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中华诊断学电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 49 -55. doi: 10.3877/cma.j.issn.2095-655X.2023.01.010

临床研究

肌酐/胱抑素C对晚期上皮性卵巢癌术后并发症的预测价值
王可珺1, 李吉镇2, 马标3, 续慧超4, 谌红珊4, 刘雷5,†()   
  1. 1. 272013　济宁医学院临床医学院
    2. 272500　济宁，汶上县人民医院心内科
    3. 272029　济宁医学院附属医院重症监护室
    4. 272029　济宁医学院附属医院临床营养科
    5. 272029　济宁医学院附属医院全科医学
  • 收稿日期:2022-10-23 出版日期:2023-02-26
  • 通信作者: 刘雷
  • 基金资助:
    济宁医学院附属医院博士科研基金(2020-BS-014)

Predictive value of creatinine/cystatin C on postoperative complications of advanced epithelial ovarian cancer

Kejun Wang1, Jizhen Li2, Biao Ma3, Huichao Xu4, Hongshan Shen4, Lei Liu5,†()   

  1. 1. Colloge of Clinical Medicine, Jining Medical University, Jining 272013, China
    2. Department of Cardiology, Wenshang People′s Hospital, Jining 272500, China
    3. Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining 272029, China
    4. Department of Clinical Nutrition, Affiliated Hospital of Jining Medical University, Jining 272029, China
    5. Department of General Medicine, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2022-10-23 Published:2023-02-26
  • Corresponding author: Lei Liu
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引用本文：

王可珺, 李吉镇, 马标, 续慧超, 谌红珊, 刘雷. 肌酐/胱抑素C对晚期上皮性卵巢癌术后并发症的预测价值[J]. 中华诊断学电子杂志, 2023, 11(01): 49-55.

Kejun Wang, Jizhen Li, Biao Ma, Huichao Xu, Hongshan Shen, Lei Liu. Predictive value of creatinine/cystatin C on postoperative complications of advanced epithelial ovarian cancer[J]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(01): 49-55.

目的

研究肌酐/胱抑素C(CCR)对晚期上皮性卵巢癌(EOC)术后并发症的预测价值。

方法

对2017年1月1日至2020年10月30日于济宁医学院附属医院妇科行手术治疗的106例晚期EOC患者进行回顾性队列研究。单因素回归分析确定术后并发症的潜在危险因素。Logistic回归分析确定术后并发症的独立影响因素。受试者工作特征(ROC)曲线确定CCR的最佳临界值。根据临界值将患者分为高CCR组及低CCR组，分析CCR与术后并发症的关系。

结果

76例(71.70%)患者发生术后并发症。调整相关混杂因素后，Logistic回归分析结果显示，术中出血量>300 ml(OR＝8.53，95%CI 2.04~35.74)是术后并发症的独立危险因素(P<0.01)；而CCR是术后并发症的独立保护因素，CCR每升高1个单位，术后并发症降低40.00%(OR＝0.60，95%CI 0.37~0.97，P<0.05)。术前CCR的最佳截断值为8.165。低CCR组术后总体并发症的发生率(72/91，79.12%)明显高于高CCR组(4/15，26.67%)(χ2＝14.46，P<0.01)；低CCR组术后轻度并发症的发生率(62/91，68.13%)明显高于高CCR组(3/15，20.00%)(χ2＝12.58，P<0.01)。

结论

术前CCR能有效预测晚期EOC患者术后并发症的发生。

关键词: 卵巢肿瘤, 肌酐/胱抑素C, 手术后并发症, 预测
Objective

To study the predictive value of creatinine/cystatin C (CCR) on complications following surgery for advanced epithelial ovarian cancer (EOC).

Methods

From January 1, 2017 to October 30, 2020, 106 patients with advanced EOC who received surgical care in the Gynecology Department of the Affiliated Hospital of Jining Medical University were the subject of a retrospective cohort research. In order to identify the potential risk factors for postoperative complications, univariate regression analysis was utilized. Multivariate logistic regression analysis was used to determine the independent influencing factors of postoperative complications. The best cutoff value for the CCR was determined using a receiver operating characteristic (ROC) curve. Patients were divided into high and low CCR groups according to the critical value to investigate the relationship between the CCR and postoperative complications.

