目的 构建和验证原发性肝细胞癌患者低血糖风险预测模型。方法 收集我科2020年4月—2021年6月原发性肝细胞癌患者共232例,将其是否发生低血糖分为低血糖组（n=67）和非低血糖组（n=165）,回顾性分析危险因素并建立风险预测模型,采用ROC曲线验证预测模型的效能。结果 经分析发现,Child-Pugh分级 C 级（OR=9.050,95%CI：2.911~28.130,P<0.001）是肝细胞癌患者发生低血糖的危险因素;糖化血红蛋白（OR=0.504,95%CI：0.325~0.780,P=0.002）是保护因素。回归模型为:Y=2.317+0.056 ×Child-Pugh分期(B)+2.203×Child-Pugh分期（C）-0.686×糖化血红蛋白;ROC曲线面积为0.737（95%CI：0.660~0.814）,灵敏度为53.7%,特异度为87.3%,模型验证结果：ROC曲线面积为0.827（95%CI：0.727~0.927）,灵敏度为55%,特异度为81.8%,提示本预测模型预测效果良好。结论 肝细胞癌伴低血糖症风险预测模型有助于识别低血糖高危人群,为医护人员采取前瞻性护理干预提供科学依据。
Abstract
Objective To construct and validate a hypoglycemia risk prediction model in patients with primary hepatocellular carcinoma(HCC). Methods A total of 232 patients with primary HCC from April 2020 to June 2021 were involved and divided into hypoglycemia group (n=67) and non-hypoglycemia group (n=165) according to the occurrence of hypoglycemia. The risk factors were retrospectively analyzed and risk prediction model was established. ROC curve was used to verify the efficacy of the prediction model. Results The analysis revealed that Child-Pugh grade C (OR=9.050,95%CI 2.911-28.130, P<0.001) was a risk factor for hypoglycemia in patients with HCC; but glycated hemoglobin (OR=0.504,95%CI 0.325-0.780, P=0.002) was a protective factor. The regression model was: Y=2.317+0.056 Child-Pugh stage (B) + 2.203 Child-Pugh stage (C) -0.686 HbA1c; The area of the ROC curve was 0.737 (95%CI 0.660-0.814), with a sensitivity of 53.7% and specificity of 87.3%. Model validation showed that the area of the ROC curve was 0.827 (95%CI 0.727-0.927), with a sensitivity of 55% and specificity of 81.8%, which suggests good prediction efficacy of the model. Conclusion The hypoglycemia risk prediction model in patients with HCC can help identify population with high risk of hypoglycemia and provide scientific basis for prospective nursing intervention for medical staff.
关键词
肝细胞癌 /
低血糖 /
风险预测模型
Key words
hepatocellular carcinoma /
hypoglycemia /
risk prediction model
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Ong Y, Huey CWT, Shelat VG.Paraneoplastic syndromes in hepatocellular carcinoma: a review[J].Expert Rev Gastroent, 2022,16(5):449-471. DOI:10.1080/17474124.2022.2085556.
[2] Izutsu T, Ito H, Fukuda I, et al.Early improvement of non-islet cell tumor hypoglycemia by chemotherapy using lenvatinib in a case with type 2 diabetes and Hepatocellular carcinoma producing big IGF-II[J]. Intern Med, 2021,60(9):1427-1432. DOI:10.2169/internalmedicine.5328-20.
[3] Ulger Y, Delik A.Paraneoplastic syndrome frequency and prognostic effect in Hepatocellular carcinoma patients[J]. Eur J Gastroen Hepat, 2022,34(7):769-773. DOI:10.1097/MEG.0000000000002341.
[4] Regino CA, L6pez-Montoya V, L6pez-Urbano F,et al. Paraneoplastic hypoglycemia in hepatocarcinoma: case report and literature review[J]. Cureus,2020,12(12):e12013. DOI:10.7759/cureus.12013.
[5] 丘利宜,王方,段钢,等.肝癌患者发生低血糖的原因及危险因素分析[J].中国社区医师,2020, 36(7):19-20.DOI:10.3969/j.issn.1007-614x.2020.07.010.
[6] 李成,周建.2019年ADA糖尿尿病医学诊疗标准解读[J].中国医学前沿杂志,2019, 11(1):66-74.DOI :10.12037/YXQY.2019.01-08.
[7] 李艳芬,蒋文慧.不同肝功能分级慢性乙型肝炎肝硬化患者糖代谢及炎症因子变化情况[J].中国卫生工程学,2023,22(4):557-559.DOI: 10.19937/j.issn.1671-4199.2023.04.042.
[8] European Association for the Study of the Liver.EASL Clinical practice guidelines: management of hepatocellular carcinoma[J].J Hepatol, 2018, 69(1):182-236.DOI: 10.1016/j.jhep.2018.03.019.
