基于肝癌临床特征构建的logistic回归模型对原发性肝癌中医证型的判断效能

林栋毅; 彭波; 郑景辉; 王宗玉; 黎汉忠; 何剑波; 李科志; 邬国斌; 陈闯

doi:10.3969/j.issn.1001-5256.2020.06.021

基于肝癌临床特征构建的logistic回归模型对原发性肝癌中医证型的判断效能

DOI: 10.3969/j.issn.1001-5256.2020.06.021

1. 广西医科大学附属肿瘤医院中医科
2. 广东省珠海市中西医结合医院肿瘤风湿科
3. 广西中医药大学学科建设办公室
4. 广西医科大学附属肿瘤医院化疗二科
5. 广西医科大学附属肿瘤医院实验研究部
6. 广西医科大学附属肿瘤医院肝胆外科

基金项目:

广西科学研究与技术开发计划项目(桂科攻1598012-54)；广西科技计划项目(广西重点研发计划)(桂科AB18126066)；

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中图分类号: R273
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出版历程
- 出版日期: 2020-06-20

Value of a logistic regression model based on the clinical features of liver cancer in judging the traditional Chinese medicine syndrome types of primary liver cancer

Research funding:

摘要

摘要:
目的探究肝癌患者白蛋白-胆红素（ALBI）评分、中性粒细胞/淋巴细胞比值（NLR）等临床特征与原发性肝癌中医证型的相关性,建立原发性肝癌中医辨证分型的临床判断模型。方法选取2016年11月1日-2018年10月31日在广西医科大学附属肿瘤医院收治的经病理或临床诊断为原发性肝癌的初治患者289例,并对患者进行中医辨证分型。符合正态分布的计量资料采用单因素方差分析;不符合正态分布的计量资料采用Kruskal-Wallis H检验;计数资料组间比较采用χ2检验。将单因素分析显示存在显著差异的资料进行logistic回归分析,采用ROC曲线评价这些临床特征对肝癌中医辨证分型的判断效能。结果 ALBI（F=5. 487,P <0. 001）、NLR（χ2=30. 146,P <0. 001）、BCLC分期（χ2=71. 973,P <0. 001）、Alb （χ2=18. 887,P <0. 001）、TBil （χ2=12. 138,P=0. 007）、ALT（...
- 肝肿瘤 /
- 证候 /
- logistic模型
Abstract:
Objective To investigate the association of the clinical features of liver cancer patients,including albumin-bilirubin( ALBI)and neutrophil-lymphocyte ratio( NLR),with the traditional Chinese medicine( TCM) syndrome types of primary liver cancer,and to establish a clinical judgment model for TCM syndrome differentiation of primary liver cancer. Methods A total of 289 previously untreated patients who were admitted to The Affiliated Tumor Hospital of Guangxi Medical University from November 1,2016 to October 31,2018 and were diagnosed with primary liver cancer based on pathology or clinical examination were enrolled,and TCM syndrome differentiation was performed for all patients. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The data with significant difference in the univariate analysis were included in the logistic regression analysis,and the receiver operating characteristic( ROC) curve was used to evaluate the efficiency of these clinical features in the TCM syndrome differentiation of liver cancer. Results There were significant differences between the patients with different TCM syndrome types of liver cancer in ALBI( F = 5. 487,P < 0. 001),NLR( χ2= 30. 146,P < 0. 001),BCLC stage( χ2= 71. 973,P <0. 001),albumin( Alb)( χ2= 18. 887,P < 0. 001),total bilirubin( TBil)( χ2= 12. 138,P = 0. 007),alanine aminotransferase( ALT)( χ2= 18. 001,P < 0. 001),aspartate aminotransferase( χ2= 12. 067,P = 0. 007),absolute neutrophil count( F = 6. 262,P < 0. 001),absolute lymphocyte count( F = 2. 934,P = 0. 034),diameter of intrahepatic primary tumor( F = 4. 905,P = 0. 002),ascites( χ2=9. 034,P = 0. 021),portal vein tumor thrombus( χ2= 13. 434,P = 0. 004),and number of extrahepatic metastatic lesions( χ2= 2. 529,P= 0. 002). The logistic regression analysis showed that ALT( odds ratio [OR]= 1. 002,95% confidence interval [CI]: 1. 003-1. 021,P< 0. 05) and BCLC stage( OR = 0. 591,95% CI: 0. 413-0. 845,P < 0. 05) were independent factors for judging damp-heat accumulation; ALT( OR = 0. 985,95% CI: 0. 974-0. 997,P < 0. 05) and BCLC stage( OR = 3. 191,95% CI: 2. 042-4. 986,P < 0. 05) were also independent factors for judging liver depression and spleen deficiency; TBil( OR = 0. 966,95% CI: 0. 937-0. 995,P < 0. 05),Alb( OR = 1. 259,95% CI: 1. 064-1. 490,P < 0. 05),and ALBI( OR = 0. 088,95% CI: 0. 013-0. 607,P < 0. 05) were independent factors for judging Qi stagnation and blood stasis. The ROC curve analysis showed that ALT and BCLC stage had an area under the ROC curve( AUC) of 0. 662( 95% CI: 0. 605-0. 717),a sensitivity of 69. 4%,and a specificity of 58% in judging damp-heat accumulation,at the cut-off values of 36 U/L for ALT and stage C for BCLC stage; ALT and BCLC stage had an AUC of 0. 753( 95% CI: 0. 699-0. 801),a sensitivity of 72. 7%,and a specificity of 68. 2% in judging liver depression and spleen deficiency,at the cut-off values of 64 U/L for ALT and stage B for BCLC stage; TBil,Alb,and ALBI had an AUC of 0. 634( 95% CI: 0. 576-0. 690),a sensitivity of 56. 7%,and a specificity of 65. 3% in judging Qi stagnation and blood stasis,at the cut-off values of 28. 4 μmol/L for TBil,37. 8 g/L for Alb,and 1. 95 for ALBI. Conclusion The clinical judgment model based on ALT,BCLC stage,TBil,Alb,and ALBI can differentiate between the TCM syndrome types of damp-heat accumulation,liver depression and spleen deficiency,and Qi stagnation and blood stasis for liver cancer,and this model is simple,convenient,and objective and thus holds promise for clinical application.
- liver neoplasms /
- symptom complex /
- logistic models

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