Results

Postoperative complications occurred in 76 patients (71.70%). Multivariate logistic regression analysis revealed that intraoperative blood loss greater than 300 ml (OR=8.53, 95%CI 2.04-35.74) was an independent risk factor for postoperative complications after controlling for relevant confounding variables (P<0.01). CCR was an independent protective factor for postoperative complications. Postoperative complications were reduced by 40.00% for every unit rise in CCR (OR=0.60, 95%CI 0.37-0.97, P<0.05). The preoperative CCR′s optimum cutoff value was 8.165. The overall incidence of postoperative complications in the low CCR group (72/91, 79.12%) was significantly higher than that in the high CCR group (4/15, 26.67%)(χ2=14.46, P<0.01). The incidence of postoperative mild complications in the low CCR group (62/91, 68.13%) was significantly higher than that in the high CCR group (3/15, 20.00%)(χ2=12.58, P<0.01).

Conclusion

In patients with advanced EOC after surgery, the preoperative CCR can accurately predict postoperative problems.

Key words: Ovarian neoplasms, Creatinine/cystatin C, Postoperative complications, Forecasting
表1 晚期EOC患者一般资料比较
项目 无术后并发症组(n＝30) 有术后并发症组(n＝76) 统计量 P值
年龄(岁，±s) 54.23±7.67 56.62±9.90 t＝－1.19 0.239
初潮年龄(岁，±s) 15.33±1.83 16.49±2.22 t＝－2.53 0.011
BMI(kg/m2，±s) 24.26±2.67 23.26±3.50 t＝1.40 0.164
合并症(例，%)        
  糖尿病 1(3.33) 5(6.58) χ2＝0.42 0.515
  高血压病 6(20.00) 16(21.05) χ2＝2.56 0.278
  冠心病 1(3.33) 6(7.89) χ2＝0.73 0.394
腹部手术史(例，%) 7(23.33) 25(32.89) χ2＝4.04 0.133
白细胞计数[×109/L，M(P25，P75)] 6.33(5.20, 6.86) 6.35(5.06, 7.64) Z＝－0.33 0.744
红细胞计数(×1012/L，±s) 4.34±0.44 4.22±0.48 t＝1.15 0.251
血红蛋白(g/L，±s) 123.67±13.23 123.37±14.02 t＝0.10 0.920
血小板[×109/L，M(P25，P75)] 280.00(234.50, 344.00) 286.50(210.00, 353.75) Z＝－0.01 0.989
白蛋白(g/L，±s) 43.34±4.20 42.88±4.92 t＝0.45 0.651
肌酐(μmol/L，±s) 51.58±7.42 51.86±12.10 t＝－0.02 0.906
胱抑素C(mg/L，±s) 0.84±0.20 0.95±0.23 t＝－2.17 0.032
CCR(±s) 7.21±1.60 6.38±1.36 t＝2.71 0.008
CA125[U/ml，M(P25，P75)] 328.55(73.00, 609.82) 328.05(108.74, 1 405.17) Z＝－1.27 0.203
CA199[U/ml，M(P25，P75)] 9.76(5.74, 15.80) 10.24(4.35，15.81) Z＝－0.14 0.989
纤维蛋白原(g/L，±s) 3.25±0.97 3.66±0.89 t＝－2.09 0.004
手术时间[min，M(P25，P75)] 213.00(171.25, 250.00) 230.50(197.75, 280.00) Z＝－1.40 0.163
术中出血量[ml，M(P25，P75)] 200.00(100.00, 300.00) 300.00(187.50, 800.00) Z＝－2.83 0.004
术中输血(例，%)     χ2＝13.13 <0.001
  否 28(93.33) 43(56.58)    
  是 2(6.67) 33(43.42)    
手术类型(例，%)     χ2＝0.17 0.678
  PDS 21 (70.00) 50 (65.79)    
  NACT-IDS 9 (30.00) 26 (34.21)    
术中行上腹部手术(例，%) 3(10.00) 8(10.53) χ2＝0.01 0.936
术中行肠道手术(例，%) 18(60.00) 45(59.21) χ2＝0.01 0.941
术中行淋巴结切除(例，%)     χ2＝0.10 0.952
  无 12(40.00) 31(40.79)    
