结直肠肛门外科2025，Vol.31Issue(3)：229-236,8.DOI:10.19668/j.cnki.issn1674-0491.2025.03.009
结直肠癌患者术后发生低蛋白血症的影响因素分析及预测模型的构建
Analysis of influencing factors for postoperative hypoalbuminemia in colorectal cancer pa-tients and construction of a prediction model
摘要
Abstract
Objectives To analyze the influencing factors for postoperative hypoalbuminemia in colorectal cancer patients,construct a nomogram prediction model based on these factors,and validate the model's performance.Methods A total of 200 colorectal cancer patients admitted to Nanjing Hospital of Traditional Chinese Medicine affiliated to Nanjing Univer-sity of Chinese Medicine between January 2023 and March 2024 were randomly selected and divided into a modeling group and a validation group at a ratio of 7∶3.Patients in the modeling group were further categorized into non-hypoalbuminemia and hypoalbuminemia groups based on postoperative occurrence of hypoalbuminemia.Clinical data were collected to identify influencing factors.A nomogram model for predicting postoperative hypoalbuminemia was developed.The model's predictive performance was assessed using the receiver operating characteristic(ROC)curve and the Hosmer-Lemeshow goodness-of-fit test.Clinical utility was evaluated using decision curve analysis(DCA)and clinical im-pact curve(CIC)analysis.Results Among the 200 patients,38(19％)developed postoperative hypoalbuminemia.No sig-nificant differences were found in clinical data between the modeling and validation groups(P＞0.05).Univariate analysis showed significant differences(P＜0.05)between the non-hypoalbuminemia and hypoalbuminemia groups regarding smok-ing history,tumor diameter,preoperative neoadjuvant chemoradiotherapy,preoperative skinfold thickness,preoperative pre-albumin level,preoperative albumin(ALB)level,preoperative total protein(TP)level,preoperative hemoglobin level,and intraoperative blood loss.Multivariate Logistic regression analysis identified smoking history,tumor diameter,preoperative ALB level,preoperative TP level,and intraoperative blood loss as influencing factors for postoperative hypoalbuminemia in colorectal cancer patients(P＜0.05).The area under the ROC curve(AUC)for predicting hypoalbuminemia in the mod-eling group was 0.958(95％CI:0.920-0.996).For the validation group,the AUC was 0.903(95％CI:0.806-0.999).The Hosmer-Lemeshow test yielded a x2 value of 1.664(P=0.990).DCA and CIC results indicated that clinical intervention based on the model would yield net benefit.Conclusion The occurrence of postoperative hypoalbuminemia in colorectal cancer patients is associated with smoking history,tumor diameter,intraoperative blood loss,and preoperative serum pro-tein levels.The constructed nomogram prediction model accurately predicts the risk of postoperative hypoalbuminemia,providing a reference for its early prevention and management.关键词
结直肠癌/术后低蛋白血症/影响因素/预测模型Key words
colorectal cancer/postoperative hypoproteinemia/influencing factors/prediction model分类
医药卫生引用本文复制引用
汤小青,朱勇,李健,征贞..结直肠癌患者术后发生低蛋白血症的影响因素分析及预测模型的构建[J].结直肠肛门外科,2025,31(3):229-236,8.基金项目
2020年江苏省重点研发计划专项资金项目(BE2020723) （BE2020723）
