术前IBI联合CONUT评分对腹腔镜胃癌根治术术后并发症的预测价值

摘要

探讨术前炎症负荷指数（IBI）联合营养控制状态（CONUT）评分对腹腔镜胃癌根治术术后并发症的预测价值。回顾性分析2020年1月至2025年1月安徽省第二人民医院184例行腹腔镜胃癌根治术患者的临床资料。通过ROC曲线确定IBI和CONUT的最佳截断值并建立IBI-CONUT评分，分析其与患者临床病理因素的关系。基于单因素及多因素Logistic回归确定腹腔镜胃癌根治术后并发症的独立预测因子，并以此构建列线图预测模型。模型的区分度、校准度、临床实用性分别通过ROC曲线下面积（AUC）、校准曲线与Hosmer-Lemeshow检验、决策曲线进行评价，Bootstrap重抽样实施内部验证。IBI和CONUT的最佳截断值分别为13.82和3.5。IBI-CONUT评分与患者年龄、术前合并贫血有关（P＜0.05）。多因素Logistic回归分析结果显示，年龄≥60岁、TNM为Ⅲ～Ⅳ期、全胃切除术及IBI-CONUT评分1、2分是腹腔镜胃癌根治术术后并发症的独立危险因素（P＜0.05）。基于以上因素构建的术后并发症预测模型预测效能优异（AUC=0.832）。校准曲线与Hosmer-Lemeshow检验显示预测模型校准度良好。决策曲线显示，阈值在0.06~0.77时，该预测模式具临床实用性。Bootstrap验证结果显示一致性指数（C-index）为0.824，说明模型区分度显著。术前IBI-CONUT评分可作为预测腹腔镜胃癌根治术术后并发症的可靠指标。基于IBI-CONUT评分及其他影响因素构建的列线图预测模型具有良好的预测能力。

关键词

胃肿瘤 / 腹腔镜 / 术后并发症 / 炎症负荷指数 / 营养控制状态评分 / 列线图预测模型

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基金资助

合肥综合性国家科学中心大健康研究院职业医学与健康联合研究中心科研项目(OMH-2023-07)

安徽省高校自然科学研究项目(2023AH010084)

安徽省高校自然科学研究项目(2023AH040391)