| 赵宇亮,王魁彬,刘智慧,等.肝细胞癌病人介入术后急性严重腹痛发生危险因素及预测模型构建[J].安徽医药,2023,27(2):366-369. |
| 肝细胞癌病人介入术后急性严重腹痛发生危险因素及预测模型构建 |
| Risk factors for moderate and severe acute abdominal pain in patients with HCC after TACE and predictive model establishment |
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| DOI：10.3969/j.issn.1009-6469.2023.02.035 |
| 中文关键词: 癌，肝细胞 肝动脉插管化疗栓塞 腹痛 风险 影响因素 |
| 英文关键词: Carcinoma,hepatocellular TACE Abdominal pain Risk Influencing factors |
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| 摘要点击次数: 824 |
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| 中文摘要: |
| 目的探讨肝细胞癌( HCC)病人肝动脉插管化疗栓塞( TACE)术后急性严重腹痛发生危险因素。方法回顾性分析 2017年 1月至 2020年 9月于焦作市第二人民医院行 TACE治疗的 HCC病人共 178例临床资料，根据 TACE术后急性严重腹痛发生情况分为急性严重腹痛组和非急性严重腹痛组，采用单因素和多因素法评价 HCC病人 TACE术后急性严重腹痛发生风险独立影响因素，并基于此构建预测模型。结果 178例病人 TACE术后 24 h内发生急性严重腹痛 28例，发生率为 15.73%；急性严重腹痛组初治比例、病灶最大径 >5 cm比例、病灶数量 ≥3个比例、病灶侵犯血管比例、既往 TACE术后中重度腹痛史比例及接受载药微球 TACE比例分别为 75.00%(21/28)，64.29%(18/28)，75.00%(21/28)，46.43%(13/28)，28.57%(8/28)，60.71%(17/28)，显著高于非急性严重腹痛组的 57.62%(87/151)39.07%(59/151)50.99%(77/151)25.17%(38/151)11.92%(18/151)33.77%(51/151)(P<0.05)；急性严重腹痛组既往TACE治疗，史比例为 39.29%，(11/28)，显著少，于非急性严重腹痛，组的 62.25%(94，/151)(P<0.05)；多因素分析结果显示，肝内多发肿瘤病灶、既往 TACE术后腹痛史、既往 TACE治疗史及 TACE类型均是 HCC病人 TACE术后急性严重腹痛发生风险独立影响因素( P<0.05)； TACE术后急性中重度腹痛发生风险预测模型 ROC曲线分析结果显示， AUC=0.81，95%CI:(0.75，0.88)，最佳截断值为 0.49，灵敏度和特异度分别为 75.86%，73.10%。结论 HCC病人 TACE术后急性严重腹痛发生风险与肝内多发肿瘤病灶、既往 TACE术后腹痛史、既往 TACE治疗史及 TACE类型独立相关，基于此构建预测模型具有良好预测效能。 |
| 英文摘要: |
| Objective To investigate the risk factors for moderate and severe acute abdominal pain in patients with HCC after TACE. Methods Clinical data of 178 patients with HCC after TACE were retrospectively chosen in the Second People's Hospital of Jiaozuofrom January 2017 to September 2020. All patients were grouped according to the incidence of moderate and severe acute abdominalpain after TACE and the independent risk factors for moderate and severe acute abdominal pain after TACE were evaluated by univari-ate and multivariate methods to establish the predictive model. Results Twenty-eight cases in 178 patients had moderate or severeacute abdominal pain within 24 hours after TACE and the incidence rate was 15.73%. The proportion of initial treatment cases, lesionswith the maximum diameter of >5 cm,lesions number ≥3, lesions invading blood vessels,the history of moderate and severe abdominalpain after TACE and patients receiving drug loaded microspheres TACE in acute severe abdominal pain group were 75.00%(21/28),64.29%(18/28),75.00%(21/28),46.43%(13/28),28.57%(8/28),60.71%(17/28),respectively, which were significantly higher than those ofthe non-acute severe abdominal pain group 57.62%(87/151), 39.07%(59/151), 50.99%(77/151), 25.17%(38/151), 11.92%(18/151),33.77%(51/151) (P<0.05).The proportion of previous TACE treatment cases in the acute severe abdominal pain group for 39.29%(11/28)was significantly lower than that of non-acute severe abdominal pain group for 62.25%(94/151) (P<0.05). Multivariate analysis showedthat multiple intrahepatic tumor lesions, previous history of abdominal pain after TACE, previous TACE treatment history and type of op-eration were independent risk factors for the occurrence of moderate to severe acute abdominal pain in HCC patients after TACE (P< 0.05). ROC curve analysis of the risk prediction model of acute moderate and severe abdominal pain after TACE showed that AUC was0.81,95%CI:(0.75,0.88), the best cut-off value was 0.49,and the sensitivity and specificity were 75.86% and 73.10%, respectively.Con. clusion The risk of moderate to severe acute abdominal pain in HCC patients after TACE is independently associated with multiple in-trahepatic tumor lesions, previous history of abdominal pain after TACE,previous TACE treatment history and type of operation. |
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