  清扫 15(50.00) 36(47.37)    
  局部 3(10.00) 9(11.84)    
术中输血(例，%) 2(6.67) 33(43.42) χ2＝13.13 <0.001
残留量(例，%)     χ2＝0.40 0.817
  R0 15 (50.00) 40 (52.63)    
  R1 12 (40.00) 26 (34.21)    
  R2 3 (10.00) 10 (13.16)    
FIGO分期(例，%)     χ2＝3.97 0.265
  ⅢA 1 (3.33) 2 (2.63)    
  ⅢB 10 (33.33) 14 (18.42)    
  ⅢC 18 (60.00) 51 (67.11)    
  Ⅳ 1 (3.33) 9 (11.84)    
组织学分类(例，%)     χ2＝1.77 0.779
  浆液性癌 27(90.00) 70(92.11)    
  黏液性癌 1(3.33) 1(1.32)    
  子宫内膜样癌 0 2(2.63)    
  透明细胞癌 1(3.33) 2(2.63)    
  未分类腺癌 1(3.33) 1(1.32)    
表2 晚期上皮性卵巢癌患者术后并发症的单因素分析
变量 OR(95%CI) P值 变量 OR(95%CI) P值
年龄 1.03(0.98，1.08) 0.237 是否行上腹部手术   0.936
初潮年龄 1.30(1.05，1.60) 0.016   否 1.00  
体重指数 0.91(0.80，1.04) 0.165   是 1.06(0.26，4.29)  
合并症     是否行肠道手术   0.941
  糖尿病 2.04(0.23，18.25) 0.523   否 1.00  
  高血压病 1.07(0.37，3.05) 0.902   是 0.97(0.41，2.29)  
  冠心病 2.49(0.29，21.57) 0.409 术中行淋巴结切除    
腹部手术史 1.61(0.61，4.26) 0.342   无 1.00  
白细胞计数 0.99(0.95，1.03) 0.567   清扫 0.93(0.38，2.28) 0.872
红细胞计数 0.58(0.23，1.47) 0.251   局部 1.16(0.27，5.03) 0.842
血红蛋白 1.02(0.97，1.05) 0.919 残留量    
血小板 1.04(0.97，1.08) 0.769   R0 1.00  
白蛋白 0.98(0.89，1.07) 0.648   R1 0.81(0.33，2.01) 0.653
肌酐/胱抑素C 0.68(0.50，0.91) 0.011   R2 1.25(0.30，5.17) 0.758
糖类抗原125 1.60(1.20，2.01) 0.087 国际妇产科联盟分期    
糖类抗原199 1.20(1.13，1.31) 0.861   ⅢA 1.00  
纤维蛋白原 1.79(1.02，3.16) 0.044   ⅢB 0.70(0.06，8.82) 0.783
手术时间 1.03(0.81，1.12) 0.520   ⅢC 1.42(0.12，16.58) 0.781
术中出血量 14.66(2.21，97.05) 0.005   Ⅳ 4.50(0.19，106.82) 0.352
术中输血   0.002 组织学分类    
  否 1.00     浆液性癌 1.00  
  是 10.74(2.39，48.37)     黏液性癌 0.39(0.02，6.39) 0.506
手术类型   0.678   子宫内膜样癌 0.39(0.02，6.39) 0.506
  PDS 1.00     透明细胞癌 0.77(0.07，8.86) 0.835
  NACT-IDS 1.21(0.49，3.02)     未分类腺癌 0.39(0.02，6.39) 0.506
表3 晚期EOC患者术后并发症的多因素Logistic回归分析
项目 模型一 模型二
OR值(95%CI) P值 OR值(95%CI) P值
CCR 0.68(0.48，0.95) 0.024 0.60(0.37，0.97) 0.039a
月经初潮年龄 1.29(1.02，1.62) 0.030 1.34(0.98，1.84) 0.062b
纤维蛋白原 1.77(1.00，3.14) 0.051 1.80(0.82，3.92) 0.141c
术中出血量        
  ≤300 ml 1.00   1.00  
  >300 ml 5.34 (1.69，16.85) 0.004 8.53(2.04，35.74) 0.003d
图1 晚期EOC患者术前CCR的ROC曲线注：EOC为上皮性卵巢癌；CCR为肌酐/胱抑素C
表4 低CCR组与高CCR组患者术后并发症发生率比较(例，%)
并发症 CCR<8.165 (n＝91) CCR≥8.165 (n＝15) χ2值 P值
总体并发症 72(79.12) 4(26.67) 14.46 <0.001
轻度并发症(Ⅰ－Ⅱ级) 62(68.13) 3(20.00) 12.58 0.000
淋巴囊肿* 8(8.79) 0   0.597
腹腔积液a* 6(6.59) 0   0.591
电解质紊乱* 9(9.89) 0   0.353
盆腹腔感染 10(10.99) 1(6.67) 0.26 0.611
中重度贫血 20(21.98) 1(6.67) 1.90 0.168
静脉血栓形成* 21(23.08) 0   0.038
低蛋白血症 31(34.07) 1(6.67) 4.58 0.032
不完全肠梗阻* 0 1(6.67)   0.142
重度并发症(Ⅲ级) 10(10.99) 1(6.67) 0.26 0.611
腹腔积液b* 8(8.79) 0   0.597
刀口愈合不良/刀口感染* 2(2.20) 1(6.67)   0.370
肾积水* 0 1(6.67)   0.142
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