[9] 赵婧菲,石小倩,侯小丫,等.原发性肝癌伴癌综合征的临床类型及相关机制的研究进展[J].中华肝胆外科杂志,2022,28(1):71-76.DOI:10.3760/cma.j.cn113884-20210817-00271.
[10] Yu B, Douli R, Suarez JA, et al.Non-islet cell tumor hypoglycemia as an initial presentation of hepatocellular carcinoma coupled with end-stage liver cirrhosis: a case report and review of literature[J]. World J Hepatol, 2020, 12(8):110-115. DOI: 10.4254/wjh.v12.i8.519.
[11] Prachi, Rana, Brian, et al. A unique case of IGF-2 induced hypoglycemia associated with hepatocellular carcinoma[J]. Case Rep Endocrinol, 2019(2019):1-4. DOI: 10.1155/2019/4601484.
[12] 程玉,谭诗云,黄世雪,等.以低血糖癫痫发作为首发表现的原发性肝癌一例[J]. 中华全科医师杂志,2020,19(6):547-548. DOI:10.3760/cma.j.cn114798-20200410-00439.
[13] American Diabetes Association.Standards of medical care in diabetes-2019[J]. Diabetes Care, 2019, 42(Suppl 1):S1-S193.
[14] Huan Li, Fang Sun, Wenyan Yang,et al. Clinical study of abnormal glucose metabolism and insulin resistance in patients with liver cirrhosis[J]. AM J Transl Res,2021,13(4)3522-3528.
[15] 毛杭飞,徐亦虹,徐虹霞.肝癌晚期胰岛素样生长因子-2过度分泌频发低血糖患者的护理[J].中华急危重症护理杂志, 2023,4(6):534-536.DOI: 10.3761/j.issn.2096-7446.2023.06.010.
[16] Shengsheng Y, Alex Z,Samuel S,et al.Association between hypoglycemia risk and hemoglobin A1C in patients with type 2 diabetes mellitus[J].Curr Med Res Opin,2016,32(8):1409-1416.DOI:10.1080/03007995.2016.1176017.
[17] 郑莉,魏东,叶鹏,等.动态血糖监测评估糖化血红蛋白、血糖波动与低血糖之间的关系[J].四川医学, 2019,40(2):146-150.DOI:10.16252/j.cnki.issn1004-0501-2019.02.010.[18] Zhao MJY, Prentice JC, Mohr DC,et al. Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus[J]. BMJ Open Diabetes Res Care,2021,9(1):e001797:1-9. DOI10.1136/bmjdrc-2020-001797.
[19] 郑小静,严红虹,甘彬,等.肝细胞癌患者低血糖发生率和影响因素研究[J].护理学报,2022,29(17):43-46. DOI:10.16460/j.issn1008-9969.2022.17.043.
[20] 董晓颖,尹经霞,余丽,等.美国糖尿病协会2024版糖尿病诊疗标准更新要点解读[J].现代医药卫生,2024, 40(4):541-547.DOI: 10.3969/j.issn.1009-5519.2024.04.001.
[21] 吕素珍,黄旭芳,毛剑婷,等.强化血糖管理在肝癌合并糖尿病患者射频消融围手术期的应用研究[J].介入放射学杂志,2019,28(6):582-585.DOI:10.3969/j.issn.1008-794X.2019.06.018.
[22] American Diabetes Association Professional Practice Committee. Diagnosis and classification of diabetes: standards of care in diabetes-2024[J]. Diabetes Care, 2024,47(Suppl 1):S20-S42. DOI:10.2337/dc24-S002.
[23] Andrew J, Melissa M,Howard H, et al.Association of real-time continuous glucose monitoring with glycemic control and acute metabolic events among patients with insulin treated diabetes[J].JAMA, 2021, 325(22):2273-2284.DOI: 10.1001/jama.2021.6530.
[24] Thomas MD, Roy W, Ryan MS,et al.Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin a randomized clinical trial[J]. JAMA, 2021, 325(22):2262-2272. DOI: 10.1001/jama.2021.7444.
[25] Galindo R J,Aleppo G.Continuous glucose monitoring:the achievement of 100 years of innovation in diabetes technology[J]. Diabetes Res Clin Pr,2020,170(1):1-23. DOI: 10.1016/j.diabres.2020.108502.
[26] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)(下)[J]. 中国实用内科杂志,2021,41(9): 757-784. DOI: 10.19538/j.nk2021090106.
[27] 王娜,王海涛,杨鑫,等.奥曲肽所致低血糖风险的回顾性研究[J].实用药物与临床,2021,24(1):82-84.DOI: 10.14053/j.cnki.ppcr.202101017.
PDF(991 KB)
