质量,18.5 kg/m2≤BMI<24.0 kg/m2;低体质量,BMI<18.5 kg/m2;超重或肥胖,BMI≥24 kg/m2

    下载: 导出CSV

    表  2  两组患者L3-SMI、IL-6、Activin A水平比较

    Table  2.   Cmparison of the level of L3-SMI,IL-6,Activin A between the two groups

    指标

    恶病质组

    n=58)

    非恶病质组

    n=16)

    t P
    L3-SMI(cm2/m2 28.44±4.32 39.45±5.16 8.649 <0.001
    IL-6(ng/L) 6.52±2.44 4.48±2.08 3.049 0.003
    Activin A(ng/L) 0.61±0.15 0.28±0.12 8.100 <0.001
    下载: 导出CSV

    表  3  胰腺癌恶病质发生的多因素Logistic回归分析

    Table  3.   Multivariate Logistic regression analysis of the occurrence of pancreatic cancer cachexia

    因素 β SE Wald P OR 95%CI
    常数项 -0.954 0.495 4.033 0.045 0.373 0.143~0.977
    L3-SMI -1.326 0.482 7.568 0.006 0.266 0.103~0.683
    IL-6 1.425 0.567 6.316 0.012 4.158 1.368~12.233
    Activin A 1.634 0.610 7.175 0.007 5.124 1.550~16.939
    下载: 导出CSV

    表  4  L3-SMI、IL-6、Activin A单独或联合检测对胰腺癌恶病质的预测价值

    Table  4.   Predictive value of L3-SMI, IL-6, and Activin A measured alone or in combination for pancreatic cancer cachexia

    因素 AUC 特异度(%) 敏感度(%) cut-off值 约登指数 95%CI
    L3-SMI 0.851 84.6 78.8 32.5 cm2/m2 0.634 0.750~0.953
    IL-6 0.752 52.6 82.6 5.2 ng/L 0.353 0.633~0.871
    Activin A 0.791 66.7 81.8 0.44 ng/L 0.485 0.674~0.909
    L3-SMI+IL-6+Activin A 0.946 87.8 90.9 0.788 0.890~1.000
    下载: 导出CSV
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  • 收稿日期:  2024-02-20
  • 录用日期:  2024-03-25
  • 出版日期:  2024-06-25
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