| 丁洁,文丽芳,王全义,等.原发性肝癌病人经导管动脉化疗栓塞后并发栓塞后综合征的危险因素及列线图模型[J].安徽医药,2025,29(9):1844-1849. |
| 原发性肝癌病人经导管动脉化疗栓塞后并发栓塞后综合征的危险因素及列线图模型 |
| Risk factors of PES in patients with primary liver cancer after TACE and construct a nomogram model |
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| DOI：10.3969/j.issn.1009-6469.2025.09.030 |
| 中文关键词: 肝肿瘤 栓塞后综合征 经导管动脉化疗栓塞 因素 列线图 |
| 英文关键词: Liver neoplasms Post-embolization syndrome Transcatheter arterial chemoembolization Factors A line chart |
| 基金项目:山西省高校科技创新计划项目( 2022L179)；山西省卫生健康委科研课题计划项目( 2020152) |
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| 中文摘要: |
| 目的探讨原发性肝癌( PLC)病人经导管动脉化疗栓塞( TACE)后并发栓塞后综合征( PES)的危险因素并构建列线图模型。方法采取前瞻性研究，选择 2022年 4月至 2024年 4月山西省汾阳医院收治的 150例行 TACE治疗的 PLC病人作为研究对象。根据病人 TACE后 14 d内 PES发生情况分组，将发生 PES病人纳入 PES组，将未发生 PES病人纳入非 PES组。统计并比较两组病人基线资料。采用 LASSO回归筛选可能影响 PLC病人 TACE后 PES发生的因素并进行二元 logistic回归分析，根据回归结果构建列线图模型，采用 Bootstrap内部验证法对列线图模型进行验证。结果 150例原发性肝癌病人经 TACE治疗后，发生 PES 81例，发生率为 54.00%；PES组结节数目为多发、 TACE次数为多次、微球类型为载药微球、微球直径为 100~300 μm、巴塞罗那分期为 C病人占比高于非 PES组， TACE次数多于非 PES组( P<0.05)；通过 LASSO回归模型，最终筛选出 6个潜在的相关因素，分别为结节数目、 TACE次数、微球类型、微球个数、微球直径、巴塞罗那分期；行二元 logistic回归分析结果显示，节数目为多发、 TACE次数为多次、微球类型为载药微球、巴塞罗那分期为 C是 PLC病人 TACE后 PES发生的危险因素( OR>1，结P<0.05)；微球个数多、微球直径在 >300~500 μm是 PLC病人 TACE后 PES发生的保护因素( OR<1，P<0.05)；使用 Bootstrap内部验证法对列线图模型进行验证， C-index值 0.81，ROC评估列线图预测价值 AUC为 0.85，95%CI:(0.78，0.91)灵敏度 0.75，特异度 0.78，约登指数 0.54。结论结节数目、 TACE次数、微球类型及巴塞罗那分期与 PLC病人 TACE后 PES发生，密切相关，且根据上述因素构建预测模型具有较好预测效能。 |
| 英文摘要: |
| Objective To investigate the risk factors of post-embolization syndrome (PES) after transcatheter arterial chemoemboliza-tion (TACE) in patients with primary liver cancer (PLC) and to construct a nomogram model.Methods A prospective study was con-ducted to select 150 PLC patients who underwent TACE treatment in the Fenyang Hospital from April 2022 to April 2024 as the studysubjects. According to the occurrence of PES within 14 days after TACE, patients with PES were included in the PES group, and pa-tients without PES were included in the non-PES group. The baseline data of the two groups were statistically analyzed and compared.LASSO regression was used to screen the factors that may affect the occurrence of PES in PLC patients after TACE and binary logisticregression analysis was performed. A nomogram model was constructed based on the regression results, and the nomogram model wasverified by Bootstrap internal validation method.Results After TACE treatment, 81 cases of PES occurred in 150 patients with prima-ry liver cancer, with an incidence of 54.00%. The number of nodules in the PES group was multiple, the number of TACE was multiple,the type of microsphere was drug-loaded microsphere, the diameter of microsphere was 100-300 μm, and the proportion of patients with Barcelona stage C was higher than that in the non-PES group, and the number of TACE was more than that in the non-PES group (P< 0.05). Through the LASSO regression model, six potential related factors were finally screened out, namely, the number of nodules, thenumber of TACE, the type of microspheres, the number of microspheres, the diameter of microspheres, and the Barcelona staging; theresults of binary logistic regression analysis showed that the number of nodules was multiple, the number of TACE was multiple, thetype of microspheres was drug-loaded microspheres, and the Barcelona stage was C were the risk factors for PES after TACE in PLC pa-tients (OR>1, P<0.05). The number of microspheres and the diameter of microspheres in 300-500 μm were protective factors for PES in PLC patients after TACE (OR<1, P<0.05). Bootstrap internal validation method was used to verify the nomogram model. The C-index value was 0.81. The AUC of ROC to evaluate the predictive value of the nomogram was 0.85, 95%CI: (0.78, 0.91), the sensitivity was 0.75, the specificity was 0.78, and the approximate index was 0.54.Conclusion The number of nodules, the number of TACE, thetype of microspheres and the Barcelona stage are closely related to the occurrence of PES in PLC patients after TACE, and the predic-tion model based on the above factors has a good predictive efficiency. |
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